BACKGROUND: Few studies of air pollutants address morbidity in preschool children. In this study we evaluated bronchitis in children from two Czech districts: Teplice, with high ambient air pollution, and Prachatice, characterized by lower exposures. OBJECTIVES: Our goal was to examine rates of lower respiratory illnesses in preschool children in relation to ambient particles and hydrocarbons. METHODS: Air monitoring for particulate matter < 2.5 microm in diameter (PM(2.5)) and polycyclic aromatic hydrocarbons (PAHs) was conducted daily, every third day, or every sixth day. Children born May 1994 through December 1998 were followed to 3 or 4.5 years of age to ascertain illness diagnoses. Mothers completed questionnaires at birth and at follow-up regarding demographic, lifestyle, reproductive, and home environmental factors. Longitudinal multivariate repeated-measures analysis was used to quantify rate ratios for bronchitis and for total lower respiratory illnesses in 1,133 children. RESULTS: After adjustment for season, temperature, and other covariates, bronchitis rates increased with rising pollutant concentrations. Below 2 years of age, increments in 30-day averages of 100 ng/m(3) PAHs and of 25 microg/m(3) PM(2.5) resulted in rate ratios (RRs) for bronchitis of 1.29 [95 % confidence interval (CI), 1.07-1.54] and 1.30 (95% CI, 1.08-1.58), respectively; from 2 to 4.5 years of age, these RRs were 1.56 (95% CI, 1.22-2.00) and 1.23 (95% CI, 0.94-1.62), respectively. CONCLUSION: Ambient PAHs and fine particles were associated with early-life susceptibility to bronchitis. Associations were stronger for longer pollutant-averaging periods and, among children > 2 years of age, for PAHs compared with fine particles. Preschool-age children may be particularly vulnerable to air pollution-induced illnesses.

• Keywords
• PAHs, PM2.5, air pollution, bronchitis, children’s health, infant, particulate matter, polycyclic aromatic hydrocarbons, respiratory illness, volatile organic compounds,
• MeSH
• Bronchiolitis epidemiology   MeSH
• Bronchitis epidemiology   MeSH
• Cohort Studies MeSH
• Infant MeSH
• Air Pollutants toxicity   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pneumonia epidemiology   MeSH
• Polycyclic Aromatic Hydrocarbons toxicity   MeSH
• Child, Preschool MeSH
• Retrospective Studies MeSH
• Risk MeSH
• Seasons MeSH
• Environmental Exposure adverse effects   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, U.S. Gov't, Non-P.H.S. MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Names of Substances
• Air Pollutants MeSH
• Polycyclic Aromatic Hydrocarbons MeSH

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.

• MeSH
• Housing * MeSH
• Infant MeSH
• Smoking adverse effects   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Respiration Disorders chemically induced   epidemiology   MeSH
• Child, Preschool MeSH
• Coal * MeSH
• Heating adverse effects   MeSH
• Tobacco Smoke Pollution statistics & numerical data   MeSH
• Air Pollution, Indoor statistics & numerical data   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, U.S. Gov't, Non-P.H.S. MeSH
• Geographicals
• Czech Republic epidemiology   MeSH
• Names of Substances
• Coal * MeSH
• Tobacco Smoke Pollution MeSH

Over the last decade or so, a large number of studies have investigated the possible adverse effects of ambient air pollution on birth outcomes. We reviewed these studies, which were identified by a systematic search of the main scientific databases. Virtually all reviewed studies were population based, with information on exposure to air pollution derived from routine monitoring sources. Overall, there is evidence implicating air pollution in adverse effects on different birth outcomes, but the strength of the evidence differs between outcomes. The evidence is sufficient to infer a causal relationship between particulate air pollution and respiratory deaths in the postneonatal period. For air pollution and birth weight the evidence suggests causality, but further studies are needed to confirm an effect and its size and to clarify the most vulnerable period of pregnancy and the role of different pollutants. For preterm births and intrauterine growth retardation (IUGR) the evidence as yet is insufficient to infer causality, but the available evidence justifies further studies. Molecular epidemiologic studies suggest possible biologic mechanisms for the effect on birth weight, premature birth, and IUGR and support the view that the relation between pollution and these birth outcomes is genuine. For birth defects, the evidence base so far is insufficient to draw conclusions. In terms of exposure to specific pollutants, particulates seem the most important for infant deaths, and the effect on IUGR seems linked to polycyclic aromatic hydrocarbons, but the existing evidence does not allow precise identification of the different pollutants or the timing of exposure that can result in adverse pregnancy outcomes.

• MeSH
• Infant MeSH
• Infant Mortality * MeSH
• Humans MeSH
• Infant, Low Birth Weight * MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Pregnancy Outcome MeSH
• Air Pollution adverse effects   MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH