Otitis Media ebooksclub.org Tobacco or Health Physiological and Social Damages Caused by Tobacco Smoking Second Edition

Moreover,฀ otitis฀ media฀ frequently฀ marks฀ the฀ starting฀ point฀ for฀ surgical฀ intervention฀ [74,฀213] .฀Since฀38–60฀of฀young฀children฀are฀exposed฀to฀ETS฀in฀their฀parents’฀homes,฀ passive฀smoking฀is฀an฀important฀factor฀in฀the฀development฀of฀this฀condition฀ [218–221] .฀ The฀frequency฀of฀otitis฀media,฀surgery฀and฀antimicrobial฀therapy฀during฀the฀preceding฀12฀ months฀was฀assessed฀hair฀cotinine฀measurements,฀physician฀medical฀records,฀home฀visits฀ in฀a฀study฀in฀227฀cases฀and฀398฀healthy฀controls฀who฀satisied฀the฀inclusion฀criteria฀for฀the฀ study฀Fig.฀ 9.10 ฀ [212] .฀Otitis฀media฀developed฀in฀23.9฀of฀the฀children฀and฀9.8฀had฀to฀ undergo฀ myringotomy.฀ Children฀ exposed฀ to฀ ETS฀ had฀ a฀ 2–3฀ times฀ higher฀ risk฀ of฀ otitis฀ media฀ than฀ non-exposed฀ children฀ Table฀ 9.8 .฀ These฀ results฀ are฀ consistent฀ with฀ those฀ reported฀in฀other฀studies฀ [222–225] ฀OR,฀1.80;฀CI,฀1.1–3.0฀ [222] . To฀ estimate฀ the฀ relative฀ risk฀ for฀ otitis฀ media฀ OM฀ in฀ children฀ from฀ ETS,฀ maternal฀ smoking฀ during฀ pregnancy฀ gestational฀ exposure,฀ or฀ both,฀ a฀ national฀ cross-sectional฀ health฀survey฀was฀analysed฀by฀the฀use฀of฀questionnaire฀information฀and฀serum฀cotinine฀ measurements฀ [226] .฀Children฀younger฀than฀12฀years฀N฀=฀11,728฀were฀examined฀who฀ participated฀in฀the฀Third฀National฀Health฀and฀Nutrition฀Examination฀Survey฀NHANES฀III,฀ conducted฀from฀1988฀to฀1994.฀The฀outcome฀of฀the฀study฀was฀the฀occurrence฀and฀recur- rence฀of฀ear฀infections.฀It฀was฀found฀that฀the฀cumulative฀incidence฀of฀ear฀infections฀was฀69.฀ Of฀all฀participants,฀38฀were฀exposed฀to฀passive฀smoke,฀23฀were฀exposed฀to฀gestational฀ smoke,฀and฀19฀were฀exposed฀to฀combined฀passive฀and฀gestational฀smoke.฀The฀occurrence฀ of฀any฀ear฀infection฀was฀not฀increased฀by฀passive฀smoke฀exposure฀adjusted฀risk฀ratio฀[RR],฀ 1.01;฀95฀CI,฀0.95–1.06,฀but฀was฀slightly฀increased฀by฀gestational฀adjusted฀RR,฀1.08;฀95฀ CI,฀1.01–1.14฀and฀combined฀adjusted฀RR,฀1.07;฀95฀CI,฀1.00–1.14฀smoke฀exposures.฀ The฀risk฀of฀recurrent฀ear฀infections฀³6฀lifetime฀episodes฀was฀signiicantly฀increased฀with฀ combined฀smoke฀exposure฀adjusted฀RR,฀1.44;฀95฀CI,฀1.11–1.81.฀Other฀risk฀factors฀for฀ ear฀infection฀identiied฀in฀multivariable฀analysis฀were฀raceethnicity,฀poverty–income฀ratio฀ of฀2.00฀or฀more,฀attendance฀in฀day฀care,฀history฀of฀asthma฀and฀presence฀of฀allergic฀symp- toms.฀From฀this฀study,฀it฀can฀be฀concluded฀that฀passive฀smoke฀exposure฀was฀not฀associated฀ with฀an฀increased฀risk฀of฀ever฀developing฀an฀ear฀infection.฀The฀increased฀risk฀found฀with฀ gestational฀and฀combined฀smoke฀exposures฀has฀marginal฀clinical฀signiicance.฀For฀recur- rent฀ear฀infections,฀however,฀combined฀smoke฀exposure฀had฀a฀clinically฀and฀statistically฀ signiicant฀effect฀ [226] . Continine Level [ng mg] No. of Current Household Smokers 1 0.60 0.48 0.30 n = 74 n = 13 n = 5 ≥2 0.5 1.0 1.5 2.0 Fig. 9.10 ฀฀฀Correlation฀between฀ hair฀cotinine฀concentration฀ and฀number฀of฀smokers฀in฀ household,฀according฀to฀ parental฀self-report.฀Medians฀ including฀25th฀and฀75th฀ percentiles.฀Data฀outside฀the฀ conidence฀range.฀Signiicant฀ differences฀between฀the฀ groups฀฀p฀=฀0.03฀ [212]

