Coal home heating and environmental tobacco smoke in relation to lower respiratory illness in Czech children, from birth to 3 years of age

Environ Health Perspect. 2006 Jul;114(7):1126-32. doi: 10.1289/ehp.8501.


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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Air Pollution, Indoor / statistics & numerical data*
  • Child, Preschool
  • Coal*
  • Czech Republic / epidemiology
  • Female
  • Heating / adverse effects*
  • Housing*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Respiration Disorders / chemically induced*
  • Respiration Disorders / epidemiology*
  • Smoking / adverse effects*
  • Tobacco Smoke Pollution / statistics & numerical data*


  • Coal
  • Tobacco Smoke Pollution