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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Exposure to SHS is a major cause of disease among children and there is no safe level of SHS exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> It is associated with asthma&#44; lower respiratory tract infections &#40;LRI&#41;&#44; otitis media &#40;OM&#41;&#44; and sudden infant death syndrome &#40;SIDS&#41;&#46; Moreover&#44; SHS exposure during pregnancy leads to preterm birth&#44; low birth weight &#40;LBW&#41;&#44; being small for gestational age&#44; and perinatal and infant mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#8211;3</span></a> In the past 20 years&#44; in many countries&#44; the implementation of smoking bans in public places indirectly increased voluntary smoking bans in homes&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4&#8211;6</span></a> and this effect reduced SHS-related diseases in children and in newborns&#46; A recent meta-analysis showed an association between the implementation of smoke-free legislation and reductions in hospitalization rates for asthma exacerbations&#44; LRI&#44; and LBW in children&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Despite these improvements&#44; many children and pregnant women are still exposed to SHS in the EU countries&#44; and the burden of SHS exposure in children is still considerable&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We recently published a study&#44; conducted within the TackSHS Project &#40;<a href="http://tackshs.eu/">http&#58;&#47;&#47;tackshs&#46;eu&#47;</a>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> to quantify the burden of disease due to secondhand smoke &#40;SHS&#41; exposure at home and during pregnancy among children in the past 10 years in the 28 European Union &#40;EU&#41; countries&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In our study&#44; SHS exposure was estimated using a multiple imputation procedure based on the Eurobarometer surveys&#44; and SHS exposure burden from asthma&#44; LRI&#44; OM&#44; SIDS and LBW was estimated with the comparative risk assessment method&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> using meta-analytical relative risks&#46; Data on deaths and disability-adjusted life years &#40;DALYs&#41; were collected from National statistics and from the Global Burden of Disease Study &#40;GBD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Results from our study showed that SHS exposure at home among EU children stalled from 10&#37; in 2006&#44; and 2010 to 12&#37; in 2017&#59; among pregnant women&#44; from 20&#37; in 2006&#44; 19&#37; in 2010&#44; and 21&#37; in 2017&#46; As a consequence of the trend in SHS prevalence&#44; the SHS burden was stable in 2006-2017&#46; The number of deaths and DALYs attributable to SHS exposure among children in 2017 were&#44; respectively&#44; 335 and 35&#44;633&#44; and their proportions on the total number of deaths and DALYs among EU children in 2017 were&#44; respectively&#44; 1&#46;4&#37; and 0&#46;7&#37;&#46; The proportions of DALYs were &#62;1&#46;5&#37; in Malta&#44; Slovakia&#44; Bulgaria&#44; Poland and Romania&#44; and &#60;0&#46;4&#37; in Finland&#44; The Netherlands&#44; Belgium&#44; and Luxembourg&#46; In 2017&#44; LBW caused most part of deaths and DALYs due to prenatal SHS exposure&#44; with a proportion of DALYs of 0&#46;4&#37; in the EU&#44; reaching a maximum of 1&#46;1&#37; in Poland&#59; LBW was followed by LRI&#44; asthma&#44; SIDS&#44; and finally by OM&#44; with 0&#46;1&#37; DALYs attributable to SHS exposure&#46; In Eastern EU countries&#44; such as Poland&#44; Bulgaria&#44; Slovakia&#44; and also Malta&#44; DALYs due to SHS exposure were mainly from LBW&#44; whereas in Romania and Bulgaria a high proportion of SHS-related DALYs was also recorded from LRI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our study showed a stall in SHS household exposure in children and among pregnant women and&#44; consequently&#44; in estimates of SHS exposure impact in children and newborns&#46; From 2006 to 2010&#44; slightly lower values of SHS exposure were estimated&#44; and this may be in part due to the implementation of smoking bans in 16 out of 28 EU countries &#40;Luxembourg&#44; Belgium&#44; the UK&#44; Spain&#44; Finland&#44; Slovenia&#44; Lithuania&#44; Denmark&#44; France&#44; Portugal&#44; Croatia&#44; Slovakia&#44; Latvia&#44; Cyprus&#44; Greece&#44; Germany&#41;&#46; Other 6 EU countries implemented nation-wide smoking bans in 2004&#8211;2005 &#40;Ireland&#44; Sweden&#44; Malta&#44; Italy&#44; Estonia&#44; The Netherlands&#41;&#44; whereas only 6 developed smoking bans after 2010 &#40;Poland&#44; Hungary&#44; Bulgaria&#44; Romania&#44; Czechia&#44; Austria&#41;&#46; The stall in SHS prevalence estimated in 2010&#8211;2017 suggests that comprehensive smoking bans had less influence in the adoption of smoke-free homes in the long run&#46; In this period&#44; other tobacco control measures were implemented in EU countries with no significant