9.8 Meningococcal Infections

Sepsis฀and฀meningitis฀caused฀by฀Neisseria฀meningitidis฀frequently฀have฀a฀fatal฀outcome,฀ and฀tobacco฀smoke฀should฀be฀regarded฀as฀a฀vehicle฀for฀the฀nasopharyngeal฀transport฀of฀the฀ bacteria฀ [227–229] .฀In฀particular,฀NO 2 ฀from฀tobacco฀smoke฀increases฀the฀incidence฀of฀viral฀ respiratory฀tract฀infections฀ [230] ;฀by฀impairing฀defence฀mechanisms,฀the฀gas฀encourages฀ viral฀spread฀on฀the฀mucosa.฀Cigarette฀smoke฀inhibits฀mucociliary฀clearance,฀increases฀bacte- rial฀adhesion฀and฀ruptures฀respiratory฀tract฀epithelium฀ [231–233] .฀In฀vitro฀experiments฀indi- cate฀that฀tobacco฀smoke฀harms฀neutrophil฀migration,฀and฀inhibits฀the฀phagocytic฀activity฀of฀ macrophages฀and฀the฀production฀of฀immunoglobulins฀ [231,฀232,฀234] . Passive฀smokers฀are฀more฀likely฀than฀individuals฀not฀exposed฀to฀ETS฀to฀be฀infected฀by฀ pathogenic฀meningococci.฀Alongside฀numerous฀other฀causes฀ [235] ,฀ETS฀is฀an฀important฀ factor฀in฀promoting฀meningococcal฀infection฀in฀young฀children฀ [236–238] .฀In฀a฀compari- son฀of฀129฀cases฀with฀274฀controls฀matched฀for฀age,฀sex,฀ethnic฀group฀etc.,฀having฀a฀mother฀ who฀smoked฀was฀the฀strongest฀independent฀risk฀factor฀for฀invasive฀meningococcal฀disease฀ in฀children฀18฀years฀of฀age,฀compared฀with฀non-smoking฀mothers฀OR,฀3.8;฀CI,฀1.6–8.9;฀ p฀฀0.01.฀This฀risk฀was฀additionally฀increased฀where฀the฀children฀were฀in฀school฀classes฀ of฀30฀pupils฀OR,฀5.7;฀CI,฀1.3–24.2;฀p฀=฀0.02.฀Similarly,฀the฀risk฀of฀meningococcal฀infec- tion฀showed฀a฀dose–response฀relationship฀with฀increasing฀number฀of฀maternal฀pack-years฀ of฀smoking.฀Ultimately,฀according฀to฀this฀study฀the฀incidence฀of฀meningococcal฀infection฀ in฀ETS-exposed฀children฀was฀37฀higher฀than฀in฀non-exposed฀children.฀Younger฀children฀ 5฀years฀old฀were฀at฀greater฀risk฀than฀older฀children฀5–17฀years฀old฀ [235] . In฀view฀of฀the฀risk฀of฀meningococcal฀infection,฀frequently฀a฀fatal฀condition,฀it฀is฀there- fore฀recommended฀that฀mothers฀with฀young฀children฀should฀give฀up฀smoking.

