Smoking and asthma in adults.

Studies on the effect of smoking on adulthood asthma have provided contradictory results. The current authors conducted a population-based incident case-control study to assess the effects of current and past smoking on the development of asthma in adults. During a 2.5 yr study period, all new asthma cases clinically diagnosed (n=521) and randomly selected controls (n=932) from a geographically defined district in southern Finland were recruited. The risk of developing asthma was significantly higher among current smokers with an adjusted odds ratio (OR) of 1.33 (95% confidence interval 1.00-1.77) and among ex-smokers with an adjusted OR 1.49 (1.12-1.97) compared with never-smokers. Among current smokers, the risk increased up to 14 cigarettes x day(-1), and a similar trend was observed in relation to cumulative smoking. In conclusion, the current results support the hypothesis that smoking causes asthma in adulthood.

Fetal growth and length of gestation in relation to prenatal exposure to environmental tobacco smoke assessed by hair nicotine concentration.

We assessed the effects of prenatal exposure to environmental tobacco smoke on fetal growth and length of gestation. The study population consisted of 389 nonsmoking women who were selected from a population-based study in southeast Finland on the basis of questionnaire information after delivery (response rate 94%). The final exposure assessment was based on nicotine concentration of maternal hair sampled after the delivery, which measures exposure during the past 2 months (i.e., the third trimester). The exposure categories were defined a priori as high (nicotine concentration [Greater and equal to] 4.00 microg/g; n = 52), medium (0.75 to < 4.00 microg/g; n = 186), and low as the reference category (< 0.75 microg/g; n = 151). In logistic regression analysis, controlling for confounding, the risk of preterm delivery (< 37 weeks) was higher in the high [adjusted odds ratio (OR) = 6.12; 95% confidence interval (CI), 1.31-28.7] and medium exposure categories (adjusted OR = 1.30; 95% CI, 0.30-5.58) compared with the reference category, and there was a 1.22 (95% CI, 1.07-1.39) increase in adjusted OR with a 1 microg/g increase in hair nicotine concentration. The corresponding adjusted OR was 1.06 (95% CI, 0.96-1.17) for low birth weight and 1.04 (95% CI, 0.92-1.19) for small-for-gestational-age.

Smoking during pregnancy in Finland: determinants and trends, 1987-1997.

OBJECTIVES: This study examined determinants of and trends in smoking during pregnancy in Finland from 1987 through 1997. METHODS: A repeated cross-sectional investigation of 694,926 women was conducted. RESULTS: The prevalence of smoking during pregnancy remained similar from 1987 through 1997 (at 15%). In 1997, prevalences of smoking were alarmingly high among young (37%), single (30%), and less educated (25%) women and among women living in northern (20%) and eastern (19%) Finland. These determinants were persistent over time, with the exception of an increase in regional differences. CONCLUSIONS: Despite increasing knowledge of adverse effects, smoking during pregnancy has not declined in Finland over the past decade.

Effects of a population-based smoking cessation programme on smoking in pregnancy.

A controlled study was conducted to evaluate the effects of a low-intensity population-based smoking cessation programme in maternity care clinics. Quitting smoking during pregnancy was assessed by a self-administered questionnaire and verified by hair nicotine concentration. In the intervention area, 58/306 women (19.0%) reported quitting smoking during pregnancy whereas in the reference area the numbers were 22/152 (14.5%) (difference = 4.5%, 95% confidence interval: -2.6%-11.6%). The intervention group indicated that they received more information on adverse effects of smoking, studied the material more actively, and felt that material from maternity care influenced their smoking behaviour more than the reference group.

Plastic wall materials in the home and respiratory health in young children.

OBJECTIVES: The relation between the presence of plastic wall materials in the home and respiratory health in children was assessed. METHODS: This population-based cross-sectional study involved 2568 Finnish children aged 1 to 7 years. RESULTS: In logistic regression models, lower respiratory tract symptoms--persistent wheezing (adjusted odds ratio [OR] = 3.42, 95% confidence interval [CI] = 1.13, 10.36), cough (OR = 2.41, 95% CI = 1.04, 5.63), and phlegm (OR = 2.76, 95% CI = 1.03, 7.41)--were strongly related to the presence of plastic wall materials, whereas upper respiratory symptoms were not. The risk of asthma (OR = 1.52, 95% CI = 0.35, 6.71) and pneumonia (OR = 1.81, 95% CI = 0.62, 5.29) was also increased in children exposed to such materials. CONCLUSIONS: Emissions from plastic materials indoors may have adverse effects on the lower respiratory tracts of small children.

Day-care centers and diarrhea: a public health perspective.

OBJECTIVE: To assess the relation between morbidity from acute diarrhea and the form of day care. STUDY DESIGN: The design was a retrospective cohort study. The setting was the city of Espoo, an urban-suburban municipality in southern Finland with a population of 170,000. The study population comprised 2568 randomly selected children aged 1 to 7 years. The main outcome measure was the occurrence of diarrhea. RESULTS: Children in day-care centers (DCCs) had an increased risk for acute diarrhea compared with children in home care. In the whole group of children in DCCs, the relative risk was 1.20 (95% confidence interval [CI], 1.08 to 1.34). The risk was greatest in 1- and 2-year-old children, for whom the estimated relative risks were 1.76 (95% CI, 1.28 to 2.43) and 1.56 (95% CI, 1.16 to 2.09), respectively. The proportion of diarrhea episodes attributable to DCC care in 1-year-old children was 49% (95% CI, 18% to 91%), in 2-year-old children 37% (95% CI, 11% to 73%), and in the whole group 17% (95% CI, 7% to 29%). The infection risk did not differ between children in home and family care. CONCLUSIONS: The results provide quantitative evidence that the care in DCCs is a major determinant of acute diarrhea in children, whereas family day care does not increase the infection risk.

