Coal Home Heating and Environmental Tobacco Smoke in Relation to Lower Respiratory Illness in Czech Children, from Birth to 3 Years of Age

OBJECTIVE The objective of this study was to evaluate how indoor pollution from tobacco and home heating may adversely affect respiratory health in young children. DESIGN A birth cohort was followed longitudinally for 3 years to determine incidence of lower respiratory illness (LRI). PARTICIPANTS A total of 452 children born 1994-1996 in two districts in the Czech Republic participated. EVALUATIONS Indoor combustion exposures were home heating and cooking fuel, mother's smoking during pregnancy, and other adult smokers in the household. Diagnoses of LRI (primarily acute bronchitis) from birth to 3 years of age were abstracted from pediatric records. Questionnaires completed at delivery and at 3-year follow-up provided covariate information. LRI incidence rates were modeled with generalized linear models adjusting for repeated measures and for numerous potential confounders. RESULTS LRI diagnoses occurred more frequently in children from homes heated by coal [vs. other energy sources or distant furnaces ; rate ratio (RR) = 1.45 ; 95% confidence interval (CI) , 1.07-1.97]. Maternal prenatal smoking and other adult smokers also increased LRI rates (respectively: RR = 1.48 ; 95% CI, 1.10-2.01 ; and RR = 1.29 ; 95% CI, 1.01-1.65) . Cooking fuels (primarily electricity, natural gas, or propane) were not associated with LRI incidence. For children never breast-fed, coal home heating and mother's smoking conferred substantially greater risks: RR = 2.77 (95% CI, 1.45-5.27) and RR = 2.52 (95% CI, 1.31-4.85) , respectively. CONCLUSIONS Maternal smoking and coal home heating increased risk for LRI in the first 3 years of life, particularly in children not breast-fed. RELEVANCE Few studies have described effects of coal heating fuel on children's health in a Western country. Breast-feeding may attenuate adverse effects of prenatal and childhood exposures to combustion products.