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Bråbäck, Lennart
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Pape, K., Svanes, C., Malinovschi, A., Benediktsdottir, B., Lodge, C., Janson, C., . . . Schlünssen, V. (2019). Agreement of offspring-reported parental smoking status: the RHINESSA generation study. BMC Public Health, 19, Article ID 94.
Open this publication in new window or tab >>Agreement of offspring-reported parental smoking status: the RHINESSA generation study
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2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 94Article in journal (Refereed) Published
Abstract [en]

Background: With increasing interest in exposure effects across generations, it is crucial to assess the validity of information given on behalf of others.

Aims: To compare adult's report of their parent’s smoking status against parent's own report and examine predictors for discrepant answers.

Methods: We studied 7185 offspring (18-51 years) and one of their parents, n = 5307 (27-67 years) participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Information about parent's smoking status during offspring's childhood and mother's smoking status during pregnancy was obtained by questionnaires from parents and their offspring. We calculated sensitivity, specificity and Cohen's Kappa [κ] for agreement using parent's own report as the gold standard. We performed logistic regression to examine if offspring's sex, age, educational level, asthma status, own smoking status or parental status, as well as the parent's sex and amount of smoking during childhood predicted disagreement.

Results: The sensitivity for offspring's correct report of parent's smoking status during childhood (0-10 years) was 0.82 (95% CI 0.81–0.84), specificity was 0.95 (95% CI 0.95–0.96) and a good agreement was observed, κ = 0.79 (95% CI 0.78–0.80). Offspring's report of mothers' smoking status during pregnancy showed a lower sensitivity, 0.66 (95% CI 0.60–0.71), a slightly lower specificity, 0.92 (95% CI 0.90–0.95) and a good agreement, κ = 0.61 (95% CI 0.55–0.67). In multivariate logistic regression analysis, offspring not having children was a predictor for discrepant answers (odds ratio [OR] 2.11 [95% CI 1.21–3.69]). Low amount of parents' tobacco consumption, < 10 cigarettes/day (OR 2.72 [95% CI 1.71–4.31]) also predicted disagreement compared to ≥10 cigarettes per day, and so did offspring's reports of fathers' smoking status (OR 1.73 [95% CI 1.09–2.74]) compared to mothers' smoking status. Offspring's sex, asthma status, educational level, smoking status or age was not related to discrepant answers.

Conclusions: Adults report their parent's smoking status during their childhood, as well as their mothers' smoking status when pregnant with them, quite accurately. In the absence of parents' direct report, offspring's reports could be valuable.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Agreement, Generation study, Parental smoking, Self-report, Sensitivity, Smoking during pregnancy, Specificity, Tobacco smoking, Validation study
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-155622 (URN)10.1186/s12889-019-6414-0 (DOI)000459898400003 ()30665381 (PubMedID)
Available from: 2019-01-25 Created: 2019-01-25 Last updated: 2019-03-27Bibliographically approved
Timm, S., Frydenberg, M., Abramson, M. J., Bertelsen, R. J., Bråbäck, L., Benediktsdottir, B., . . . Schlünssen, V. (2019). Asthma and selective migration from farming environments in a three-generation cohort study. European Journal of Epidemiology, 34(6), 601-609
Open this publication in new window or tab >>Asthma and selective migration from farming environments in a three-generation cohort study
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2019 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 34, no 6, p. 601-609Article in journal (Refereed) Published
Abstract [en]

