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Associate Professor Karen Waters is Research Leader of Paediatric Sleep Team at the Woolcock Institute of Medical Research, University of Sydney

“There is no doubt that exposing a child to cigarette smoke, whether it is during the pregnancy or afterwards, has negative health consequences for that child. Infants exposed to cigarette smoke are more likely to die from sudden infant death and children develop bronchitis and wheezing illnesses. Unfortunately, smoking is also more common amongst parents with less education and who live in poorer social circumstances.

This large Swedish study provides new evidence that children growing up in an environment with cigarette smoke are more likely to become allergic to pets and household allergens including foods. The association demonstrated between parents’ smoking and childrens’ illnesses is so strong that it occurs even when parents do not smoke in the house or around their children. Parental smoking can certainly make children sick.”

Associate Professor Peter Smith is a paediatric allergy specialist in Queensland

“This large Swedish study confirms a doubling of risk of developing allergies to inhalant allergies in the children of smokers. We have long known that environmental pollution increases the risk of developing allergies in the environment. This was first published in 1973 when Charles Blackley reported that allergic rhinitis was linked to urbanisation and industrialisation. This Swedish report suggests that smoking increases the pollution in the immediate environment and the developing child is most at risk. Irritation of the airways with chemicals from smoking may make allow more allergens to pass into the body or alter the way they are processed, however the exact mechanisms of this need to be determined. This paper also has found the smoking increases the risk of child developing allergic antibodies to foods. The study does not correlate antibodies and the presence of disease -so more work is required her. The relation between smoking and possible food allergy is a new finding and one that will be looked at in many further studies.

Overall, this is study reinforces some of the effects of passive smoking, with the most vulnerable being at most risk. Smoking has consequences that reach beyond the well established self-harm.”

Dr Raymond J Mullins is President elect of the Australasian Society for Clinical Immunology and Allergy (ASCIA)

“This study adds interesting information regarding the adverse effects of environmental tobacco smoke, suggesting that exposure increases the risk of children developing a measurable immune (“allergic” IgE) response to environmental triggers such as pets, grasses, tree pollens and dust mite. The authors postulate that environment or pollution may have an adjuvant effect to increase the risk of sensitisation. Previous studies have found that exposure to environmental tobacco smoke increases the risk of wheezing in young children, but not an increased risk of sensitisation to environmental allergens. Interestingly, a measurable immune response was also observed to some foods (eg. peanut, egg wheat, soy and cows milk), the first study to link environmental tobacco smoke with sensitisation to food.

Unfortunately, the study poses more questions than it answers. Even though children were followed through to the age of four years, no information is given about the correlation between a detectable immune response as measured by blood testing, and the development of clinical disease. This is unfortunate, as it is highly likely that children allergic to common food triggers such as those listed above, would have manifested their disease well before the age of four years. When it comes to food allergy, low levels of IgE are not uncommon in young children and do not always translate into food allergy, particularly when looking at very low levels of IgE less than the cut-off level of 0.35 kU/ml of specific IgE used in the study. The trend between the intensity of exposure of environmental tobacco smoke and elevation of allergen specific IgE is of interest, but does not appear to be statistically significant for any one environmental trigger other than for sensitisation to cat. Overall, this is an interesting study but its findings are difficult to interpret.”

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Dr Raoul Walsh is a Conjoint Associate Professor at the Centre for Health Research & Psycho-oncology (CHeRP), The Cancer Council NSW and University of Newcastle.

“Cigarette smoking remains the major preventable cause of adverse pregnancy outcomes in developed nations. The evidence that exposure to smoking during and after pregnancy increases the risk of SIDS has been mounting for three decades. Nonetheless, it appears that parents have responded to messages about other risk factors for SIDS, such as sleeping positions, more strongly than they have to advice about quitting smoking. This means we need renewed prevention programs to continue the impressive gains made in the past to combat SIDS.

Maternal smoking in Australia is declining. However, the change is relatively slow. The NSW Department of Health (2007) “Mothers and Babies 2005″ Report found that the proportion of mothers reporting any smoking in pregnancy fell from 17.1% in 2001 to 14.3% in 2005. Disturbingly, other data suggest the prevalence of smoking is much higher (30% or higher) in women attending public hospital antenatal clinics. These women also have higher rates of other pregnancy risk factors.

A concern has been expressed that bans on smoking in public spaces such as bars may increase smoking within private houses and therefore increase infants’ exposure to second-hand smoke in their homes. The results of a recent Scottish study (Akhtar et al, 2007) of nearly 5,000 primary school children provides some reassurance on this matter. The study measured the concentration of nicotine metabolites in the saliva of children before and after the passage of new smoke-free laws. In addition to a 51% reduction in these chemicals in non-smoking children from non-smoking households, there was no evidence of increased exposure in children from homes where the mother or both parents smoked.

Another study by Borland et al (2006) supported the view that smoke-free policies did not appear to encourage displacement of parental smoking into the home. More positively, they concluded that smoke-free public places seem to stimulate adoption of smoke-free homes. Amongst other evidence, Borland et al (2006) found that in Australia, which has a longer history of smoke-free initiatives, 34% of smokers reported their homes were smoke-free compared with only 16% of UK smokers.

Ethical and privacy issues will make any regulatory approach to smoking in free-standing private homes problematic. However, smoking in cars carrying children represents a practice crying out for child protection legislation. It seems paradoxical that governments ban smoking on public transport but have seemed happy to expose young children to dangerous levels of passive smoking in private vehicles. Levels of cigarette pollutants in cars reach higher levels than even smoky bars. If we can introduce compulsory seat belt legislation, it does not seem that difficult to ban smoking in cars containing children. South Australia has recently enacted such a ban and Tasmania will soon follow suit yet other states including our most populous, NSW and Victoria, are dragging the chain on this issue.”

Dr Chris Seton, from the Sleep Investigation and Respiratory Support unit at the Children’s Hospital Westmead

“Australia has one of the highest smoking in pregnancy rates in the world (approx 30%).Parents ,since 1991 have taken on board other SIDS reduction recommendations (back sleep,breast feeding,avoiding heat & cold etc) resulting in a marked reduction in SIDS (85% reduction 1991-2005).However smoking in this group,especially young (18-25 yr old) mothers, over the same period,has not dropped at all. This means the ‘relative risk’ of smoking in SIDS has increased markedly (because the other risk factors are reduced) & smoking now is the number 1 SIDS risk factor.

The failure of the SIDS campaign to reduce smoking probably reflects the difficulty people find in ‘giving up’.This further suggests that our current policy of simply ‘telling’ parents to stop smoking is not enough, & doctors and other health professionals now need to be proactive in helping facilitate this process.This is a huge ask,and an intervention at Government level to ban smoking on a wider (or total basis) is a more practical and effective option.

Meanwhile, it remains frustrating for all who work in this area, to see that as smoking becomes prohibited in clubs ,restaurants,hotels etc,the family home subsequently becomes a ‘sanctuary’ for smokers and young infants are therefore increasingly exposed to cigarette smoke.Sadly then ‘pub air’ may be more baby-safe than ‘home-air’ in smoking households.

A further worrying statistic in Australia is that in 2005,for the first time since the introduction of SIDS protective measures in 1991 there was an increase in SIDS deaths when compared with the previous year, suggesting perhaps a degree of complacency related to these important preventative health measures. It is therefore very important that the media continues its important role of widely disseminating these messages.”