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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Smoking exposure trajectories&#58; the 1993 Pelotas birth &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Since the landmark work of Fletcher and Peto&#44;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> insightful updates have been added to the widely accepted causal association between tobacco and lung injury&#44; especially its association with chronic obstructive pulmonary disease &#40;COPD&#41; development risk&#46; Explained for many years by an accelerated lung function decline among smokers&#44; COPD has been recently associated with submaximal levels of pulmonary function &#40;PF&#41; at early adulthood&#46; Since then&#44; a growing body of literature is shifting its attention toward early life disadvantage factors that might be involved in impaired lung growth at the beginning of adulthood&#44; being smoking exposure one of them&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2-7</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">Despite the significant decrease in tobacco use in the last decades in Brazil&#44; due to effective policies in tobacco control&#44;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> smoking at any level remains as one of the major modifiable COPD risk factors&#44; being also markedly related to lung cancer&#44; coronary heart disease&#44; stroke and all-cause mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9-12</span></a> Over the period from 1990 to 2017&#44; Brazil experienced a decrease in both the prevalence and incidence of chronic respiratory diseases&#46; However&#44; the authors sounded the alarm for the increasing risk of disability-adjusted life years &#40;DALYs&#41; attributed to COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">This study aims to identify different patterns of smoking exposure trajectories and subsequent PF and respiratory-related symptoms at young adult age among participants of the 1993 Pelotas birth cohort&#44; a large ongoing population-based study from Brazil with 22 years of follow-up so far&#46; The dose-response relationship of cigarettes smoked daily with PF at ages 15&#44; 18 and 22 was also addressed&#46; We hypothesize that those who are constantly exposed to tobacco and heavy smokers will present lower PF values at adulthood than those less exposed&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Material and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design and sample</span><p id="para0009" class="elsevierStylePara elsevierViewall">The 1993 Pelotas birth cohort is a prospective study that included neonates who were born and whose mothers resided in the urban area of Pelotas city &#40;southern Brazil&#41; in that calendar year&#46; Of the 5249 individuals from the original cohort&#44; 3350 were included in the present study after providing complete post-bronchodilation PF data at age 22&#46; The details of this cohort study have been previously published&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> The Ethics and Research Committee of the Faculty of Medicine of the Federal University of Pelotas &#40;most recent follow-up under the 1&#46;250&#46;366 protocol&#41; approved the study&#46; Written informed consent was obtained from participants or their parents if they were under 18 years old&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Pulmonary function assessment</span><p id="para0010" class="elsevierStylePara elsevierViewall">Spirometry was conducted at age 22 years by a portable ultrasonic spirometer &#40;Easy One model&#44; nDD Medical Technologies Inc&#46;&#44; Zurich Switzerland&#41;&#46; PF data were accurately assessed by trained technicians&#44; using standard procedures following the American Thoracic Society &#40;ATS&#41; and the European Respiratory Society &#40;ERS recommended guidelines&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> A minimum of three and a maximum of eight manoeuvres was performed to obtain at least three acceptable curves&#44; with a maximum difference of 150&#160;ml between the two highest values&#46; Tests were performed before and after administration of salbutamol 400mcg&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">The outcomes of interest were&#58; post-bronchodilator values of forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; and forced vital capacity &#40;FVC&#41; expressed in millilitres &#40;ml&#41;&#59; forced expiratory flow at the mid expiratory phase &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#41; expressed in millilitres&#47;seconds &#40;ml&#47;s&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio expressed as percentage points &#40;pp&#41;&#46; PF data from 15 to 18 years were also used in supplementary analyses being both measured by the same procedures over the same standardised criteria&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Smoking exposure</span><p id="para0012" class="elsevierStylePara elsevierViewall">At the perinatal follow-up&#44; the assessment of maternal smoking behaviour was recorded by the following question&#58; &#8220;Did you smoke during pregnancy&#63;&#8221;&#46; At ages 15&#44; 18 and 22&#44; individuals reported their own smoking status&#46; At age 15&#44; current smoking &#40;Yes&#44; No&#41; was defined as &#8805;1 day of cigarette consumption in the last month&#44; whereas in the remaining ages&#44; smoking status was accessed by the question &#8220;Do you smoke&#63;&#8221; &#40;at least one cigarette per week in the last month&#41;&#46; The number of cigarettes smoked daily in the last month was also addressed at 15&#44; 18 and 22 years of age&#46; Information regarding respiratory symptoms &#40;wheezing&#44; dyspnea&#44; and cough&#41; were accessed at age 22&#46; All information was assessed by ad hoc questionnaires applied by trained interviewers&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Data analysis</span><p id="para0013" class="elsevierStylePara elsevierViewall">To determine the smoking exposure trajectories over time&#44; a group-based trajectory model &#40;GBTM&#41; approach was applied&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Information on maternal smoking status during the gestational period and self-reported smoking at 15&#44; 18 and 22 years were used in the trajectory modelling&#46; Due to binary data &#40;exposed vs&#46; non-exposed&#41;&#44; we used the logit-based &#40;LOGIT&#41; model in the TRAJ set of commands in Stata software&#46; After testing different numbers of groups &#40;3&#44; 4 and 5 groups&#41; with different polynomial functions &#40;linear&#44; quadratic or cubic&#41;&#44; we selected the best model according to the Bayesian Information Criteria &#40;BIC&#41; and reasonable judgment of other fitting parameters recommended by Nagin<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a>&#58; &#40;a&#41; the average posterior probability &#8211; a value above 0&#46;70 is generally recommended&#59; &#40;b&#41; the odds of correct classification&#58; a value above 5&#46;0 shows good assignment accuracy and &#40;c&#41; correspondence between estimated and expected group probabilities &#8211; the mismatch between both must be zero for a perfectly fitting model &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S1</a>&#41;&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">Description of the sample according to socio-demographic characteristics and smoking exposure was addressed by the Student&#39;s <span class="elsevierStyleItalic">t</span>-test and ANOVA&#46; Multivariable linear regression models were used to verify the association between smoking trajectories and PF at age 22&#46; An additional sensitivity analysis verified the effect of the number of cigarettes smoked daily in the last month on PF outcomes&#46; We used a generalized estimating equation &#40;GEE&#41; to obtain the regression coefficients &#40;&#946;&#41;&#46; Model selection was performed with the GEE equivalent of the Akaike Information Criterion &#40;AIC&#41;&#44; the quasi-likelihood under the independence model criterion &#40;QIC&#41;&#46; In this case&#44; instead of trajectories&#44; both the number of cigarettes smoked and PF were measured at 15&#44; 18 and 22 years of age&#46; Individuals were allocated into two groups&#58; one composed of those who smoked 1&#8211;9 cigarettes daily and the other one of individuals who smoked 10 or more cigarettes daily&#46; Thus&#44; the change in PF outcomes should be interpreted based on the comparison between each group and the reference &#40;non-smokers&#41;&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">A logistic regression model analysed the association of smoking trajectories with respiratory-related symptoms such as wheezing&#44; dyspnea and cough at age 22&#46; Heterogeneity p-value between groups was addressed by Chi-squared test across trajectories&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">A supplementary analysis was conducted to verify the mean annual change in post-bronchodilator PF according to smoking exposure trajectories by multivariate linear regression&#46; The annual average absolute change on PF parameters was calculated through variance-weighted least square regression &#40;vwls command in Stata&#41; for each individual&#44; considering the parameter and the year of follow-up&#46; This generated a yearly change in the lung function parameter for each individual&#46; Positive values mean an annual increase in the parameter and negative values&#44; the opposite&#46; For example&#44; if an individual has a value of 0&#46;02&#44; it means that the parameter increased 0&#46;02 litres &#40;20 millilitres&#41; per year&#46; We then used this value as the outcome in the model&#44; considering all possible confounders&#46; This model deals with autocorrelation in repeated measures&#44; considering it in the calculation of this annual change&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">To assess selection bias&#44; some characteristics of cohort members included &#40;individuals with PF data at age 22&#41; and not included &#40;individuals without PF data at age 22&#41; in the study were compared by Two-sample proportion test&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">Covariates used for adjusting means of the outcome were&#58; sex&#44; height &#40;cm&#41;&#44; prematurity &#40;gestational age &#60;27 weeks&#41;&#44; low birth weight &#40;&#60;2500 g&#41;&#44; maternal schooling &#40;years of complete schooling&#41;&#44; family income &#40;minimum wages per month in Brazilian currency - a minimum wage equivalent to approximately 84 US dollars&#41;&#44; partner and co-worker&#39;s smoking exposure during pregnancy collected at the perinatal follow-up&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years&#44; household smoking exposure at age 22&#44; family history of asthma and self-reported wheezing and medical diagnosis of asthma collected at 15&#44; 18 and 22 years&#46; All analyses were performed using the Stata Statistical Software &#40;StataCorp LP&#44; College Station&#44; United States&#41;&#44; version 16&#46;0&#46; A significance level of 5&#160;&#37; was considered for all tests&#46;</p></span></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Results</span><p id="para0019" class="elsevierStylePara elsevierViewall">A total of 3350 individuals from the original cohort who had post-bronchodilator PF measures by the age of 22 years made up the final sample&#46; Compared with those not included in the present analysis &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1889&#41;&#44; these individuals were more likely to be women and showed higher maternal education and higher family income &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S2</a>&#41;&#46; However&#44; individuals did not differ in terms of smoking exposure&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">Sample distribution and mean values of PF at age 22 according to socio-demographic characteristics and smoking exposure are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46; Approximately half of the study sample were women &#40;52&#160;&#37;&#41;&#44; 42&#160;&#37; were born in families belonging to the lowest tertile of income at birth and most of them &#40;73&#46;6&#160;&#37;&#41; had mothers with low education levels &#40;&#60;9 years&#41;&#46; At baseline&#44; the prevalence of low birth weight and prematurity among individuals were 8&#46;7&#160;&#37; and 10&#46;7&#160;&#37; respectively&#46; Around 32&#46;6&#160;&#37; of the sample were exposed to tobacco in the uterus&#44; however&#44; the prevalence of non-smokers at the remaining follow-ups were more than 80&#160;&#37;&#46; Lower values of FEV<span class="elsevierStyleInf">1</span>&#44; FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> were observed in those born prematurely&#44; with low birth weight&#44; belonging to lower-income families and who had lower scholarship mothers &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; Those who were exposed to tobacco during the gestational period presented lower mean values for all PF parameters &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; Those who reported being smokers presented lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> values compared to non-smokers &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0021" class="elsevierStylePara elsevierViewall">The estimated smoking exposure trajectories are shown in <a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#46; The best-fitted model &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S2</a>&#41; presented four trajectories&#58; &#91;1&#93; no exposure &#40;NE&#41;&#59; &#91;2&#93; gestational exposure &#40;GE&#41;&#58; characterized by the highest smoking prevalence at baseline &#40;around 100&#160;&#37;&#41; and no exposure at adolescence and adulthood&#59; &#91;3&#93; gestational and adulthood exposure &#40;GAE&#41;&#58; represented by smoking exposure at gestational period followed by the highest smoking exposure prevalence at adulthood &#40;around 90&#160;&#37;&#41; with no exposure at adolescence&#59; &#91;4&#93; continuous exposure &#40;CE&#41;&#58; characterized by a persistent smoking exposure prevalence which slightly increases from 60&#160;&#37; at baseline to over 80&#160;&#37; by the age of 22 years&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0022" class="elsevierStylePara elsevierViewall">Smoking trajectories were associated with lower PF at age 22 &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#41;&#46; When the analysis was adjusted for sex and height &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#8211; Model 1&#41;&#44; those in the CE and GAE trajectories showed greater PF deficits compared to the NE group &#40;reference&#41;&#46; Lower values of FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;&#8722;2&#46;03 pp&#44; 95&#160;&#37; CI&#58; &#8722;3&#46;05&#59; &#8722;1&#46;01 for CE and &#8722;1&#46;59 pp&#44; 95&#160;&#37; CI&#58; &#8722;2&#46;17&#59; &#8722;1&#46;02 for GAE trajectory&#41;&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio &#40;&#8722;8&#46;84 pp&#44; 95&#160;&#37; CI&#58; &#8722;13&#46;32&#59; &#8722;4&#46;36 for CE and &#8722;6&#46;26 pp&#44; 95&#160;&#37; CI&#58; &#8722;8&#46;79&#59; &#8722;3&#46;73 for GAE trajectory&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> &#40;&#8722;248&#160;ml&#47;s&#44; 95&#160;&#37; CI&#58; &#8722;428&#59; &#8722;68 for CE and &#8722;233&#160;ml&#47;s&#44; 95&#160;&#37; CI&#58; &#8722;335&#59; &#8722;132 for GAE trajectory&#41; were related to both trajectories&#46; After adjustment for a wider set of potential confounders &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#8211; model 2&#41;&#44; comparing to the NE category&#44; the GAE trajectory was related to lower values of FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;&#8722;1&#46;58 pp&#59; 95&#160;&#37; CI&#58; &#8722;2&#46;35&#59; &#8722;0&#46;80&#41;&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio &#40;&#8722;6&#46;04 pp&#44; 95&#160;&#37; CI&#58; &#8722;9&#46;53&#59; &#8722;2&#46;55&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> &#40;&#8722;253&#160;ml&#47;s<span class="elsevierStyleInf">&#59;</span> 95&#160;&#37; CI&#58; &#8722;393&#59; &#8722;112&#41; whereas the CE and the GE trajectories remained significantly related to lower values of both FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;&#8722;1&#46;77 pp&#59; 95&#160;&#37; CI&#58; &#8722;3&#46;11&#59; &#8722;0&#46;42 and &#8722;0&#46;96 pp&#44; 95&#160;&#37; CI&#58; &#8722;1&#46;68&#59; &#8722;0&#46;25 respectively&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio &#40;&#8722;7&#46;27 pp&#44; 95&#160;&#37; CI&#58; &#8722;13&#46;35&#59; &#8722;1&#46;18 and &#8722;4&#46;08 pp&#44; 95&#160;&#37; CI&#58; &#8722;7&#46;30&#59; &#8722;0&#46;86 respectively&#41;&#46; Lower FEV<span class="elsevierStyleInf">1</span> values were only observed in the GAE trajectory &#40;&#8722;68&#160;ml&#59; 95&#160;&#37; CI&#58; &#8722;130&#59; &#8722;6&#41;&#46; The GE trajectory was related to a statistically significant increase in FVC &#40;80&#160;ml&#59; 95&#160;&#37; CI&#58; 15&#59; 145&#41;&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0023" class="elsevierStylePara elsevierViewall">Pulmonary function between ages 15&#44; 18 and 22 was analysed between smoking groups and non-smokers &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; Compared to those who never smoked between ages 15&#44; 18&#44; and 22 years&#44; individuals who smoked 10 or more cigarettes daily presented a reduction in the FEV1&#47;FVC ratio by 1&#46;37 pp &#40;95&#160;&#37; CI&#58; &#8722;2&#46;08&#59; &#8722;0&#46;66&#41;&#44; FEF25&#8211;75&#160;&#37; by 126&#160;ml &#40;95&#160;&#37; CI&#58; &#8722;225&#59; &#8722;27&#41; and the FEF25&#8211;75&#160;&#37;&#47;FVC ratio by 3&#46;62 pp &#40;95&#160;&#37; CI&#58; &#8722;6&#46;43&#59; &#8722;0&#46;82&#41;&#46; No difference was found in the PF between those who smoked less than ten cigarettes daily and those who never smoked&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">Associations of smoking trajectories with respiratory-related symptoms at age 22 are shown in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#46; Gestational exposure alone was not associated with later respiratory symptoms&#46; However&#44; individuals belonging to the CE and GAE trajectories presented the higher odds of wheezing &#40;OR 4&#46;14&#59; 95&#160;&#37; CI&#58; 2&#46;11&#59;8&#46;14 and OR 2&#46;92&#59; 95&#160;&#37; CI&#58; 1&#46;87&#59;4&#46;54 respectively&#41; and cough &#40;OR 2&#46;39&#59; 95&#160;&#37; CI&#58; 1&#46;39&#59;4&#46;10 and OR 2&#46;37&#59; 95&#160;&#37; CI&#58; 1&#46;72&#59;3&#46;27 respectively&#41; compared to those who were never exposed&#46; The GAE trajectory also showed higher odds of dyspnea &#40;OR 2&#46;54&#59; 95&#160;&#37; CI&#58; 1&#46;23&#59;5&#46;25&#41;&#46; Heterogeneity p-value showed statistical difference between groups estimated effects&#46; The average annual change in PF between 15&#44; 18 and 22 years did not differ between exposed and non-exposed smoking trajectories &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Discussion</span><p id="para0025" class="elsevierStylePara elsevierViewall">By using 22 years of follow-up information&#44; we were able to estimate PF at adulthood within each smoking exposure trajectory&#46; Four trajectories were identified and characterised by different periods and probabilities of exposure throughout the years of follow-up&#58; &#40;NE&#41; zero probability of exposure&#44; which represented the reference group&#59;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> higher probability of exposure during the gestational period only &#40;GE&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> higher probability of exposure at gestational period and adulthood only &#40;GAE&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> probability of exposure in all follow-ups &#40;CE&#41;&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">The results presented here showed lower PF values among individuals exposed to maternal smoking during pregnancy who also reported themselves as current smokers at adolescence &#40;15 years&#41; and later at ages 18 and 22 years &#40;CE and GAE trajectories&#41;&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">The GAE trajectory was the only one associated with lower FEV<span class="elsevierStyleInf">1</span> values compared to the non-exposed group&#46; Recent findings from the Tasmanian Longitudinal Health Study Cohort &#40;TAHS&#41; showed that an interaction between maternal smoking post-birth and personal smoking enhances the risk of following submaximal FEV<span class="elsevierStyleInf">1</span> trajectories until adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Similarly&#44; data from the Manchester Asthma Allergy Study Cohort &#40;MASS&#41; and Avon Longitudinal Study of Parents and Children &#40;ALSPAC&#41; revealed that lifelong smoking exposure was also related to lower FEV<span class="elsevierStyleInf">1</span> growth&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> However&#44; unlikely our study&#44; smoking exposure was not addressed as trajectories in both studies&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">All smoking trajectories were associated with reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio when compared to non-smokers&#46; However&#44; only in the GAE trajectory&#44; the lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio resulted from a significantly reduced FEV<span class="elsevierStyleInf">1</span> with no change in FVC&#46; In the remaining smoking trajectories&#44; no differences were observed for FEV<span class="elsevierStyleInf">1&#44;</span> and the reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio was then related to higher values of FVC&#46; In the literature&#44; a reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio with normal FEV<span class="elsevierStyleInf">1</span> and higher &#40;or normal&#41; FVC has been termed dysanapsis&#44; a mismatch between airway tree calibre and lung size&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Recent studies significantly related dysanapsis to lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a>&#41; and to greater COPD risk<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> among older adults&#46; These findings provide evidence that even in the absence of a classic pattern of airflow obstruction&#44; i&#46;e&#46; in case of normal FEV<span class="elsevierStyleInf">1</span>&#44; dysanapsis associated with reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio may result in clinical implications to respiratory health&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Individuals in the GAE trajectory also presented lower FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> values&#44; another spirometry measure that comprehends airflow limitation&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">Most studies have investigated the effect of either