impact on SHS exposure at home&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2017&#44; the SHS burden was higher in Eastern countries and lower in Northern European countries&#44; part of which implemented a smoking ban earlier&#46; By analyzing the SHS burden distribution by disease&#44; a not uniform pattern was estimated in EU countries&#44; with LBW being the disease with the highest proportion of SHS attributable deaths and DALYs&#44; suggesting a notable problem of SHS exposure in pregnancy&#44; especially in Eastern EU countries&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We recently published a systematic review evaluating the burden of disease due to SHS exposure in children from different countries worldwide&#44; with population attributable fractions estimates that varied considerably&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> since they depend on country-specific SHS exposure prevalence&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> In 2017&#44; the GBD study estimated a total of 186 deaths and 20&#44;870 DALYs attributable to SHS exposure in European children aged<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14 years&#44; substantially less than our estimate of 335 deaths and 35&#44;633 DALYs&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> This is likely due to the exclusion from the GBD burden quantification of SIDS&#44; asthma and LBW&#44; the latter being one of the diseases that mainly contributed to the burden from SHS exposure in children&#44; determined from SHS exposure in pregnancy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; in the past decade&#44; despite that smoke-free homes initially increased&#44; presumably as a result of the implementation of smoking bans&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> our results showed that&#44; in the long run&#44; the SHS-related diseases in children are still not negligible&#46; This suggests that household SHS exposure among children and pregnant women are still high&#46; Up to 1&#46;6&#37; of total DALYs could be avoided eliminating SHS exposure among children and during pregnancy&#46; Preventing exposure of children to SHS at home and prenatal exposure to maternal SHS exposure in the EU therefore still requires great and coordinated efforts&#46;</p></span>"
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Editorial
Morbidity Attributable to Second-Hand Smoke in European Children
Morbilidad atribuible al tabaquismo pasivo en niños europeos
Giuseppe Gorini
Corresponding author
g.gorini@ispro.toscana.it

Corresponding author.
, Giulia Carreras
Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Exposure to SHS is a major cause of disease among children and there is no safe level of SHS exposure&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a> It is associated with asthma&#44; lower respiratory tract infections &#40;LRI&#41;&#44; otitis media &#40;OM&#41;&#44; and sudden infant death syndrome &#40;SIDS&#41;&#46; Moreover&#44; SHS exposure during pregnancy leads to preterm birth&#44; low birth weight &#40;LBW&#41;&#44; being small for gestational age&#44; and perinatal and infant mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#8211;3</span></a> In the past 20 years&#44; in many countries&#44; the implementation of smoking bans in public places indirectly increased voluntary smoking bans in homes&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4&#8211;6</span></a> and this effect reduced SHS-related diseases in children and in newborns&#46; A recent meta-analysis showed an association between the implementation of smoke-free legislation and reductions in hospitalization rates for asthma exacerbations&#44; LRI&#44; and LBW in children&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Despite these improvements&#44; many children and pregnant women are still exposed to SHS in the EU countries&#44; and the burden of SHS exposure in children is still considerable&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We recently published a study&#44; conducted within the TackSHS Project &#40;<a href="http://tackshs.eu/">http&#58;&#47;&#47;tackshs&#46;eu&#47;</a>&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> to quantify the burden of disease due to secondhand smoke &#40;SHS&#41; exposure at home and during pregnancy among children in the past 10 years in the 28 European Union &#40;EU&#41; countries&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In our study&#44; SHS exposure was estimated using a multiple imputation procedure based on the Eurobarometer surveys&#44; and SHS exposure burden from asthma&#44; LRI&#44; OM&#44; SIDS and LBW was estimated with the comparative risk assessment method&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> using meta-analytical relative risks&#46; Data on deaths and disability-adjusted life years &#40;DALYs&#41; were collected from National statistics and from the Global Burden of Disease Study &#40;GBD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Results from our