Individuals raised on a farm appear to have less asthma than individual raised elsewhere. However, selective migration might contribute to this as may also the suggested protection from farm environment. This study investigated if parents with asthma are less likely to raise their children on a farm. This study involved three generations: 6045 participants in ECRHS/RHINE cohorts (born 1945-1973, denoted G1), their 10,121 parents (denoted G0) and their 8260 offspring participating in RHINESSA (born 1963-1998, denoted G2). G2-offspring provided information on parents not participating in ECRHS/RHINE. Asthma status and place of upbringing for all three generations were reported in questionnaires by G1 in 2010-2012 and by G2 in 2013-2016. Binary regressions with farm upbringing as outcome were performed to explore associations between parental asthma and offspring farm upbringing in G0-G1 and G1-G2. Having at least one parent with asthma was not associated with offspring farm upbringing, either in G1-G2 (RR 1.11, 95% CI 0.81-1.52) or in G0-G1 (RR 0.99, 0.85-1.15). G1 parents with asthma born in a city tended to move and raise their G2 offspring on a farm (RR 2.00, 1.12-3.55), while G1 parents with asthma born on a farm were less likely to raise their G2 offspring on a farm (RR 0.34, 0.11-1.06). This pattern was not observed in analyses of G0-G1. This study suggests that the protective effect from farm upbringing on subsequent asthma development could not be explained by selective migration. Intriguingly, asthmatic parents appeared to change environment when having children.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Asthma, ECRHS, Farming, RHINE, RHINESSA, Selective migration
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-156264 (URN)10.1007/s10654-019-00491-9 (DOI)000466919800009 ()30729356 (PubMedID)2-s2.0-85061192239 (Scopus ID)
Available from: 2019-02-11 Created: 2019-02-11 Last updated: 2019-06-13Bibliographically approved
Al-Tamprouri, C., Barman, M., Hesselmar, B., Bråbäck, L. & Sandin, A. (2019). Cat and dog ownership during/after the first year of life and risk for sensitization and reported allergy symptoms at age 13. Immunity, Inflammation and Disease
Open this publication in new window or tab >>Cat and dog ownership during/after the first year of life and risk for sensitization and reported allergy symptoms at age 13
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2019 (English)In: Immunity, Inflammation and Disease, E-ISSN 2050-4527Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Avoidance of pets as a strategy for preventing atopic diseases has been questioned. This study aimed to identify the risk of sensitization and allergic symptoms at age 13 in relation to dog‐ and cat‐keeping during and after the first year of life.

Methods: The study included all children born at Östersund Hospital in Northern Sweden between February 1996 and January 1997 (n = 1231). At inclusion, parents were asked to answer questionnaires about lifestyle, including cat‐ and dog‐keeping. Dog allergy, cat allergy, hay fever, and asthma were diagnosed based on parental reported allergic symptoms at 13 years of age (n = 834). The risks of sensitization or allergy in relation to dog‐ and cat‐keeping during and after the first year of life were analyzed with logistic regression. To adjust for reverse causation, all subjects that had reported avoidance of pets due to allergic symptoms of the child or allergy in the family (n = 177) were excluded.

Results: Dog‐ or cat‐keeping during the first year of life reduced the risk of sensitization to dog or cat allergens, respectively, and to birch and to at least one of the 10 allergens tested. Cat‐keeping, both during and after the first year of life, reduced the risk of cat allergy and hay fever. Having a dog at home during the first year of life reduced the risk of dog and cat allergy, whereas dog‐keeping after the first year of life did not affect allergic symptoms.

Conclusions: Cat ownership, either during or after the first year of life, may be a strategy for preventing the development of cat allergy and hay fever later in life. Dog ownership reduced the risk of sensitization to dog and birch allergen, and also the risk of cat and dog allergy, but had no effect on hay fever.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
allergic symptoms, asthma, birth cohort, cat-keeping, dog-keeping, sensitization
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-164646 (URN)10.1002/iid3.267 (DOI)000484624700001 ()31464382 (PubMedID)2-s2.0-85071341963 (Scopus ID)
Available from: 2019-11-08 Created: 2019-11-08 Last updated: 2019-11-08
Bråbäck, L., Olsson, D. & Forsberg, B. (2019). Grandmaternal smoking during pregnancy and asthma in grandchildren [Letter to the editor]. Journal of Allergy and Clinical Immunology, 144(2), Article ID 624.
Open this publication in new window or tab >>Grandmaternal smoking during pregnancy and asthma in grandchildren
2019 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 144, no 2, article id 624Article in journal, Letter (Refereed) Published
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-162528 (URN)10.1016/j.jaci.2019.03.036 (DOI)000478789300039 ()31213286 (PubMedID)
Available from: 2019-08-21 Created: 2019-08-21 Last updated: 2019-08-23Bibliographically approved
Timm, S., Schlünssen, V., Benediktsdottir, B., Bertelsen, R. J., Bråbäck, L., Holm, M., . . . Frydenberg, M. (2019). Offspring reports on parental place of upbringing: is it valid? [Letter to the editor]. Epidemiology, 30(3), e16-e18
Open this publication in new window or tab >>Offspring reports on parental place of upbringing: is it valid?
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2019 (English)In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 30, no 3, p. e16-e18Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Wolters Kluwer, 2019
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-156788 (URN)10.1097/EDE.0000000000000988 (DOI)000480682000003 ()30789435 (PubMedID)
Available from: 2019-02-27 Created: 2019-02-27 Last updated: 2019-08-30Bibliographically approved
Accordini, S., Calciano, L., Johannessen, A., Portas, L., Benediktsdóttir, B., Bertelsen, R. J., . . . Svanes, C. (2018). A three-generation study on the association of tobacco smoking with asthma. International Journal of Epidemiology, 47(4), 1106-1117
Open this publication in new window or tab >>A three-generation study on the association of tobacco smoking with asthma
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2018 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 47, no 4, p. 1106-1117Article in journal (Refereed) Published
Abstract [en]