gestational smoking exposure or personal smoking alone on PF growth&#44; but not both&#46; In-utero exposure to tobacco<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> and smoking behaviour in adolescence<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> were previously related to reduced FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio among adolescents&#46; A reduction in FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> of &#8722;262&#160;ml&#47;s in men aged 21 years had also been associated with in utero tobacco exposure&#44; even after adjusting for birth weight&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Using path analysis&#44; the Isle of Wight &#40;IOW&#41; cohort found that gestational exposure to maternal smoking was associated directly with a reduction in FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio at 18 years&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Later&#44; assessing individuals PF from age 10 to 26 years&#44; the same cohort demonstrated signs of airflow limitation in current smokers at age 26 &#40;lower FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio&#41; compared to non-smokers&#44; with the differences persisting after bronchodilation&#46; No difference was observed for FEV<span class="elsevierStyleInf">1</span> though&#46; Smokers also presented a significantly FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> decline between ages 18 and 26 years&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0030" class="elsevierStylePara elsevierViewall">Our findings can be better related to those reported by one study conducted with data from the BAMSE birth cohort &#40;Barn&#47;child&#44; Allergy&#44; Milieu&#44; Stockholm&#44; Epidemiology&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Although PF was measured at 16 years instead of adulthood and smoking exposure was not explored as a trajectory&#44; the authors also related the combined effects of maternal smoking during the gestational period and adolescent smoking to airway obstruction&#46; Exposure to maternal smoking alone resulted in a reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio of &#8722;1&#46;1&#160;&#37; &#40;95&#160;&#37; CI &#8722;2&#46;0&#59; &#8722;0&#46;2&#41;&#44; and teenage smoking was associated with a significantly lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio of &#8722;0&#46;9&#160;&#37; &#40;95&#160;&#37; CI &#8722;1&#46;8&#59; &#8722;0&#46;1&#160;&#37;&#41; compared to the non-exposed group&#46; However&#44; those who were in-utero exposed and smoked at age 16 had a reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio of &#8722;2&#46;5&#160;&#37; &#40;95&#160;&#37; CI &#8722;4&#46;3&#59; &#8722;0&#46;7&#41;&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">Previous studies reported FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> as highly sensitive to predicting small airway disease which is affected early in smoke-related lung injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> However&#44; a concern relays on the intersubject variability of FEF which originates from its dependency on the FVC&#46; As recommended in the literature&#44; we aimed to correct this drawback by dividing FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> to FVC&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> After doing this&#44; individuals belonging to all smoking trajectories showed lower values of FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio compared to those never exposed&#44; which also tends to suggest a small airway disease&#46; This finding can be related to an increased COPD risk in which airway calibre decreases &#40;decreased FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#41; but the lung volume increases &#40;increased FVC&#41; due to air trapping<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> or&#44; as stated previously&#44; due to dysanapsis&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">In our study&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;&#44;</span> FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio were more sensitive than parameters of central obstruction like FEV<span class="elsevierStyleInf">1</span> in detecting PF impairment in young adults exposed to tobacco&#46; The FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio was decreased by 1&#46;37 pp &#40;95&#160;&#37; CI&#58; &#8722;2&#46;08&#59; &#8722;0&#46;66&#41;&#44; the FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> by 126&#160;ml &#40;95&#160;&#37; CI&#58; &#8722;225&#59; &#8722;27&#41; and the FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio by 3&#46;62 pp &#40;95&#160;&#37; CI&#58; &#8722;6&#46;43&#59; &#8722;0&#46;82&#41; if ten or more cigarettes were smoked daily compared to never smokers&#46; This finding relates the smoking burden to some extent of airflow limitation in our cohort&#46; An association between the number of cigarettes smoked and PF was previously observed in 10&#46;060 boys and girls aged 10 to 18 years&#46; When compared to never smokers&#44; those belonging to the light &#40;1&#8260;2 to 4 cigarettes per day&#41;&#44; medium &#40;5 to 14 cigarettes per day&#41; and heavy &#40;15 or more cigarettes per day&#41; subgroups of smokers presented lower values of both FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a></p><p id="para0033" class="elsevierStylePara elsevierViewall">Only individuals who kept smoking throughout adolescence and those who were also currently smokers at young adult age presented respiratory symptoms like wheezing&#44; dyspnea&#44; and cough&#46; These results add some clinical evidence of possible airflow inflammation related to PF loss among those currently exposed to tobacco noxious substances&#46; Our findings may suggest the silent beginning of lung damage developing in those very early exposed&#44; as shown by PF reduction and the appearance of some clinical respiratory symptoms&#44; even if they do not meet the standard threshold of PF impairment that define COPD &#40;such as FEV<span class="elsevierStyleInf">1</span>&#47;FVC below the lower limit of normal&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> Results from the COPDGene study revealed that accelerated FEV<span class="elsevierStyleInf">1</span> decline in COPD&#44; for instance&#44; was preceded by evident signs of radiographically small airways abnormalities at earlier ages&#44; even among individuals without classically defined airflow obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> This is particularly relevant as the at-risk population shifts younger whereas most COPD studies target individuals with mean ages older than 60 years&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> To effectively reduce the COPD burden related to tobacco exposure&#44; we strongly believe that strategies to promote lung health should include reducing maternal smoking and especially encouraging avoidance of personal smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> Despite PF reduction was related to ten or more cigarettes smoked daily in our study&#44; it does not imply that smoking less is a safe threshold of exposure&#46; Therefore&#44; any amount of cigarette consumption must be avoided&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Strengths of the present study include the evaluation of PF in the emerging adulthood&#44; a crucial period to track individuals who may be at risk of developing many disadvantaged health outcomes related to poor PF&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> The follow-up from birth to young adult age with high participation rates and the use of standardized spirometry tests are additional strengths&#46; A potential limitation of our study is the self-reporting of tobacco exposure&#44; especially regarding maternal smoking status&#44; that may have led to information bias&#44; with underestimation&#46; Self-reported smoking status during pregnancy underestimated the true prevalence of smoker mothers in a previous study&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a> Such a misclassification could minimize the effect of smoking patterns on PF&#46; We could not adjust our analyses for second hand smoking exposure nor could we analyse exposure to indoor&#47;outdoor pollution during infancy&#44; which is an important period of lung development&#46; We could not infer a dose response between cigarettes smoked daily and PF as our data were collected in a categorical way&#46; Besides&#44; missing data implied another limitation to our study&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Conclusions</span><p id="para0035" class="elsevierStylePara elsevierViewall">Smoking exposure may compromise lung development leading to reduced maximum attained PF and can also be related with respiratory symptoms like wheezing&#44; dyspnea and cough in early adulthood&#46; Although the exposure to maternal smoking alone also appears to longstanding effect on the lungs&#44; the perpetuation of smoking habit at 15&#44; 18 and 22 years is undoubtedly determinant for lower PF&#46; To guarantee that more individuals reach PF peak values and lifelong respiratory health&#44; smoking cessation policies must be encouraged in all lung growth phases&#46;</p></span><span id="sec0009a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015a">CRediT authorship contribution statement</span><p id="para0035a" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">P&#46; Weber&#58;</span> Conceptualization&#44; Formal analysis&#44; Writing &#8211; original draft&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">A&#46;M&#46;B&#46; Menezes&#58;</span> Data curation&#44; Project administration&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">H&#46; Gon&#231;alves&#58;</span> Data curation&#44; Project administration&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">P&#46;D&#46; de Oliveira&#58;</span> Data curation&#44; Project administration&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">A&#46; Wendt&#58;</span> Formal analysis&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">R&#46; Perez-Padilla&#58;</span> Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">F&#46;C&#46; Wehrmeister&#58;</span> Conceptualization&#44; Data curation&#44; Project administration&#44; Formal analysis&#44; Writing &#8211; original draft&#44; Writing &#8211; review &#38; editing&#46;</p></span></span>"
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          "identificador" => "xres1999234"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abss0001"
              "titulo" => "Objectives"
            ]
            1 => array:2 [
              "identificador" => "abss0002"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abss0003"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abss0004"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1713508"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0001"
          "titulo" => "Introduction"
        ]
        3 => array:3 [
          "identificador" => "sec0002"
          "titulo" => "Material and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0003"
              "titulo" => "Study design and sample"
            ]
            1 => array:2 [
              "identificador" => "sec0004"
              "titulo" => "Pulmonary function assessment"
            ]
            2 => array:2 [
              "identificador" => "sec0005"
              "titulo" => "Smoking exposure"
            ]
            3 => array:2 [
              "identificador" => "sec0006"
              "titulo" => "Data analysis"
