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

Rebecca J. Baker, Irva Hertz-Picciotto, Miroslav Dostál, Jean A. Keller, Jiři Nožička, František Kotěšovec, Jan Dejmek, Dana Loomis, Radim J. Šrám

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1126-1132
Number of pages7
JournalEnvironmental Health Perspectives
Issue number7
StatePublished - Jul 2006


  • Air pollution
  • Breast-feeding
  • Bronchitis
  • Childrens health
  • Coal heating
  • Environmental tobacco smoke
  • Indoor

ASJC Scopus subject areas

  • Environmental Science(all)
  • Environmental Chemistry
  • Public Health, Environmental and Occupational Health


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