study showed that SHS exposure at home among EU children stalled from 10&#37; in 2006&#44; and 2010 to 12&#37; in 2017&#59; among pregnant women&#44; from 20&#37; in 2006&#44; 19&#37; in 2010&#44; and 21&#37; in 2017&#46; As a consequence of the trend in SHS prevalence&#44; the SHS burden was stable in 2006-2017&#46; The number of deaths and DALYs attributable to SHS exposure among children in 2017 were&#44; respectively&#44; 335 and 35&#44;633&#44; and their proportions on the total number of deaths and DALYs among EU children in 2017 were&#44; respectively&#44; 1&#46;4&#37; and 0&#46;7&#37;&#46; The proportions of DALYs were &#62;1&#46;5&#37; in Malta&#44; Slovakia&#44; Bulgaria&#44; Poland and Romania&#44; and &#60;0&#46;4&#37; in Finland&#44; The Netherlands&#44; Belgium&#44; and Luxembourg&#46; In 2017&#44; LBW caused most part of deaths and DALYs due to prenatal SHS exposure&#44; with a proportion of DALYs of 0&#46;4&#37; in the EU&#44; reaching a maximum of 1&#46;1&#37; in Poland&#59; LBW was followed by LRI&#44; asthma&#44; SIDS&#44; and finally by OM&#44; with 0&#46;1&#37; DALYs attributable to SHS exposure&#46; In Eastern EU countries&#44; such as Poland&#44; Bulgaria&#44; Slovakia&#44; and also Malta&#44; DALYs due to SHS exposure were mainly from LBW&#44; whereas in Romania and Bulgaria a high proportion of SHS-related DALYs was also recorded from LRI&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Our study showed a stall in SHS household exposure in children and among pregnant women and&#44; consequently&#44; in estimates of SHS exposure impact in children and newborns&#46; From 2006 to 2010&#44; slightly lower values of SHS exposure were estimated&#44; and this may be in part due to the implementation of smoking bans in 16 out of 28 EU countries &#40;Luxembourg&#44; Belgium&#44; the UK&#44; Spain&#44; Finland&#44; Slovenia&#44; Lithuania&#44; Denmark&#44; France&#44; Portugal&#44; Croatia&#44; Slovakia&#44; Latvia&#44; Cyprus&#44; Greece&#44; Germany&#41;&#46; Other 6 EU countries implemented nation-wide smoking bans in 2004&#8211;2005 &#40;Ireland&#44; Sweden&#44; Malta&#44; Italy&#44; Estonia&#44; The Netherlands&#41;&#44; whereas only 6 developed smoking bans after 2010 &#40;Poland&#44; Hungary&#44; Bulgaria&#44; Romania&#44; Czechia&#44; Austria&#41;&#46; The stall in SHS prevalence estimated in 2010&#8211;2017 suggests that comprehensive smoking bans had less influence in the adoption of smoke-free homes in the long run&#46; In this period&#44; other tobacco control measures were implemented in EU countries with no significant impact on SHS exposure at home&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2017&#44; the SHS burden was higher in Eastern countries and lower in Northern European countries&#44; part of which implemented a smoking ban earlier&#46; By analyzing the SHS burden distribution by disease&#44; a not uniform pattern was estimated in EU countries&#44; with LBW being the disease with the highest proportion of SHS attributable deaths and DALYs&#44; suggesting a notable problem of SHS exposure in pregnancy&#44; especially in Eastern EU countries&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We recently published a systematic review evaluating the burden of disease due to SHS exposure in children from different countries worldwide&#44; with population attributable fractions estimates that varied considerably&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> since they depend on country-specific SHS exposure prevalence&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> In 2017&#44; the GBD study estimated a total of 186 deaths and 20&#44;870 DALYs attributable to SHS exposure in European children aged<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>14 years&#44; substantially less than our estimate of 335 deaths and 35&#44;633 DALYs&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> This is likely due to the exclusion from the GBD burden quantification of SIDS&#44; asthma and LBW&#44; the latter being one of the diseases that mainly contributed to the burden from SHS exposure in children&#44; determined from SHS exposure in pregnancy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; in the past decade&#44; despite that smoke-free homes initially increased&#44; presumably as a result of the implementation of smoking bans&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> our results showed that&#44; in the long run&#44; the SHS-related diseases in children are still not negligible&#46; This suggests that household SHS exposure among children and pregnant women are still high&#46; Up to 1&#46;6&#37; of total DALYs could be avoided eliminating SHS exposure among children and during pregnancy&#46; Preventing exposure of children to SHS at home and prenatal exposure to maternal SHS exposure in the EU therefore still requires great and coordinated efforts&#46;</p></span>"
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ISSN: 03002896
Original language: English
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