9.9 Breast Cancer

Although฀a฀causal฀association฀between฀passive฀smoking฀and฀an฀increased฀risk฀of฀breast฀ cancer฀is฀not฀immediately฀evident฀ [239] ฀see฀Sect.฀7.8.4฀in฀ Chap.฀7 ,฀initial฀indings฀indicate฀ that฀an฀association฀does฀exist.฀Evidently,฀in฀genetically฀“sensitive”฀individuals฀ [240–242] ฀ the฀inhaled฀ETS฀produces฀hormonal฀changes฀consistent฀with฀an฀anti-oestrogen฀effect฀and฀ oestrogen-induced฀mitogenesis฀ [243,฀244] .฀According฀to฀a฀study฀conducted฀in฀334฀women฀ with฀breast฀cancer,฀ever-active฀smokers฀had฀an฀OR฀of฀2.0฀CI:฀1.1–3.6฀when฀compared฀ with฀never-active,฀never-passive฀smokers.฀Risk฀levels฀were฀higher฀in฀women฀who฀smoked฀ only฀before฀their฀irst฀pregnancy฀OR,฀5.6;฀CI,฀1.5–21฀and฀in฀women฀who฀quit฀smoking฀ 5–15฀years฀before฀their฀index฀year฀OR,฀3.9;฀CI,฀1.4–10.฀Passive-only฀smokers฀had฀an฀OR฀ of฀2.0฀CI:฀1.1–3.7.฀Among฀those฀women฀who฀were฀exposed฀to฀ETS฀before฀the฀age฀of฀ 12฀years,฀the฀ORs฀were฀4.5฀CI:฀1.2–16฀for฀passive-only฀smokers,฀and฀7.5฀CI:฀1.6–36฀for฀ ever-active฀smokers฀ [245] .฀It฀is฀possible฀that฀ETS฀exposure฀needs฀to฀occur฀at฀a฀very฀early฀ stage,฀shortly฀before฀the฀development฀of฀breast฀tissue,฀in฀order฀to฀induce฀mitogenic฀changes฀ consistent฀with฀carcinogenesis฀ [246] .฀More฀extensive฀studies฀are฀certainly฀required฀in฀this฀ area฀before฀a฀deinitive฀verdict฀can฀be฀given. Johnson฀and฀Glantz฀compared฀the฀strength฀of฀evidence฀from฀epidemiologic฀studies฀of฀ second฀hand฀smoke฀of฀the฀US฀Surgeon฀General’s฀1986฀conclusion฀that฀secondhand฀smoke฀ caused฀ lung฀ cancer฀ with฀ the฀ California฀ Environmental฀ Protection฀ Agency’s฀ CalEPA฀ similar฀2005฀conclusion฀on฀breast฀cancer฀in฀younger,฀primarily฀premenopausal฀women฀ [247] .฀They฀reviewed฀each฀report฀for฀criteria฀used฀to฀assess฀causality:฀number฀of฀studies,฀ statistically฀signiicant฀increases฀in฀risk,฀and฀pooled฀summary฀risk฀estimates.฀The฀authors฀ showed฀that฀both฀the฀Surgeon฀General฀and฀CalEPA฀used฀updated฀Bradford฀Hill฀criteria฀for฀ assessing฀causality฀and฀found฀that฀the฀evidence฀met฀those฀criteria.฀Six฀of฀13฀lung฀cancer฀ studies฀46฀had฀statistically฀signiicant฀increases฀one฀of฀three฀cohort฀studies.฀Pooled฀ risk฀ estimates฀ for฀ lung฀ cancer฀ for฀ spousal฀ exposure฀ were฀ 1.53฀ for฀ ten฀ combined฀ case-฀ control฀studies฀and฀1.88฀for฀seven฀studies฀with฀dose–response฀results.฀The฀CalEPA฀reported฀ 10฀of฀14฀studies฀71฀had฀statistically฀signiicant฀increases฀in฀breast฀cancer฀risk฀two฀of฀ four฀cohort฀studies.฀Pooled฀relative฀risk฀estimates฀for฀younger,฀primarily฀premenopausal฀ women฀were฀1.68฀95฀CI:฀1.33,฀2.12฀for฀all฀exposed฀women฀and฀2.19฀95฀CI:฀1.68,฀ 2.84฀for฀ive฀studies฀with฀better฀exposure฀assessment.฀It฀was฀concluded฀that฀the฀evidence฀ from฀epidemiologic฀studies฀of฀passive฀smoke฀in฀2005฀for฀breast฀cancer฀in฀younger,฀primar- ily฀premenopausal฀women฀was฀stronger฀than฀for฀lung฀cancer฀in฀1986.

9.10 Psychosocial Changes

Children฀exposed฀to฀ETS฀display฀behavioural฀changes฀that฀can฀be฀linked฀with฀ETS.฀Within฀a฀ family฀ setting,฀ lifestyle฀ habits฀ evolve฀ e.g.฀ smoking,฀ fat฀ consumption,฀ sedentary฀ lifestyle฀ increased฀alcohol฀consumption฀which฀in฀turn฀may฀be฀regarded฀as฀risk฀factors฀for฀the฀children฀ because฀they฀adopt฀these฀lifestyle฀habits฀ [248,฀249] .฀Body฀measurements฀were฀performed฀in฀ a฀study฀of฀804฀children฀aged฀10–12฀years;฀additionally,฀smoking฀behaviour฀and฀dietary฀char- acteristics฀were฀identiied.฀Among฀the฀children฀from฀these฀families,฀19฀of฀boys฀and฀10฀of฀ girls฀were฀already฀smokers.฀Among฀the฀children฀who฀smoked,฀57฀boys฀and฀68฀girls฀ came฀from฀families฀in฀which฀at฀least฀one฀parent฀smoked฀OR,฀2.1;฀CI,฀1.2–3.8.฀In฀the฀longer฀ term,฀however,฀girls฀were฀less฀likely฀to฀adopt฀the฀smoking฀habits฀of฀their฀parents฀OR,฀0.4;฀ CI,฀0.2–0.6.฀Parental฀smoking฀behaviour฀was฀an฀additive฀predictor฀in฀children฀of฀lower฀ physical฀activity฀and฀more฀television฀watching,฀regardless฀of฀which฀parent฀smoked.฀Children’s฀ fat฀intake฀was฀signiicantly฀greater฀if฀either฀parent฀smoked,฀whereas฀children’s฀body฀mass฀ index฀and฀waist-to-hip฀ratio฀were฀signiicantly฀greater฀if฀mothers฀smoked฀ [250] . Overall,฀children฀who฀grow฀up฀in฀“smoker฀households”฀take฀health฀risks฀upon฀them- selves฀ regardless฀ of฀ the฀ risks฀ already฀ present฀ as฀ a฀ result฀ of฀ smoking฀ during฀ pregnancy฀ [251] .฀Parental฀smoking฀is฀formative฀in฀encouraging฀an฀unhealthy฀lifestyle฀in฀children,฀