Academic journal article International Journal of Child Health and Human Development

Impact of the Home Environment on the Relationship between Prenatal Exposure to Environmental Tobacco Smoke and Child Behavior

Academic journal article International Journal of Child Health and Human Development

Impact of the Home Environment on the Relationship between Prenatal Exposure to Environmental Tobacco Smoke and Child Behavior

Article excerpt


The adverse effects of active maternal smoking during pregnancy are well established and can include premature birth, birth defects, and infant death (1). The adverse effects of passive maternai smoking during pregnancy, or prenatal environmental tobacco smoke (ETS) exposure, also have been documented. Most results link prenatal ETS exposure to increased respiratory illness in children, including increased rates of respiratory tract infections and childhood asthma, but reports of effects of prenatal ETS exposure on adverse behavioral and cognitive outcomes are inconsistent (2). Children with serum cotinine levels consistent with ETS exposure had lower reading, math, and block design scores, suggesting cognitive deficits at low levels of exposure (3). Prenatal ETS exposure has also been significantly associated with ADHD diagnosis and ADHD-like behavior (4). An earlier review of 17 studies looking at the effects of prenatal ETS exposure on children found prenatal ETS exposure was associated with subtle changes in neurodevelopment and behavior, but the review noted methodological limitations including confounding factors, imprecise measurement of ETS, and colinearity between pre- and postnatal maternal smoking (5).

Children who experience adverse social conditions, especially those living in low-income urban areas with high minority populations, are at a greater disadvantage for many reasons, including increased risk of exposure to tobacco in these populations (6). Prenatal ETS exposure had a significant effect on child cognitive function at age 24 months, and this effect was greater among children whose mothers reported having greater material hardship, including difficulty affording food, housing, and clothing (6). In the New York City neighborhoods where the participants in this study reside, smoking rates are as high as 27% and 31% to 41% of the residents live below the poverty line (depending on the neighborhood) (7-9). This suggests that children in this population are at high risk of being exposed to prenatal ETS.

A significant part of a child's cognitive and behavioral outcome is determined by the home environment, but finding a standardized way to measure the home environment has been challenging, specifically in nontraditional cultures. One method uses eight subscales to measure the quality of attachment, support, and stimulation that a child is exposed to in the home environment as a meaningful predictor of a child's social and behavioral relationships later in life (10). These subscales include the dimensions of Learning Materials, Language Stimulation, Academic Stimulation, and Modeling. HOME has been significantly correlated with both cognitive development and attachment, in both Caucasian and non-Caucasian families (11).

Although the role of the home environment in child development has been well demonstrated, few studies have examined whether the home environment can modify the effects of exposure to neurotoxicants on behavioral and/or cognitive outcomes in children. Growing up in a high quality home environment did not mitigate the adverse effects of prenatal chlorpyrifos exposure (a neurotoxic organophosphate pesticide) on working memory (12). In contrast, rats with prenatal exposure to lead who were raised in an enriched learning environment performed just as well on a spatial learning task as non-exposed rats raised in a similar environment (13). Rats that were exposed to lead prenatally but raised in an isolated environment were unable to complete the spatial learning task, or completed it at a much slower rate (13). Further study is needed to determine the role of the home in moderating the effects of early life exposure to different neurotoxicants.

Because of the high prevalence of children exposed to secondhand smoke in the United States, especially in minority populations, and because many children from low-income, minority, and urban populations tend to have less optimal home environments, this study examined the role of the home environment in moderating the effects of prenatal ETS exposure on child behavior. …

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