Background: Mothers' smoking during pregnancy increases asthma risk in their offspring. There is some evidence that grandmothers' smoking may have a similar effect, and biological plausibility that fathers' smoking during adolescence may influence offspring's health through transmittable epigenetic changes in sperm precursor cells. We evaluated the three-generation associations of tobacco smoking with asthma.

Methods: Between 2010 and 2013, at the European Community Respiratory Health Survey III clinical interview, 2233 mothers and 1964 fathers from 26 centres reported whether their offspring (aged ≤51 years) had ever had asthma and whether it had coexisted with nasal allergies or not. Mothers and fathers also provided information on their parents' (grandparents) and their own asthma, education and smoking history. Multilevel mediation models within a multicentre three-generation framework were fitted separately within the maternal (4666 offspring) and paternal (4192 offspring) lines.

Results: Fathers' smoking before they were 15 [relative risk ratio (RRR) = 1.43, 95% confidence interval (CI): 1.01-2.01] and mothers' smoking during pregnancy (RRR = 1.27, 95% CI: 1.01-1.59) were associated with asthma without nasal allergies in their offspring. Grandmothers' smoking during pregnancy was associated with asthma in their daughters [odds ratio (OR) = 1.55, 95% CI: 1.17-2.06] and with asthma with nasal allergies in their grandchildren within the maternal line (RRR = 1.25, 95% CI: 1.02-1.55).

Conclusions: Fathers' smoking during early adolescence and grandmothers' and mothers' smoking during pregnancy may independently increase asthma risk in offspring. Thus, risk factors for asthma should be sought in both parents and before conception.

Place, publisher, year, edition, pages
Oxford University Press, 2018
Keywords
asthma, mothers’ smoking during pregnancy, grandmothers’ smoking during pregnancy, fathers’ smoking during puberty, multilevel mediation model, Ageing Lungs in European Cohorts (ALEC) Study
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-145740 (URN)10.1093/ije/dyy031 (DOI)000444559900020 ()29534228 (PubMedID)
Funder
EU, Horizon 2020, GA-633212
Available from: 2018-03-16 Created: 2018-03-16 Last updated: 2018-10-05Bibliographically approved
Kuiper, I. N., Svanes, C., Benediktsdottir, B., Bertelsen, R. J., Bråbäck, L., Dharmage, S. C., . . . Johannessen, A. (2018). Agreement in reporting of asthma by parents or offspring - the RHINESSA generation study. BMC Pulmonary Medicine, 18, Article ID 122.
Open this publication in new window or tab >>Agreement in reporting of asthma by parents or offspring - the RHINESSA generation study
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2018 (English)In: BMC Pulmonary Medicine, ISSN 1471-2466, E-ISSN 1471-2466, Vol. 18, article id 122Article in journal (Refereed) Published
Abstract [en]

