maternal and paternal indoor or outdoor smokingand the risk of asthma in their children: A nationwide prospective birth cohort study

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Drug and Alcohol Dependence 147 (2015) 103–108
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Drug and Alcohol Dependence
j ourna l h o me pa ge:
Maternal and paternal indoor or outdoor smoking and the risk ofasthma in their children: A nationwide prospective birth cohortstudyTakahiro Tabuchia,b,*, Takeo Fujiwarab, Tomio Nakayamaa, Isao Miyashiroa,Hideaki Tsukumaa, Koken Ozakic, Naoki Kondob,daCenter for Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome, Higashinari-ku,Osaka 537-8511, JapanbDepartment of Social Medicine, National Research Institute for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo 157-8535, JapancGraduate School of Business Sciences, University of Tsukuba, 3-29-1, Otsuka, Bunkyo-ku, Tokyo 112-0012, JapandSchool of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japana r t i c l e i n f oArticle history:Received 17 September 2014Received in revised form 1 December 2014Accepted 1 December 2014Available online 16 December 2014Keywords:Parental smokingOutdoor smokingAsthmaJapana b s t r a c tBackground: Little is known about the differential impact of combinations of parental smoking behavior(indoor or outdoor smoking, or not smoking) on preventing childhood asthma. Our objective was toexamine the association between parental smoking behavior and children’s asthma.Methods: A nationally representative population-based birth cohort of 40,580 babies, aged 0.5 years in2001 (response rate, 87.8%), was studied to estimate adjusted odds ratios of combinations of maternaland paternal indoor or outdoor smoking at home for physician visits and hospitalization for childhoodasthma up to 8-years-old, and population attributable fractions.Results: Odds of hospitalization for asthma among children whose father alone smokes indoors at homedid not largely increase (up to 20%). However, if the mother also smokes indoors at home, the oddsstrongly increased. After adjusting for demographic, perinatal and socioeconomic factors, the increase inodds for children whose father and mother both smoke indoors compared to children with non-smokingparents was 54% (95% confidence interval: 21–96%), 43% (8–90%) and 72% (22–143%) for children aged0.5 < -2.5, 2.5 < -4.5 and 4.5 < -8 years-old, respectively. The odds ratios of smoking outdoors did notlargely differ from those of smoking indoors. Our estimation of population attributable fractions revealedthat if all parents in Japan quit smoking, hospitalization of children for asthma could be reduced by 8.3%(2.2–14.3%), 9.3% (0.9–17.6%) and 18.2% (7.7–28.8%), respectively.Conclusions: Parental indoor smoking at home increased and exacerbated children’s asthma. Smoking athome, whether it is indoors or outdoors, may increase the risks for asthma attacks of their children.© 2014 Elsevier Ireland Ltd. All rights reserved.1. IntroductionChildren are likely to be exposed to second hand tobacco smoke(SHS) at home (U.S. Department of Health and Human Services[USDHHS], 2006). A study in Japan has shown that 64.8% of 6-monthold children live with smoking parent(s), and of those, 57.9% ofSupplementary material can be found by accessing the online version of thispaper at and by entering doi:10.1016/j.drugalcdep.2014.12.001.*Corresponding author at: Center for Cancer Control and Statistics, OsakaMedical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome,Higashinari-ku, Osaka 537-8511, Japan. Tel.: +81 6 6972 1181; fax: +81 6 6972 7581.E-mail addresses:, Tabuchi).parents smoke indoors at home (Kaneita et al., 2006). Althoughmany previous studies have revealed the risk of SHS for childhoodasthma (Royal College of Physicians, 2010; USDHHS, 2006), a recentreview by Burke et al. (2012) showed several evidence gaps in thisfield of research. There has been no prospective study of the risk ofpaternal smoking for asthma in children aged 2 years or less andonly one study for children aged 3–4 years. Further, a wide range ofestimated effect size of postnatal maternal smoking on incidence ofchildhood asthma was observed, indicating a need to confirm theresults. One objective of our study was to approach these gaps. Aprevious study by Kanoh et al. (2012), using data from the Longitu-dinal Survey of Newborns in the 21st Century, reported a positivehazard risk between parental smoking and childhood asthma inci-dence. However, they did not focus on the gaps (i.e., did not use
0376-8716/© 2014 Elsevier Ireland Ltd. All rights reserved

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