Faber, T. et al. Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis. The Lancet Public Health. Volume 2, No. 9, e420–e437, September 2017
A global study published in The Lancet Public Health journal has concluded that Child health has improved significantly since the introduction of public smoking bans in many countries. The systematic review and meta-analysis showed that rates of children needing hospital care for severe chest infections have fallen by more than 18% since anti-smoking laws were introduced.
In line with earlier research, the study authors estimated that severe asthma attacks had fallen by almost 10% while the number of babies born prematurely had dropped by around 4% overall.
Raising taxes on tobacco products may also have improved child health, the researchers said, but the findings were less conclusive.
New resources launched and webinar scheduled on e-cigarette use in pregnancy | via The Royal College of Midwives
Two new resources on the use of e-cigarettes during pregnancy have been launched to help midwives in their consultations with women. The resources were developed in response to midwives and health visitors being asked for advice on e-cigarette use.
These resources for health professionals address some of the most frequently asked questions in consultations with women who have expressed an interest in using e-cigarettes to quit smoking.
The documents say that, although not completely risk-free, electronic cigarettes carry a fraction of the risk of smoking for users, with no known risks to bystanders and that e-cigarettes contain no carbon monoxide.
Background The adverse effects of maternal and paternal smoking on child health have been studied. However, few studies demonstrate the interaction effects of maternal/paternal smoking, and birth outcomes other than birth weight have not been evaluated. The present study examined individual effects of maternal/paternal smoking and their interactions on birth outcomes.
Methods A follow-up hospital-based study from pregnancy to delivery was conducted from 1997 to 2010 with parents and newborn infants who delivered at a large hospital in Hamamatsu, Japan. The relationships between smoking and growth were evaluated with logistic regression.
Results The individual effects of maternal smoking are related to low birth weight (LBW), short birth length and small head circumference. The individual effects of paternal smoking are related to short birth length and small head circumference. In the adjusted model, both parents’ smoking showed clear associations with LBW (odds ratio [OR] = 1.64, 95% confidence interval [CI] 1.18–2.27) and short birth length (−1 standard deviation [SD] OR = 1.38, 95% CI 1.07–1.79; −2 SD OR = 2.75, 95% CI 1.84–4.10).
Conclusions Maternal smoking was significantly associated with birth weight and length, but paternal smoking was not. However, if both parents smoked, the risk of shorter birth length increased.
Early exposure to nicotine can trigger widespread genetic changes that affect formation of connections between brain cells long after birth, a new Yale-led study has found. The finding helps explains why maternal smoking has been linked to behavioral changes such as attention deficit and hyperactivity disorder, addiction and conduct disorder.
Nicotine does this by affecting a master regulator of DNA packaging, which in turn influences activity of genes crucial to the formation and stabilization of synapses between brain cells, according to the study published online May 30 in the journal Nature Neuroscience.
An inability to focus is the hallmark of attention deficit hyperactivity disorder and other behavioral disorders, which have been linked to maternal smoking and exposure to second-hand smoke. However, scientists did not understand how early environmental exposure to smoking could create behavioral problems years later.
Picciotto’s lab found that mice exposed to nicotine during early development did indeed develop behavioral problems that mimic symptoms of attention deficit disorder in humans. They then did extensive genomic screening of mice exposed to nicotine and found higher levels of activity in a key regulator of histone methylation — a process that controls gene expression by changing the DNA wrapping around chromosomes. The researchers found that genes essential to the creation of brain synapses were heavily effected.
Furthermore, the scientists found that these genetic changes were maintained even in adult mice. However, when researchers inhibited the master regulator of histone methylation, these adult mice were calmer and no longer reacted to a stimulus they should ignore. In a final test, they triggered expression of this regulator in mice never exposed to nicotine, and the mice exhibited behavior that mimicked attention deficit disorder.
Daly, J. et al. JAMA Pediatrics. 2016 170(2):138-147
Importance: Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children.
Objective: To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children.
Data Sources A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015.
Results: Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95% CI, 0.74-1.50; P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53; 95% CI, 1.10-2.14; P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity.
Conclusions and Relevance: Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.