Background: Self-report questionnaires are commonly used in epidemiology, but may be susceptible to misclassification, especially if answers are given on behalf of others, e.g. children or parents. The aim was to determine agreement and analyse predictors of disagreement in parents' reports of offspring asthma, and in offspring reports of parents' asthma. Methods: In the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study, 6752 offspring (age range 18-51 years) and their parents (age range 39-66 years) reported their own and each other's asthma status. Agreement between asthma reports from offspring and parents was determined by calculating sensitivity, specificity, positive and negative predictive value and Cohen's kappa. The participants' own answers regarding themselves were defined as the gold standard. To investigate predictors for disagreement logistic regression analyses were performed to obtain odds ratios (OR) with 95% confidence intervals (CI) for sex, smoking status, education, comorbidity and severity of asthma. Results: Agreement was good for parental report of offspring early onset asthma (< 10 years, Cohen's kappa 0.72) and moderate for offspring later onset asthma (Cohen's kappa 0.46). Specificity was 0.99 for both, and sensitivity was 0.68 and 0.36, respectively. For offspring report of maternal and paternal asthma the agreement was good (Cohen's kappa 0.69 and 0.68), specificity was 0.96 and 0.97, and sensitivity was 0.72 and 0.68, respectively. The positive predictive value (PPV) was lowest for offspring report of maternal asthma (0.75), and highest for parents' report of early onset asthma in the offspring (0.83). The negative predictive value (NPV) was high for all four groups (0.94-0.97). In multivariate analyses current smokers (OR = 1.46 [95% CI 1.05, 2.02]) and fathers (OR = 1.31 [95% CI 1. 08, 1.59]) were more likely to report offspring asthma incorrectly. Offspring wheeze was associated with reporting parental asthma incorrectly (OR = 1.60 [95% CI 1.21, 2.11]), both under- and over reporting. Conclusions: Asthma reports across generations show moderate to good agreement, making information from other generations a useful tool in the absence of direct reports.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Agreement, Validation, Asthma, Questionnaire, Self-report, Transgenerational
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-150671 (URN)10.1186/s12890-018-0687-4 (DOI)000440024600001 ()30053806 (PubMedID)2-s2.0-85050675097 (Scopus ID)
Available from: 2018-08-17 Created: 2018-08-17 Last updated: 2018-08-17Bibliographically approved
Bråbäck, L., Lowe, A. J., Lodge, C. J., Dharmage, S. C., Olsson, D. & Forsberg, B. (2018). Childhood asthma and smoking exposures before conception - a three-generational cohort study.. Pediatric Allergy and Immunology, 29(4), 361-368
Open this publication in new window or tab >>Childhood asthma and smoking exposures before conception - a three-generational cohort study.
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2018 (English)In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 29, no 4, p. 361-368Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Some human and animal studies have recently shown that maternal grandmother's smoking during pregnancy increases the risk of asthma in the grandchildren. We have investigated whether sex of the exposed parent and/or grandchild modifies the association between grandmaternal smoking and grandchild asthma.

METHODS: We formed a cohort study based on linkage of national registries with prospectively collected data over three generations. Smoking habits in early pregnancy were registered since 1982 and purchases of prescribed medication since 2005. In all, 10329 children born since 2005 had information on maternal and grandmaternal smoking on both sides and were followed from birth up to 6 years of age. Ages when medication was purchased were used to classify the cohort into never, early transient (0-3 years), early persistent (0-3 and 4-6 years) and late-onset (4-6 years) phenotypes of childhood asthma.

RESULTS: Maternal grandmother's smoking was associated with an increased odds of early persistent asthma after adjustment for maternal smoking and other confounders (odds ratio 1.29, 95% confidence interval 1.10-1.51). Grandchild sex did not modify the association. Paternal grandmother's smoking was not associated with any of the asthma phenotypes.

CONCLUSION: Maternal but not paternal exposure to nicotine before conception was related to an increased risk of early persistent childhood asthma, but not other asthma phenotypes. Our findings are possibly consistent with a sex specific mode of epigenetic transfer. 

Keywords
childhood asthma, grandmother, multigenerational study, pregnancy, tobacco smoke
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-145533 (URN)10.1111/pai.12883 (DOI)000434155900004 ()29512835 (PubMedID)
Available from: 2018-03-09 Created: 2018-03-09 Last updated: 2018-07-16Bibliographically approved
Lodge, C. J., Bråbäck, L., Lowe, A. J., Dharmage, S. C., Olsson, D. & Forsberg, B. (2018). Grandmaternal smoking increases asthma risk in grandchildren: a nationwide Swedish cohort. Clinical and Experimental Allergy, 48(2), 167-174
Open this publication in new window or tab >>Grandmaternal smoking increases asthma risk in grandchildren: a nationwide Swedish cohort
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2018 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, E-ISSN 1365-2222, Vol. 48, no 2, p. 167-174Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is growing interest in exposures prior to conception as possible risk factors for offspring asthma. Although partially supported by evidence from limited human studies, current evidence is inconsistent, and based on recall of exposure status.

