Meta-analysis on the association between environmental tobacco smoke (ETS) exposure and the prevalence of lower respiratory tract infection in early childhood

Pediatr Pulmonol. 1999 Jan;27(1):5-13. doi: 10.1002/(sici)1099-0496(199901)27:1<5::aid-ppul3>;2-5.


The aim of this study was to obtain quantitative information from published data on the association between environmental tobacco smoke (ETS) exposure and the prevalence of serious lower respiratory tract infections (LRTI) in infancy and early childhood. We identified 21 relevant publications on the relation between ETS and the prevalence of serious LRTI by reviewing reference lists in relevant reports and by conducting manual and computer searches (Medline database; Dissertation abstracts index of Xerox University Microfilms) of published reports between 1966 and 1995. Thirteen studies were included in a quantitative overview using random effects modeling to derive pooled odds ratios. Sensitivity analyses were conducted to test the decision rules used in extracting odds ratio data. The results of community and hospital studies are broadly consistent and show that the child of a parent who smokes is at approximately twice the risk of having a serious respiratory tract infection in early life that requires hospitalization. This association was pronounced in children younger than age two and diminished after the age of two. The combined odds ratio for hospitalization for lower respiratory tract infections in infancy or early childhood is 1.93 (95% CI 1.66-2.25); the combined odds ratio of prevalence of serious LRTI at age less than 2 years, between 0 and 6 years, and between 3 and 6 years were 1.71 (95% CI 1.33-2.20); 1.57 (1.28-1.91), and 1.25 (0.88-1.78), respectively. There was no evidence of heterogeneity across the studies in these combined odds ratios. We conclude that this meta-analysis provides strong evidence that exposure to ETS causes adverse respiratory health outcomes such as either a serious LRTI or hospitalization for LRTI. New public health campaigns are urgently needed to discourage smoking in the presence of young children.

Publication types

  • Meta-Analysis

MeSH terms

  • Age Distribution
  • Case-Control Studies
  • Child
  • Child, Preschool
  • China / epidemiology
  • Cohort Studies
  • Confidence Intervals
  • Cross-Sectional Studies
  • Europe / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • New Zealand / epidemiology
  • North America / epidemiology
  • Odds Ratio
  • Prevalence
  • Prognosis
  • Respiratory Tract Infections / epidemiology*
  • Respiratory Tract Infections / etiology*
  • Respiratory Tract Infections / pathology
  • Risk Factors
  • Severity of Illness Index
  • Tobacco Smoke Pollution / adverse effects*


  • Tobacco Smoke Pollution