Health effects of secondhand smoke on children under 5 years of life




secondhand tobacco smoke, respiratory symptoms, children, exposure


Background. The high prevalence of smoking among adults suggests the almost inevitable effects of second-hand tobacco smoke (SHS) on children and adults who do not smoke. The negative effects of SHS are most pronounced in young children, especially in families where the mother is a smoker. The aim was to assess the effects of prenatal and postnatal exposure to SHS in children under five years of life. Materials and me­thods. The survey among 520 families with children was conducted ­using online self-reported questionnaire. Families with extremely and very preterm children and children with inherited diseases of bronchopulmonary system were excluded from the analysis. During the analysis, all children (n = 414; 55.07 % of boys and 44.93 % of girls, mean age — 36.38 ± 7.19 months) were divided according to SHS exposure. 186 children exposed to SHS were included in the main group, and 228 children without SHS exposure — in the control group. Results. 22.46 % of children were prenatally exposed to SHS. Maternal smoking ­during pregnancy significantly increased the risk of the intraute­rine growth retardation (IUGR) (OR 2.43 [95% CI 1.07–5.52]). Postnatal exposure to SHS was present in 56.52 % of children. These children were significantly more likely to be formula-fed (OR 1.75 [95% CI 1.15–2.65]). The frequency of formula fee­ding was significantly increased by mothers’ use of both traditional tobacco products and electronic nicotine delivery systems (OR 2.10 and 2.99, respectively). Exclusively maternal smoking in the family increased the risk of frequent acute respiratory viral infections (ARI) in 3 years old children more than 1.5 times (OR 1.60 [95% CI 1.01–2.60]). Household SHS exposure increased the probability of bronchial obstruction (BO) during ARI in a child in 1.61 times, while exclusively maternal smoking increased the risk in 2.88 times. An increased risk of frequent ARI (OR 3.25 [95% CI 1.68–6.28]) was also present in the subgroup of children whose mothers smoked electronic nicotine delivery devices. The use of traditional tobacco products and electronic nicotine delivery systems, both by mothers and other family members, has significantly affected the risk of developing BO in children with respiratory disease. Conclusions. Maternal smoking during pregnancy in the studied cohort is a proven risk factor for IUGR. Household smoking is statistically likely to affect the incidence and likelihood of developing BO in children of the first five years of life, regardless of the type of tobacco product. This risk is greatest among children whose mothers are smokers.


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World Health Organization; WHO Regional Office for Europe. WHO report on the global tobacco epidemic, 2015: raising taxes on tobacco. Copenhagen: WHO Press; 2015. 204 p.

Ministry of Нealth of Ukraine; World Health Organization. Global'ne opytuvannja doroslyh shhodo vzhyvannja tjutjunu: zvit Ukrai'na 2017 [Global Adult Tobacco Survey: Ukraine 2017 Report]. Kyiv; 2017. 240 p. (in Ukrainian).

Eriksen M, Mackay J, Schluger N, Gomeshtapeh F, Drope J. The tobacco atlas. 5th ed. Atlanta, GA: American Cancer Society; 2015. 88 p.

Chuanwei M, Emerald GH, Zilin L, Min Z, Yajun L, Bo X. Global trends in the prevalence of secondhand smoke exposure among adolescents aged 12-16 years from 1999 to 2018: an analysis of repeated cross-sectional surveys. Lancet;2021:9(12):e1667-e1678. doi:10.1016/ S2214-109X(21)00365-X.

Matt GE, Quintana PJ, Destaillats H, et al. Thirdhand tobacco smoke: emerging evidence and arguments for a multidisciplinary research agenda. Environ Health Perspect. 2011 Sep;119(9):1218-1226. doi:10.1289/ehp.1103500.

Raghuveer G, White DA, Hayman LL, et al. Cardiovascular Consequences of Childhood Secondhand Tobacco Smoke Exposure: Prevailing Evidence, Burden, and Racial and Socioeconomic Disparities: A Scientific Statement From the American Heart Association. Circulation. 2016 Oct 18;134(16):e336-e359. doi:10.1161/CIR.0000000000000443.

Hawkins SS, Berkman L. Identifying infants at high-risk for second-hand smoke exposure. Child Care Health Dev. 2014 May;40(3):441-445. doi:10.1111/cch.12058.

Oberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011 Jan 8;377(9760):139-146. doi:10.1016/S0140-6736(10)61388-8.

Levine MD, Cheng Y, Marcus MD, Kalarchian MA, Emery RL. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial. JAMA Intern Med. 2016 Apr;176(4):443-452. doi:10.1001/jamainternmed.2016.0248.

Pereira PP, Da Mata FA, Figueiredo AC, de Andrade KR, Pereira MG. Maternal Active Smoking During Pregnancy and Low Birth Weight in the Americas: A Systematic Review and Meta-analysis. Nicotine Tob Res. 2017 May 1;19(5):497-505. doi:10.1093/ntr/ntw228.

Kharkova OA, Grjibovski AM, Krettek A, Nieboer E, Odland JØ. Effect of Smoking Behavior before and during Pregnancy on Selected Birth Outcomes among Singleton Full-Term Pregnancy: A Murmansk County Birth Registry Study. Int J Environ Res Public Health. 2017 Aug 2;14(8):867. doi:10.3390/ijerph14080867.

