title: Environmental tobacco smoke exposure: prevalence and mechanisms of causation of infections in children.
abstract: OBJECTIVE
  Environmental tobacco smoke (ETS) exposure is probably one of the most important public health hazards in our community. Our aim with this article is to (1) review the prevalence of ETS exposure in the United States and how this prevalence is often measured in practice and (2) summarize current thinking concerning the mechanism by which this exposure may cause infections in young children.
  
  
  METHODS
  We conducted a Medline search to obtain data published mainly in peer-reviewed journals.
  
  
  RESULTS
  There is still a very high prevalence of ETS exposure among US children ranging from 35% to 80% depending on the method of measurement used and the population studied. The mechanism by which ETS may be related to these infections is not entirely clear but may be through suppression or modulation of the immune system, enhancement of bacterial adherence factors, or impairment of the mucociliary apparatus of the respiratory tract, or possibly through enhancement of toxicity of low levels of certain toxins that are not easily detected by conventional means.
  
  
  CONCLUSIONS
  The prevalence of ETS exposure in the United States is still very high, and its role in causing infections in children is no longer in doubt even if still poorly understood. Research, therefore, should continue to focus on the various mechanisms of causation of these infections and how to best reduce the exposure levels.
authors.affiliation: Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA. pkumnji@vcu.edu
authors.forename: Philip
authors.initials: P
authors.lastname: Kum-Nji
authors.forename: Linda
authors.initials: L
authors.lastname: Meloy
authors.forename: Henry G
authors.initials: HG
authors.lastname: Herrod
mesh_terms: D002648:Child; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010033:Otitis Media / Q000209:etiology; D010510:Periodontal Diseases / Q000209:etiology; D011247:Pregnancy; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013398:Sudden Infant Death / Q000209:etiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution