Childhood exposure to smoke may increase risk of back pain in later lifeBMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7460.250 (Published 29 July 2004) Cite this as: BMJ 2004;329:250
All rapid responses
EDITOR---This communication in response to the recent paper on
passive smokers during childhood and long term work disability (1) and the
comments in the BMJ (2), where the focus was on the increased risk for
back pain later in life. This study (1) was conducted in Oslo with 4,744
nurse aides exposed to environmental tobacco smoke (ETS) and followed for
15 months. The aides exposed to ETS were more likely to have neck pain,
high back pain, lower back pain and more like to take sick leave exceeding
eight weeks. We have looked at long term effects (more than 30 years) of
maternal smoking on later quality of life of children exposed in uterine
The Copenhagen Perinatal Birth Cohort 1959-61 is a prospective
longitudinal perinatal study that included all deliveries (over 20 weeks
gestation, birthweight over 250g) that took place at the University
Hospital (Rigshospitalet) in Copenhagen, Denmark during the period of
September 21, 1959 to December 21, 1961 and used in our follow-up study to
investigate the connection between maternal smoking during pregnancy and
the quality of life of the child 31-33 years later.
The latest follow-up study from the cohort was performed in 1993 and
7,222 of the surviving children were identified (now aged between 31-33
years). They were contacted with a non-anonymous questionnaire on several
aspects of quality of life issues.
There were 4,626 usable responses (f = 2,489, m = 2,131)
corresponding to a response rate of 64.1%. The children whose mothers were
non-smokers or smoked less than three cigarettes a day had a quality of
life that was 2.7% better than those children where mothers had smoked
over ten cigarettes per day. At first glance these figures seemed small,
however, when compared with other early life factors we saw that mothers
smoking more than ten cigarettes a day was one of the most important early
predictors in our study for the quality of life (QOL) of the child as
adult. As most people in our study have a QOL rating between 55% and 85%,
2,7% is about 10% of normal variation.
The author in the Norwegian study (1) believed that smoke could have
effects on the developing spine, which together with other studies makes
the suspicion that smoke long term could effect spinal pain. It seemed
from our study (3) that exposure to tobacco smoke during pregnancy had a
small, but significant effect on the quality of life in later adult life.
However the underlying causal factor for this reduction in quality of life
remains unclear. Nevertheless, pregnant mothers should be made aware of
the potential long-term effects smoking can have on their child. Further
studies are needed to find the exact damage.
Mohammed Morad, MD, is a family physician, the medical director of a
large area clinic in the city of Beer-Sheva, Israel. E-mail:
Isack Kandel, MA, PhD is a senior lecturer at the Faculty of Social
Sciences, Department of Behavioral Sciences and Social Work, Academic
college of Judea and samaria, Ariel, Israel.
Joav Merrick, MD, DMSc is professor of child health and human
development, director of the National Institute of Child Health and Human
Development and the medical director of the Division for Mental
Retardation, Ministry of Social Affairs, Jerusalem, Israel.
E-mail: email@example.com. Website: www.nichd-israel.com
1. Eriksen W, Do people who were passive smokers during childhood
have increased risk of long-term work disability? Eur J Public Health
2. Dobson R. Childhhod esposure to smoke may increase risk of back
pain later in life. BMJ 2004;329:250.
3. Ventegodt S, Merrick J. Long Term Effects of Maternal Smoking on
Quality of Life. Results from the Copenhagen Perinatal Birth Cohort 1959-
61. ScientificWorldJournal 2003;3:714-20.
Competing interests: No competing interests