Blatt K, Moore E, Chen A, Van Hook J, DeFranco EA. Association of reported trimester-specific smoking cessation with fetal growth restriction. Obstet Gynecol. 2015 Jun;125(6):1452-1459. doi:10.1097/AOG.0000000000000679.

Leonardi-Bee J, Britton J, Venn A. Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: a meta-analysis. Pediatrics. 2011 Apr;127(4):734-741. doi:10.1542/peds.2010-3041.

Crane JM, Keough M, Murphy P, Burrage L, Hutchens D. Effects of environmental tobacco smoke on perinatal outcomes: a retrospective cohort study. BJOG. 2011 Jun;118(7):865-871. doi:10.1111/j.1471-0528.2011.02941.x.

Cox B, Martens E, Nemery B, Vangronsveld J, Nawrot TS. Impact of a stepwise introduction of smoke-free legislation on the rate of preterm births: analysis of routinely collected birth data. BMJ. 2013 Feb 14;346:f441. doi:10.1136/bmj.f441.

National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. The Health Consequences of Smoking - 50 Years of Progress: A Report of the Surgeon General. 7 - Respiratory Diseases. Atlanta (GA): Centers for Disease Control and Prevention (US); 2014.

Farber HJ, Groner J, Walley S, Nelson K; Section on Tobacco Control. Protecting children from tobacco, nicotine, and tobacco smoke. Pediatrics. 2015 Nov;136(5):e1439-67. doi:10.1542/peds.2015-3110.

Maedel C, Kainz K, Frischer T, Reinweber M, Zacharasiewicz A. Increased severity of respiratory syncytial virus airway infection due to passive smoke exposure. Pediatr Pulmonol. 2018 Sep;53(9):1299-1306. doi:10.1002/ppul.24137.

Thacher JD, Gruzieva O, Pershagen G, et al. Pre- and postnatal exposure to parental smoking and allergic disease through adolescence. Pediatrics. 2014 Sep;134(3):428-434. doi:10.1542/peds.2014-0427.

Burke H, Leonardi-Bee J, Hashim A, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012 Apr;129(4):735-744. doi:10.1542/peds.2011-2196.

Carreras G, Lugo A, Gallus S, et al. Burden of disease attributable to second-hand smoke exposure: A systematic review. Prev Med. 2019 Dec;129:105833. doi:10.1016/j.ypmed.2019.105833.

Royal College of Physicians of London; Tobacco Advisory Group. Passive smoking and children: a report/by the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians; 2010. 200 p.

Christensen DN, Franks ZG, McCrary HC, Saleh AA, Chang EH. A Systematic Review of the Association between Cigarette Smoke Exposure and Chronic Rhinosinusitis. Otolaryngol Head Neck Surg. 2018 May;158(5):801-816. doi:10.1177/0194599818757697.

Tang SD, Zhang YX, Chen LM, Wang YY, Cheng Y, Tang LQ. Influence of life-style factors, including second-hand smoke, on dental caries among 3-year-old children in Wuxi, China. J Paediatr Child Health. 2020 Feb;56(2):231-236. doi:10.1111/jpc.14566.

Merianos AL, Jandarov RA, Mahabee-Gittens EM. Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations. Am J Prev Med. 2017 Oct;53(4):441-448. doi:10.1016/j.amepre.2017.03.020.

Juárez SP, Merlo J. Revisiting the effect of maternal smoking during pregnancy on offspring birthweight: a quasi-experimental sibling analysis in Sweden. PLoS One. 2013 Apr 17;8(4):e61734. doi:10.1371/journal.pone.0061734.

Prabhu N, Smith N, Campbell D, et al. First trimester maternal tobacco smoking habits and fetal growth. Thorax. 2010 Mar;65(3):235-240. doi:10.1136/thx.2009.123232.

Benjamin-Garner R, Stotts A. Impact of smoking exposure change on infant birth weight among a cohort of women in a prenatal smoking cessation study. Nicotine Tob Res. 2013 Mar;15(3):685-692. doi:10.1093/ntr/nts184.

Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res. 2011 Jan 10;12(1):5. doi:10.1186/1465-9921-12-5.

Shi T, Balsells E, Wastnedge E, et al. Risk factors for respiratory syncytial virus associated with acute lower respiratory infection in children under five years: Systematic review and meta-analysis. J Glob Health. 2015 Dec;5(2):020416. doi:10.7189/jogh.05.020416.

Silvestri M, Franchi S, Pistorio A, Petecchia L, Rusconi F. Smoke exposure, wheezing, and asthma development: a systematic review and meta-analysis in unselected birth cohorts. Pediatr Pulmonol. 2015 Apr;50(4):353-362. doi:10.1002/ppul.23037.

Cohen SS, Alexander DD, Krebs NF, et al. Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis. J Pediatr. 2018 Dec;203:190-196.e21. doi:10.1016/j.jpeds.2018.08.008.

Suzuki D, Wariki WMV, Suto M, et al. Secondhand Smoke Exposure During Pregnancy and Mothers' Subsequent Breastfeeding Outcomes: A Systematic Review and Meta-Analysis. Sci Rep. 2019 Jun 12;9(1):8535. doi:10.1038/s41598-019-44786-z.



How to Cite

Kovalenko, D. (2022). Health effects of secondhand smoke on children under 5 years of life. CHILD`S HEALTH, 17(2), 78–84.



Clinical Pediatrics