Form of day care and respiratory infections among Finnish children.

The relationship between respiratory infectious diseases and form of day care was assessed in a retrospective cohort study of 2568 randomly selected children aged 1 through 7 years in Espoo, Finland. Day-care center children had an increased risk for the common cold, acute otitis media, and pneumonia. The risk concentrated in 1-year-old children, for whom the adjusted relative risks (incidence density ratios) for the common cold, otitis media, and pneumonia were 1.69 (95% confidence interval [CI] = 1.43, 2.01), 1.99 (95% CI = 1.57, 2.52), and 9.69 (95% CI = 2.31, 40.55), respectively. Among 1-year-old children, the proportion of infections attributable to care at day-care centers were 41% (95% CI = 30, 50) for colds, 50% (95% CI = 36, 60) for otitis media, and 85% (95% CI = 57, 98) for pneumonia. The results provide evidence that care in day-care centers is a determinant of acute respiratory infections in children under 2, whereas family day care does not essentially increase risk.

Dampness and molds in day-care centers as an occupational health problem.

To assess the occurrence of respiratory and other symptoms among workers in relation to dampness in day-care centers, a random sample of 30 day-care centers in the city of Espoo, Finland, was selected for the study. The study population consisted of 268 female day-care workers, who filled in a questionnaire. Dampness was found to be common: water damage had taken place in 70% of the centers, and workers perceived mold odor in 17% of them. Adjusted risk of work-related eye and respiratory symptoms was in general higher among the day-care workers exposed to both water damage and mold odor than among the unexposed. The prevalence of eye symptoms was statistically significantly higher. The results provide new evidence of the importance of dampness and mold problems in the work environment as determinants of respiratory and irritative symptoms.

What are the determinants of children's exposure to environmental tobacco smoke at home?

The objective of the study was to assess the role of smoking parents' education, socioeconomic status and knowledge of the child's health as determinants of the child's exposure to environmental tobacco smoke (ETS) at home. A population-based cross-sectional study was carried out by mailing a parent-administered questionnaire (response rate 80.3%) to a random sample of children aged 1 to 6 years, in Espoo. The present analyses focused on the 1003 children at whom one or both parents or guardians were currently smokers. A total of 253 children (25.2%) of smoking parents were reported to be exposed to ETS at home at the time when the questionnaire was filled in, while 750 (74.8%) children were not. Adjusted odds ratios (OR) for being exposed to ETS were assessed in the logistic regression. The risk of exposure to ETS was significantly higher when the parents had no professional education, compared to university or college education (OR 2.42, 95% Confidence Interval (CI) 1.43-4.11), but socioeconomic status was not associated with exposure. The risk was higher with a single parent or guardian than in families with two parents (2.17, 1.36-3.44). The risk decreased significantly for atopic children (0.61, 0.38-0.98), indicating that knowledge of the child's illness affects the smoking behavior of the parents.

Home dampness and molds as determinants of respiratory symptoms and asthma in pre-school children.

The objective of our study was to assess the occurrence of respiratory symptoms in relation to dampness and molds in dwellings in pre-school children. A population-based cross-sectional study was carried out by mailing a parent-administered questionnaire to a random sample of children in a source population consisting of all children aged 1 to 6 years of Espoo, an urban-suburban city (pop. 170,000) in the Helsinki metropolitan area. The study population included a total of 2568 children whose parents filled the questionnaire (response rate 80%). Included were questions on respiratory health, partly modified from ATS-DLD-78-C questionnaire, and potential personal and environmental determinants of the outcome. The determinants of interest were histories of water damage, presence of moisture and visible molds and perceived mold odor at home. The outcomes included persistent cough, phlegm and wheezing, persistent nasal congestion and excretion during the past 12 months and current asthma. The determinant-outcome relations were estimated in the logistic regression controlling for age, gender, parents' education, single parent or guardian, environmental tobacco smoke, gas cooking, pets and type of day care. The occurrence of persistent cough (OR 2.17; 95% CI 1.39, 3.39), phlegm (2.20; 1.27, 3.82), wheezing (2.62; 1.39, 4.39), nasal congestion (1.94; 1.15, 4.98), and nasal excretion (1.43; 0.95, 2.17) during the past year were higher with the presence of any determinant, but the occurrence of asthma (OR 1.10; 0.54, 2.24) was similar compared to the reference group. Mold odor during the past year (ORs from 2.38 to 6.87) and water damage over a year ago (ORs from 2.54 to 8.67) had the strongest association with the respiratory symptoms. A dose-response relation of the occurrence of the symptoms associated with the frequency of days with mold odor was observed. There was also a compatible time sequence between water damage taking place more than a year ago and the occurrence of symptoms during the past year. The results provide further evidence on the importance of home dampness and molds in the etiology of respiratory symptoms and new information on the role of mold odor as a risk indicator.