Published online May 1, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. 1745-1754 (doi:10.1542/peds.2005-1886)
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REVIEW ARTICLE

Environmental Tobacco Smoke Exposure: Prevalence and Mechanisms of Causation of Infections in Children

Philip Kum-Nji, MDa, Linda Meloy, MDa and Henry G. Herrod, MDb

a Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
b Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee

BACKGROUND AND OBJECTIVES. Environmental tobacco smoke (ETS) exposure is probably one of the most important public health hazards in our community. Our aim with this article is to (1) review the prevalence of ETS exposure in the United States and how this prevalence is often measured in practice and (2) summarize current thinking concerning the mechanism by which this exposure may cause infections in young children.

METHODS. We conducted a Medline search to obtain data published mainly in peer-reviewed journals.

RESULTS. There is still a very high prevalence of ETS exposure among US children ranging from 35% to 80% depending on the method of measurement used and the population studied. The mechanism by which ETS may be related to these infections is not entirely clear but may be through suppression or modulation of the immune system, enhancement of bacterial adherence factors, or impairment of the mucociliary apparatus of the respiratory tract, or possibly through enhancement of toxicity of low levels of certain toxins that are not easily detected by conventional means.

CONCLUSIONS. The prevalence of ETS exposure in the United States is still very high, and its role in causing infections in children is no longer in doubt even if still poorly understood. Research, therefore, should continue to focus on the various mechanisms of causation of these infections and how to best reduce the exposure levels.

Key Words: environmental tobacco smoke exposure • prevalence • environmental tobacco smoke and infections

Abbreviations: ETS—environmental tobacco smoke • SIDS—sudden infant death syndrome • NHANES—National Health and Nutrition Examination Survey • Th—T helper • Ig—immunoglobulin • IL—interleukin • ET—eustachian tube • POD—periodontal disease • PAR—population attributable risk

Accepted Oct 3, 2005.




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