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Burden of disease from exposure to secondhand smoke in children in Europe

Abstract

Background

Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006–2017 for the 28 European Union (EU) countries.

Methods

Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study.

Results

Exposure to SHS and its attributable burden stalled in 2006–2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight.

Conclusions

Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant.

Impact

  • Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children.

  • Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial.

  • In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633.

  • Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden.

  • Eastern European Union countries showed the highest burden.

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Fig. 1: Rank of the proportion of disability-adjusted life years (DALYs) attributable to secondhand smoke on total DALYs among children in 2017 in the European Union.
Fig. 2: Proportion of DALYs attributable to SHS on total DALYs by cause and country, 2017.

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Acknowledgements

E.F. thanks CERCA Programme/Generalitat de Catalunya for institutional support. This work was supported by the European Union’s Horizon 2020 research and innovation program [grant number 681040]; the 2017 Italian Health Ministry CCM Programme Project “Choosing health priorities and selecting effective interventions to prevent the burden of chronic non-communicable diseases” (http://www.ccm-network.it/progetto.jsp?id=node/1977&idP=740); the Ministry of Research and Universities from the Government of Catalonia to EF [grant number 2017SGR319]; the Instituto Carlos III and co-funded by the European Regional Development Fund, FEDER [INT16/00211 and INT17/00103], Government of Spain to E.F. and the Italian League Against Cancer (Milan) to S.G. This manuscript was prepared by the TackSHS Project Consortium and does not necessarily reflect the views of the European Commission. The European Commission is not responsible for any use that may be made of the information that contains in this manuscript.

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G.C., A.L., B.C., S.G., E.F., and G.G. made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; M.J.L., A.L.N., A.L., M.T.P., J.B.S., and E.F. contributed in drafting the article or revising it critically for important intellectual content; G.C., A.L., B.C., S.G., M.J.L., A.L.N., A.L., M.T.P., J.B.S., E.F., and G.G. gave the final approval of the version to be published.

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Correspondence to Giulia Carreras.

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Carreras, G., Lachi, A., Cortini, B. et al. Burden of disease from exposure to secondhand smoke in children in Europe. Pediatr Res 90, 216–222 (2021). https://doi.org/10.1038/s41390-020-01223-6

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