OBJECTIVE: We aimed to investigate grandmaternal smoking during pregnancy and the risk of asthma in grandchildren using prospectively collected population-based data.

METHODS: Information on grandmaternal and maternal smoking during pregnancy and grandchild use of asthma medications was collected from national Swedish registries. Associations between grandmaternal smoking during pregnancy (10-12 weeks), and asthma medication use in grandchildren were investigated using generalized estimating equations. Ages at which asthma medications were prescribed classified childhood asthma into never, early transient (0-3years), late onset (3-6 years) and early persistent (0-3 and 3-6 years) phenotypes.

RESULTS: From 1982 to 1986, 44,583 grandmothers gave birth to 46,197 mothers, who gave birth to 66,271 grandchildren (born 1996-2010). Children aged 1-6 years had an increased asthma risk if their grandmothers had smoked during pregnancy, with a higher risk for more exposure (10+ cigs/day; adjusted OR 1·23; 1·17, 1·30). Maternal smoking did not modify this relationship.

CONCLUSIONS & CLINICAL RELEVANCE: Children had an increased risk of asthma in the first six years of life if their grandmothers smoked during early pregnancy, independent of maternal smoking. Importantly this exhibited a dose-response relationship and was associated with a persistent childhood asthma phenotype. These findings support possible epigenetic transmission of risk from environmental exposures in previous generations. 

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
Asthma, Smoking, Transgenerational, cohort, epigenetics
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-140399 (URN)10.1111/cea.13031 (DOI)000423674000007 ()28925522 (PubMedID)
Available from: 2017-10-10 Created: 2017-10-10 Last updated: 2018-06-09Bibliographically approved
Oudin, A., Bråbäck, L., Oudin Åström, D. & Forsberg, B. (2017). Air pollution and dispensed medications for asthma, and possible effect modifiers related to mental health and socio-economy: a longitudinal cohort study of Swedish children and adolescents. International Journal of Environmental Research and Public Health, 14(11), Article ID 1392.
Open this publication in new window or tab >>Air pollution and dispensed medications for asthma, and possible effect modifiers related to mental health and socio-economy: a longitudinal cohort study of Swedish children and adolescents
2017 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 14, no 11, article id 1392Article in journal (Refereed) Published
Abstract [en]

It has been suggested that children that are exposed to a stressful environment at home have an increased susceptibility for air pollution-related asthma. The aim here was to investigate the association between air pollution exposure and asthma, and effect modification by mental health and by socio-economic status (as markers of a stressful environment). All individuals under 18 years of age in four Swedish counties during 2007 to 2010 (1.2 million people) were included. The outcome was defined as dispensing at least two asthma medications during follow up. We linked data on NO₂ from an empirical land use regression to data from national registers on outcome and potential confounders. Data was analyzed with logistic regression. There was an odds ratio (OR) of 1.02 (95% Confidence Interval (CI: 1.01-1.03) for asthma associated with a 10 µg·m(-3) increase in NO₂. The association only seemed to be present in areas where NO₂ was higher than 15 µg·m(-3) with an OR of 1.09 (95% CI: 1.07-1.12), and the association seemed stronger in children with parents with a high education, OR = 1.05 (95% CI: 1.02-1.09) and OR = 1.04 (95% CI: 1.01-1.07) in children to mothers and father with a high education, respectively. The association did not seem to depend on medication history of psychiatric disorders. There was weak evidence for the association between air pollution and asthma to be stronger in neighborhoods with higher education levels. In conclusion, air pollution was associated with dispensed asthma medications, especially in areas with comparatively higher levels of air pollution, and in children to parents with high education. We did not observe support for our hypothesis that stressors linked to socio-economy or mental health problems would increase susceptibility to the effects of air pollution on the development of asthma.

Place, publisher, year, edition, pages
Basel: MDPI AG, 2017
Keywords
air pollution, asthma, childhood asthma, mental health, socio-economy, stress
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:umu:diva-142065 (URN)10.3390/ijerph14111392 (DOI)000416545200108 ()29144419 (PubMedID)
Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2018-06-09Bibliographically approved
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