            ]
          ]
        ]
        4 => array:2 [
          "identificador" => "sec0007"
          "titulo" => "Results"
        ]
        5 => array:2 [
          "identificador" => "sec0008"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0009"
          "titulo" => "Conclusions"
        ]
        7 => array:2 [
          "identificador" => "sec0009a"
          "titulo" => "CRediT authorship contribution statement"
        ]
        8 => array:2 [
          "identificador" => "xack698695"
          "titulo" => "Funding"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2022-06-26"
    "fechaAceptado" => "2023-09-15"
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          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1713508"
          "palabras" => array:3 [
            0 => "Longitudinal studies"
            1 => "Smoking"
            2 => "Spirometry"
          ]
        ]
      ]
    ]
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objectives</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">To investigate smoking trajectories and their association with pulmonary function &#40;PF&#41; and respiratory symptoms at age 22&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Data from a population-based cohort study of 3350 individuals and their spirometries were analysed&#46; The outcomes were&#58; forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; forced vital capacity &#40;FVC&#41;&#44; forced expiratory flow at the mid expiratory phase &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC ratio&#46; Smoking data were collected at perinatal follow-up &#40;gestational exposure&#41; and 15&#44; 18 and 22 years&#46; Group-based trajectory model was applied&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">Four groups were identified&#58; no exposure &#40;NE&#41;&#44; gestational &#40;GE&#41;&#44; gestational and adulthood &#40;GAE&#41; and continuous &#40;CE&#41; exposure&#46; Both CE and GAE trajectories were associated with lower values of FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#8722;1&#46;77pp&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;01 and &#8722;1&#46;58 pp&#59; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001 respectively&#41; and FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC ratio &#40;&#8722;7&#46;27pp&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;019 and &#8722;6&#46;04pp&#59; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001 respectively&#41; compared to the NE trajectory&#46; Lower FEV<span class="elsevierStyleInf">1</span> and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> values were also related to the GAE trajectory &#40;&#8722;68&#160;ml&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;03 and &#8722;253&#160;ml&#47;s<span class="elsevierStyleInf">&#59;</span><span class="elsevierStyleItalic">p</span>&#60;0&#46;001 respectively&#41;&#46; Compared to those who never smoked&#44; individuals who smoked 10 or more cigarettes daily presented a reduction in the FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio by 1&#46;37pp &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> by 126&#160;ml &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;012&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio by 3&#46;62pp &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;011&#41;&#46; CE trajectory showed higher odds of wheezing &#40;OR 4&#46;14&#59; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41; and cough &#40;OR 2&#46;39&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002&#41; compared to the non-exposed group&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">The in-uterus exposure to maternal smoking reduces PF later in life&#46; However&#44; the perpetuation of smoking behaviour throughout adolescence and early adulthood is determinant for PF main reduction and the emergence of respiratory-related symptoms&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "nota" => "<p class="elsevierStyleNotepara" id="notep0001">Fernando C&#233;sar Wehrmeister&#44; Ana Maria Baptista Menezes and Helen Gon&#231;alves received scholarship for productivity in research from the Brazilian National Research Council for Scientific and Technological Development &#40;CNPQ&#41; during the conduct of the study&#46; Paula Duarte de Oliveira&#44; Andrea Wendt and Rogelio Perez-Padilla have nothing to disclose&#46;</p>"
        "identificador" => "fn1"
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          0 => array:4 [
            "apendice" => "<p id="para0036a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="ecom0001"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix"
            "titulo" => "Supplementary materials"
            "identificador" => "sec0011"
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Smoking exposure trajectories&#58; the 1993 Pelotas birth &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Mean differences in pulmonary function values measured at age 22 by smoking exposure trajectories&#46; Abbreviations&#58; &#40;A&#41; FEV<span class="elsevierStyleInf">1</span>&#58; forced expiratory volume in the first second&#59; &#40;B&#41; FVC&#58; forced vital capacity&#59; &#40;C&#41; FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio&#59; &#40;D&#41; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#58; forced expiratory flow mid at the expiratory phase&#59; &#40;E&#41; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC ratio&#59; GE&#58; gestational exposure&#59; GAE&#58; gestational and adulthood exposure&#59; CE&#58; continuous exposure&#46; Results expressed by regression coefficient &#40;&#946;&#41; and 95&#160;&#37; confidence interval&#44; with no exposure being the reference group&#46; Model 1 adjusted for sex and height&#46; Model 2 adjusted for sex&#44; height&#44; low birth weight&#44; prematurity&#44; family income&#44; maternal schooling&#44; partner and co-worker&#39;s smoking exposure during pregnancy&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years and household smoking exposure at age 22&#44; family history of asthma&#44; self-reported wheezing and medical diagnosis of asthma collected at 15&#44; 18 and 22 years &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
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          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>&#58; forced expiratory volume in the first second&#59; FVC&#58; forced vital capacity&#59; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#58; forced expiratory flow at the expiratory phase&#46; All information collected at perinatal follow-up&#44; except smoking status at ages 15&#44; 18 and 22 years which were collected at the respective ages&#46; The student&#39;s <span class="elsevierStyleItalic">t</span>-test and ANOVA determined p-values&#46; Results are shown as mean and standard error &#40;SE&#41;&#46; Bold values indicate <span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#46; &#42;Missing information &#40;maximum of 354 missing for prematurity&#41;&#46;</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;47 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;92 &#40;0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">974 &#40;29&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;61 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;17 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;79 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;46 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;73 &#40;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">933 &#40;28&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;74 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;30 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;16 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;60 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;85 &#40;0&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Birth Weight &#40;grams&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;870&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;2500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">291 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;30 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;81 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;94 &#40;0&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;15 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;13 &#40;0&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;2500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3059 &#40;91&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;67 &#40;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;23 &#40;0&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;96 &#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;54 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;91 &#40;1&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0078"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Prematurity</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2675 &#40;89&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;66 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;22 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;0 &#40;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;53 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;19 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0092"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">321 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;51 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;07 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;6 &#40;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;36 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;83 &#40;1&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Maternal education &#40;years&#41;&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;857&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;380&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">883 &#40;26&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;49 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;03 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;89 &#40;0&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;37 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;14 &#40;0&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#8211;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1578 &#40;47&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;20 &#40;0&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;95 &#40;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;53 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;49 &#40;0&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0120"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>9&#8211;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">612 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;77 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;35 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;97 &#40;0&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;61 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">107&#46;99 &#40;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">272 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;78 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;35 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;24 &#40;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;61 &#40;0&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;27 &#40;1&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Gestational smoking exposure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;004</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;004</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2257 &#40;67&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;67 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;22 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;23 &#40;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;57 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;10 &#40;0&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0148"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1093 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;56 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;13 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;40 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;37 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">107&#46;61 &#40;0&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Smoking exposure at age 15</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;010</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0162"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2981 &#40;94&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#40;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;20 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;03 &#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;52 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;51 &#40;0&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0169"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">173 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;44 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;03 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;77 &#40;0&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;14 &#40;0&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&#46;76 &#40;1&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0176"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Smoking exposure at age 18</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;426&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;873&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;005</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0183"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2727 &#40;86&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#40;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;19 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;14 &#40;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;53 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;95 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0190"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">418 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;63 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;25 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;75 &#40;0&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0195"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;38 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0196"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&#46;56 &#40;1&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0197"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Smoking exposure at age 22</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;973&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;048</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0204"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2772 &#40;82&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;63 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;17 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;22 &#40;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;52 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;38 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0211"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">575 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0213"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;69 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;32 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;73 &#40;0&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;43 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&#46;08 &#40;1&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3319557.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Description of the sample with pulmonary function data at age 22 according to socio-demographic characteristics and smoking exposure &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0004"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>&#58; forced expiratory volume in the first second&#59; FVC&#58; forced vital capacity&#59; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#58; forced expiratory flow at the mid expiratory phase&#46; Results are shown as regression coefficient &#40;&#946;&#41; and their respective confidence interval &#40;CI&#41;&#59; pp&#58; percentage points&#46; Note&#58; the changes in outcomes are relative to a comparation between smoking groups and non-smokers as the reference group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2324&#41;&#46; Model adjusted for sex&#44; height&#44; family income&#44; prematurity&#44; low birth weight&#44; maternal schooling&#44; partner and co-worker&#39;s smoking exposure during pregnancy collected at the perinatal follow-up&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years and household smoking exposure at age 22&#44; family history of asthma and self-reported wheezing and medical diagnosis of asthma collected at 15&#44; 18 and 22 years&#46;</p>"
          "tablatextoimagen" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0218"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">1&#8211;9 cigarettes &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;924&#41;</th><a name="en0220"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#8805;10 cigarettes &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;328&#41;</th></tr><tr title="table-row"><a name="en0221"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0222"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#946; &#40;95&#160;&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0223"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0224"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#946; &#40;95&#160;&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0225"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0226"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV<span class="elsevierStyleInf">1</span> &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0227"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;2 &#40;&#8722;29&#59; 25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0228"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;888&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0229"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;5 &#40;&#8722;46&#59; 36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0230"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;810&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0231"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FVC &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0232"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;5 &#40;&#8722;37&#59; 24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0233"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;737&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0234"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">51 &#40;&#8722;7&#59; 94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0235"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;095&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0236"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;pp&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0237"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;26 &#40;&#8722;0&#46;22&#59; 0&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0238"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;322&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0239"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;1&#46;37 &#40;&#8722;2&#46;08&#59; &#8722;0&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0240"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0241"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEF<span class="elsevierStyleInf">25&#8211;75</span> &#40;ml&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0242"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;34 &#40;&#8722;99&#59; 32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0243"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0244"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;126 &#40;&#8722;225&#59; &#8722;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0245"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0246"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC &#40;pp&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0247"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;98 &#40;&#8722;0&#46;76&#59; 2&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0248"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;271&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0249"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;3&#46;62 &#40;&#8722;6&#46;43&#59; &#8722;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0250"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab3319558.png"
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          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">Pulmonary function between ages 15&#44; 18 and 22 years compared by smoking groups and non-smokers&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0003"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "alt0005"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Logistic regression adjusted to sex&#44; family income&#44; prematurity&#44; low birth weight&#44; maternal schooling&#44; partner and co-worker&#39;s smoking exposure during pregnancy collected at the perinatal&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">follow-up&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years and household smoking exposure at age 22&#44; family history of asthma and self-reported medical diagnosis of asthma collected at 15&#44; 18 and 22 years&#46; Results are shown as Odds Ratio &#40;OR&#41; and their respective confidence interval &#40;CI&#41;&#46; <span class="elsevierStyleSup">&#43;</span> Bold values indicate Heterogeneity p-values addressed by Chi-squared test across trajectories&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0251"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Wheezing</th><a name="en0253"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Dyspnea</th><a name="en0254"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Cough</th></tr><tr title="table-row"><a name="en0255"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0256"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;CI95&#160;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0257"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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Original article
Smoking exposure trajectories and pulmonary function in early adulthood in a Brazilian cohort
P. Webera,b,
Corresponding author
priscila.weber@ebserh.gov.br

Corresponding author at: Postgraduate Program in Epidemiology. Marechal Deodoro St., 1169, 3º floor, Pelotas, Rio Grande do Sul, Postcode: 96020-220, Brazil.
, A.M.B. Menezesa, H. Gonçalvesa, P.D. de Oliveiraa,b, A. Wendtc, R. Perez-Padillad, F.C. Wehrmeistera,1
a Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
b Brazilian Company of Hospital Services (EBSERH), Brasilia, Brazil
c Graduate Program in Health Technology, Pontifical Catholic University of Parana, Curitiba, Brazil
d National Institute of Respiratory Diseases (INER), Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0006" class="elsevierStylePara elsevierViewall">Since the landmark work of Fletcher and Peto&#44;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> insightful updates have been added to the widely accepted causal association between tobacco and lung injury&#44; especially its association with chronic obstructive pulmonary disease &#40;COPD&#41; development risk&#46; Explained for many years by an accelerated lung function decline among smokers&#44; COPD has been recently associated with submaximal levels of pulmonary function &#40;PF&#41; at early adulthood&#46; Since then&#44; a growing body of literature is shifting its attention toward early life disadvantage factors that might be involved in impaired lung growth at the beginning of adulthood&#44; being smoking exposure one of them&#46;<a class="elsevierStyleCrossRefs" href="#bib0002"><span class="elsevierStyleSup">2-7</span></a></p><p id="para0007" class="elsevierStylePara elsevierViewall">Despite the significant decrease in tobacco use in the last decades in Brazil&#44; due to effective policies in tobacco control&#44;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> smoking at any level remains as one of the major modifiable COPD risk factors&#44; being also markedly related to lung cancer&#44; coronary heart disease&#44; stroke and all-cause mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9-12</span></a> Over the period from 1990 to 2017&#44; Brazil experienced a decrease in both the prevalence and incidence of chronic respiratory diseases&#46; However&#44; the authors sounded the alarm for the increasing risk of disability-adjusted life years &#40;DALYs&#41; attributed to COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a></p><p id="para0008" class="elsevierStylePara elsevierViewall">This study aims to identify different patterns of smoking exposure trajectories and subsequent PF and respiratory-related symptoms at young adult age among participants of the 1993 Pelotas birth cohort&#44; a large ongoing population-based study from Brazil with 22 years of follow-up so far&#46; The dose-response relationship of cigarettes smoked daily with PF at ages 15&#44; 18 and 22 was also addressed&#46; We hypothesize that those who are constantly exposed to tobacco and heavy smokers will present lower PF values at adulthood than those less exposed&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Material and methods</span><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Study design and sample</span><p id="para0009" class="elsevierStylePara elsevierViewall">The 1993 Pelotas birth cohort is a prospective study that included neonates who were born and whose mothers resided in the urban area of Pelotas city &#40;southern Brazil&#41; in that calendar year&#46; Of the 5249 individuals from the original cohort&#44; 3350 were included in the present study after providing complete post-bronchodilation PF data at age 22&#46; The details of this cohort study have been previously published&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> The Ethics and Research Committee of the Faculty of Medicine of the Federal University of Pelotas &#40;most recent follow-up under the 1&#46;250&#46;366 protocol&#41; approved the study&#46; Written informed consent was obtained from participants or their parents if they were under 18 years old&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Pulmonary function assessment</span><p id="para0010" class="elsevierStylePara elsevierViewall">Spirometry was conducted at age 22 years by a portable ultrasonic spirometer &#40;Easy One model&#44; nDD Medical Technologies Inc&#46;&#44; Zurich Switzerland&#41;&#46; PF data were accurately assessed by trained technicians&#44; using standard procedures following the American Thoracic Society &#40;ATS&#41; and the European Respiratory Society &#40;ERS recommended guidelines&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> A minimum of three and a maximum of eight manoeuvres was performed to obtain at least three acceptable curves&#44; with a maximum difference of 150&#160;ml between the two highest values&#46; Tests were performed before and after administration of salbutamol 400mcg&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">The outcomes of interest were&#58; post-bronchodilator values of forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41; and forced vital capacity &#40;FVC&#41; expressed in millilitres &#40;ml&#41;&#59; forced expiratory flow at the mid expiratory phase &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#41; expressed in millilitres&#47;seconds &#40;ml&#47;s&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio expressed as percentage points &#40;pp&#41;&#46; PF data from 15 to 18 years were also used in supplementary analyses being both measured by the same procedures over the same standardised criteria&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Smoking exposure</span><p id="para0012" class="elsevierStylePara elsevierViewall">At the perinatal follow-up&#44; the assessment of maternal smoking behaviour was recorded by the following question&#58; &#8220;Did you smoke during pregnancy&#63;&#8221;&#46; At ages 15&#44; 18 and 22&#44; individuals reported their own smoking status&#46; At age 15&#44; current smoking &#40;Yes&#44; No&#41; was defined as &#8805;1 day of cigarette consumption in the last month&#44; whereas in the remaining ages&#44; smoking status was accessed by the question &#8220;Do you smoke&#63;&#8221; &#40;at least one cigarette per week in the last month&#41;&#46; The number of cigarettes smoked daily in the last month was also addressed at 15&#44; 18 and 22 years of age&#46; Information regarding respiratory symptoms &#40;wheezing&#44; dyspnea&#44; and cough&#41; were accessed at age 22&#46; All information was assessed by ad hoc questionnaires applied by trained interviewers&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Data analysis</span><p id="para0013" class="elsevierStylePara elsevierViewall">To determine the smoking exposure trajectories over time&#44; a group-based trajectory model &#40;GBTM&#41; approach was applied&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Information on maternal smoking status during the gestational period and self-reported smoking at 15&#44; 18 and 22 years were used in the trajectory modelling&#46; Due to binary data &#40;exposed vs&#46; non-exposed&#41;&#44; we used the logit-based &#40;LOGIT&#41; model in the TRAJ set of commands in Stata software&#46; After testing different numbers of groups &#40;3&#44; 4 and 5 groups&#41; with different polynomial functions &#40;linear&#44; quadratic or cubic&#41;&#44; we selected the best model according to the Bayesian Information Criteria &#40;BIC&#41; and reasonable judgment of other fitting parameters recommended by Nagin<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a>&#58; &#40;a&#41; the average posterior probability &#8211; a value above 0&#46;70 is generally recommended&#59; &#40;b&#41; the odds of correct classification&#58; a value above 5&#46;0 shows good assignment accuracy and &#40;c&#41; correspondence between estimated and expected group probabilities &#8211; the mismatch between both must be zero for a perfectly fitting model &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S1</a>&#41;&#46;</p><p id="para0014" class="elsevierStylePara elsevierViewall">Description of the sample according to socio-demographic characteristics and smoking exposure was addressed by the Student&#39;s <span class="elsevierStyleItalic">t</span>-test and ANOVA&#46; Multivariable linear regression models were used to verify the association between smoking trajectories and PF at age 22&#46; An additional sensitivity analysis verified the effect of the number of cigarettes smoked daily in the last month on PF outcomes&#46; We used a generalized estimating equation &#40;GEE&#41; to obtain the regression coefficients &#40;&#946;&#41;&#46; Model selection was performed with the GEE equivalent of the Akaike Information Criterion &#40;AIC&#41;&#44; the quasi-likelihood under the independence model criterion &#40;QIC&#41;&#46; In this case&#44; instead of trajectories&#44; both the number of cigarettes smoked and PF were measured at 15&#44; 18 and 22 years of age&#46; Individuals were allocated into two groups&#58; one composed of those who smoked 1&#8211;9 cigarettes daily and the other one of individuals who smoked 10 or more cigarettes daily&#46; Thus&#44; the change in PF outcomes should be interpreted based on the comparison between each group and the reference &#40;non-smokers&#41;&#46;</p><p id="para0015" class="elsevierStylePara elsevierViewall">A logistic regression model analysed the association of smoking trajectories with respiratory-related symptoms such as wheezing&#44; dyspnea and cough at age 22&#46; Heterogeneity p-value between groups was addressed by Chi-squared test across trajectories&#46;</p><p id="para0016" class="elsevierStylePara elsevierViewall">A supplementary analysis was conducted to verify the mean annual change in post-bronchodilator PF according to smoking exposure trajectories by multivariate linear regression&#46; The annual average absolute change on PF parameters was calculated through variance-weighted least square regression &#40;vwls command in Stata&#41; for each individual&#44; considering the parameter and the year of follow-up&#46; This generated a yearly change in the lung function parameter for each individual&#46; Positive values mean an annual increase in the parameter and negative values&#44; the opposite&#46; For example&#44; if an individual has a value of 0&#46;02&#44; it means that the parameter increased 0&#46;02 litres &#40;20 millilitres&#41; per year&#46; We then used this value as the outcome in the model&#44; considering all possible confounders&#46; This model deals with autocorrelation in repeated measures&#44; considering it in the calculation of this annual change&#46;</p><p id="para0017" class="elsevierStylePara elsevierViewall">To assess selection bias&#44; some characteristics of cohort members included &#40;individuals with PF data at age 22&#41; and not included &#40;individuals without PF data at age 22&#41; in the study were compared by Two-sample proportion test&#46;</p><p id="para0018" class="elsevierStylePara elsevierViewall">Covariates used for adjusting means of the outcome were&#58; sex&#44; height &#40;cm&#41;&#44; prematurity &#40;gestational age &#60;27 weeks&#41;&#44; low birth weight &#40;&#60;2500 g&#41;&#44; maternal schooling &#40;years of complete schooling&#41;&#44; family income &#40;minimum wages per month in Brazilian currency - a minimum wage equivalent to approximately 84 US dollars&#41;&#44; partner and co-worker&#39;s smoking exposure during pregnancy collected at the perinatal follow-up&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years&#44; household smoking exposure at age 22&#44; family history of asthma and self-reported wheezing and medical diagnosis of asthma collected at 15&#44; 18 and 22 years&#46; All analyses were performed using the Stata Statistical Software &#40;StataCorp LP&#44; College Station&#44; United States&#41;&#44; version 16&#46;0&#46; A significance level of 5&#160;&#37; was considered for all tests&#46;</p></span></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Results</span><p id="para0019" class="elsevierStylePara elsevierViewall">A total of 3350 individuals from the original cohort who had post-bronchodilator PF measures by the age of 22 years made up the final sample&#46; Compared with those not included in the present analysis &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1889&#41;&#44; these individuals were more likely to be women and showed higher maternal education and higher family income &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S2</a>&#41;&#46; However&#44; individuals did not differ in terms of smoking exposure&#46;</p><p id="para0020" class="elsevierStylePara elsevierViewall">Sample distribution and mean values of PF at age 22 according to socio-demographic characteristics and smoking exposure are shown in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46; Approximately half of the study sample were women &#40;52&#160;&#37;&#41;&#44; 42&#160;&#37; were born in families belonging to the lowest tertile of income at birth and most of them &#40;73&#46;6&#160;&#37;&#41; had mothers with low education levels &#40;&#60;9 years&#41;&#46; At baseline&#44; the prevalence of low birth weight and prematurity among individuals were 8&#46;7&#160;&#37; and 10&#46;7&#160;&#37; respectively&#46; Around 32&#46;6&#160;&#37; of the sample were exposed to tobacco in the uterus&#44; however&#44; the prevalence of non-smokers at the remaining follow-ups were more than 80&#160;&#37;&#46; Lower values of FEV<span class="elsevierStyleInf">1</span>&#44; FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> were observed in those born prematurely&#44; with low birth weight&#44; belonging to lower-income families and who had lower scholarship mothers &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; Those who were exposed to tobacco during the gestational period presented lower mean values for all PF parameters &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46; Those who reported being smokers presented lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> values compared to non-smokers &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0021" class="elsevierStylePara elsevierViewall">The estimated smoking exposure trajectories are shown in <a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a>&#46; The best-fitted model &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S2</a>&#41; presented four trajectories&#58; &#91;1&#93; no exposure &#40;NE&#41;&#59; &#91;2&#93; gestational exposure &#40;GE&#41;&#58; characterized by the highest smoking prevalence at baseline &#40;around 100&#160;&#37;&#41; and no exposure at adolescence and adulthood&#59; &#91;3&#93; gestational and adulthood exposure &#40;GAE&#41;&#58; represented by smoking exposure at gestational period followed by the highest smoking exposure prevalence at adulthood &#40;around 90&#160;&#37;&#41; with no exposure at adolescence&#59; &#91;4&#93; continuous exposure &#40;CE&#41;&#58; characterized by a persistent smoking exposure prevalence which slightly increases from 60&#160;&#37; at baseline to over 80&#160;&#37; by the age of 22 years&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0022" class="elsevierStylePara elsevierViewall">Smoking trajectories were associated with lower PF at age 22 &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#41;&#46; When the analysis was adjusted for sex and height &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#8211; Model 1&#41;&#44; those in the CE and GAE trajectories showed greater PF deficits compared to the NE group &#40;reference&#41;&#46; Lower values of FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;&#8722;2&#46;03 pp&#44; 95&#160;&#37; CI&#58; &#8722;3&#46;05&#59; &#8722;1&#46;01 for CE and &#8722;1&#46;59 pp&#44; 95&#160;&#37; CI&#58; &#8722;2&#46;17&#59; &#8722;1&#46;02 for GAE trajectory&#41;&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio &#40;&#8722;8&#46;84 pp&#44; 95&#160;&#37; CI&#58; &#8722;13&#46;32&#59; &#8722;4&#46;36 for CE and &#8722;6&#46;26 pp&#44; 95&#160;&#37; CI&#58; &#8722;8&#46;79&#59; &#8722;3&#46;73 for GAE trajectory&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> &#40;&#8722;248&#160;ml&#47;s&#44; 95&#160;&#37; CI&#58; &#8722;428&#59; &#8722;68 for CE and &#8722;233&#160;ml&#47;s&#44; 95&#160;&#37; CI&#58; &#8722;335&#59; &#8722;132 for GAE trajectory&#41; were related to both trajectories&#46; After adjustment for a wider set of potential confounders &#40;<a class="elsevierStyleCrossRef" href="#fig0002">Fig&#46; 2</a>&#8211; model 2&#41;&#44; comparing to the NE category&#44; the GAE trajectory was related to lower values of FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;&#8722;1&#46;58 pp&#59; 95&#160;&#37; CI&#58; &#8722;2&#46;35&#59; &#8722;0&#46;80&#41;&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio &#40;&#8722;6&#46;04 pp&#44; 95&#160;&#37; CI&#58; &#8722;9&#46;53&#59; &#8722;2&#46;55&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> &#40;&#8722;253&#160;ml&#47;s<span class="elsevierStyleInf">&#59;</span> 95&#160;&#37; CI&#58; &#8722;393&#59; &#8722;112&#41; whereas the CE and the GE trajectories remained significantly related to lower values of both FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;&#8722;1&#46;77 pp&#59; 95&#160;&#37; CI&#58; &#8722;3&#46;11&#59; &#8722;0&#46;42 and &#8722;0&#46;96 pp&#44; 95&#160;&#37; CI&#58; &#8722;1&#46;68&#59; &#8722;0&#46;25 respectively&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio &#40;&#8722;7&#46;27 pp&#44; 95&#160;&#37; CI&#58; &#8722;13&#46;35&#59; &#8722;1&#46;18 and &#8722;4&#46;08 pp&#44; 95&#160;&#37; CI&#58; &#8722;7&#46;30&#59; &#8722;0&#46;86 respectively&#41;&#46; Lower FEV<span class="elsevierStyleInf">1</span> values were only observed in the GAE trajectory &#40;&#8722;68&#160;ml&#59; 95&#160;&#37; CI&#58; &#8722;130&#59; &#8722;6&#41;&#46; The GE trajectory was related to a statistically significant increase in FVC &#40;80&#160;ml&#59; 95&#160;&#37; CI&#58; 15&#59; 145&#41;&#46;</p><elsevierMultimedia ident="fig0002"></elsevierMultimedia><p id="para0023" class="elsevierStylePara elsevierViewall">Pulmonary function between ages 15&#44; 18 and 22 was analysed between smoking groups and non-smokers &#40;<a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>&#41;&#46; Compared to those who never smoked between ages 15&#44; 18&#44; and 22 years&#44; individuals who smoked 10 or more cigarettes daily presented a reduction in the FEV1&#47;FVC ratio by 1&#46;37 pp &#40;95&#160;&#37; CI&#58; &#8722;2&#46;08&#59; &#8722;0&#46;66&#41;&#44; FEF25&#8211;75&#160;&#37; by 126&#160;ml &#40;95&#160;&#37; CI&#58; &#8722;225&#59; &#8722;27&#41; and the FEF25&#8211;75&#160;&#37;&#47;FVC ratio by 3&#46;62 pp &#40;95&#160;&#37; CI&#58; &#8722;6&#46;43&#59; &#8722;0&#46;82&#41;&#46; No difference was found in the PF between those who smoked less than ten cigarettes daily and those who never smoked&#46;</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia><p id="para0024" class="elsevierStylePara elsevierViewall">Associations of smoking trajectories with respiratory-related symptoms at age 22 are shown in <a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a>&#46; Gestational exposure alone was not associated with later respiratory symptoms&#46; However&#44; individuals belonging to the CE and GAE trajectories presented the higher odds of wheezing &#40;OR 4&#46;14&#59; 95&#160;&#37; CI&#58; 2&#46;11&#59;8&#46;14 and OR 2&#46;92&#59; 95&#160;&#37; CI&#58; 1&#46;87&#59;4&#46;54 respectively&#41; and cough &#40;OR 2&#46;39&#59; 95&#160;&#37; CI&#58; 1&#46;39&#59;4&#46;10 and OR 2&#46;37&#59; 95&#160;&#37; CI&#58; 1&#46;72&#59;3&#46;27 respectively&#41; compared to those who were never exposed&#46; The GAE trajectory also showed higher odds of dyspnea &#40;OR 2&#46;54&#59; 95&#160;&#37; CI&#58; 1&#46;23&#59;5&#46;25&#41;&#46; Heterogeneity p-value showed statistical difference between groups estimated effects&#46; The average annual change in PF between 15&#44; 18 and 22 years did not differ between exposed and non-exposed smoking trajectories &#40;<a class="elsevierStyleCrossRef" href="#sec0010">supplementary table S3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Discussion</span><p id="para0025" class="elsevierStylePara elsevierViewall">By using 22 years of follow-up information&#44; we were able to estimate PF at adulthood within each smoking exposure trajectory&#46; Four trajectories were identified and characterised by different periods and probabilities of exposure throughout the years of follow-up&#58; &#40;NE&#41; zero probability of exposure&#44; which represented the reference group&#59;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> higher probability of exposure during the gestational period only &#40;GE&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> higher probability of exposure at gestational period and adulthood only &#40;GAE&#41;&#59;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> probability of exposure in all follow-ups &#40;CE&#41;&#46;</p><p id="para0026" class="elsevierStylePara elsevierViewall">The results presented here showed lower PF values among individuals exposed to maternal smoking during pregnancy who also reported themselves as current smokers at adolescence &#40;15 years&#41; and later at ages 18 and 22 years &#40;CE and GAE trajectories&#41;&#46;</p><p id="para0027" class="elsevierStylePara elsevierViewall">The GAE trajectory was the only one associated with lower FEV<span class="elsevierStyleInf">1</span> values compared to the non-exposed group&#46; Recent findings from the Tasmanian Longitudinal Health Study Cohort &#40;TAHS&#41; showed that an interaction between maternal smoking post-birth and personal smoking enhances the risk of following submaximal FEV<span class="elsevierStyleInf">1</span> trajectories until adulthood&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> Similarly&#44; data from the Manchester Asthma Allergy Study Cohort &#40;MASS&#41; and Avon Longitudinal Study of Parents and Children &#40;ALSPAC&#41; revealed that lifelong smoking exposure was also related to lower FEV<span class="elsevierStyleInf">1</span> growth&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> However&#44; unlikely our study&#44; smoking exposure was not addressed as trajectories in both studies&#46;</p><p id="para0028" class="elsevierStylePara elsevierViewall">All smoking trajectories were associated with reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio when compared to non-smokers&#46; However&#44; only in the GAE trajectory&#44; the lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio resulted from a significantly reduced FEV<span class="elsevierStyleInf">1</span> with no change in FVC&#46; In the remaining smoking trajectories&#44; no differences were observed for FEV<span class="elsevierStyleInf">1&#44;</span> and the reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio was then related to higher values of FVC&#46; In the literature&#44; a reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio with normal FEV<span class="elsevierStyleInf">1</span> and higher &#40;or normal&#41; FVC has been termed dysanapsis&#44; a mismatch between airway tree calibre and lung size&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Recent studies significantly related dysanapsis to lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio &#40;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a>&#41; and to greater COPD risk<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> among older adults&#46; These findings provide evidence that even in the absence of a classic pattern of airflow obstruction&#44; i&#46;e&#46; in case of normal FEV<span class="elsevierStyleInf">1</span>&#44; dysanapsis associated with reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio may result in clinical implications to respiratory health&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Individuals in the GAE trajectory also presented lower FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> values&#44; another spirometry measure that comprehends airflow limitation&#46;</p><p id="para0029" class="elsevierStylePara elsevierViewall">Most studies have investigated the effect of either gestational smoking exposure or personal smoking alone on PF growth&#44; but not both&#46; In-utero exposure to tobacco<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> and smoking behaviour in adolescence<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> were previously related to reduced FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio among adolescents&#46; A reduction in FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> of &#8722;262&#160;ml&#47;s in men aged 21 years had also been associated with in utero tobacco exposure&#44; even after adjusting for birth weight&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> Using path analysis&#44; the Isle of Wight &#40;IOW&#41; cohort found that gestational exposure to maternal smoking was associated directly with a reduction in FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio at 18 years&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> Later&#44; assessing individuals PF from age 10 to 26 years&#44; the same cohort demonstrated signs of airflow limitation in current smokers at age 26 &#40;lower FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> and FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio&#41; compared to non-smokers&#44; with the differences persisting after bronchodilation&#46; No difference was observed for FEV<span class="elsevierStyleInf">1</span> though&#46; Smokers also presented a significantly FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> decline between ages 18 and 26 years&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a></p><p id="para0030" class="elsevierStylePara elsevierViewall">Our findings can be better related to those reported by one study conducted with data from the BAMSE birth cohort &#40;Barn&#47;child&#44; Allergy&#44; Milieu&#44; Stockholm&#44; Epidemiology&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> Although PF was measured at 16 years instead of adulthood and smoking exposure was not explored as a trajectory&#44; the authors also related the combined effects of maternal smoking during the gestational period and adolescent smoking to airway obstruction&#46; Exposure to maternal smoking alone resulted in a reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio of &#8722;1&#46;1&#160;&#37; &#40;95&#160;&#37; CI &#8722;2&#46;0&#59; &#8722;0&#46;2&#41;&#44; and teenage smoking was associated with a significantly lower FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio of &#8722;0&#46;9&#160;&#37; &#40;95&#160;&#37; CI &#8722;1&#46;8&#59; &#8722;0&#46;1&#160;&#37;&#41; compared to the non-exposed group&#46; However&#44; those who were in-utero exposed and smoked at age 16 had a reduced FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio of &#8722;2&#46;5&#160;&#37; &#40;95&#160;&#37; CI &#8722;4&#46;3&#59; &#8722;0&#46;7&#41;&#46;</p><p id="para0031" class="elsevierStylePara elsevierViewall">Previous studies reported FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> as highly sensitive to predicting small airway disease which is affected early in smoke-related lung injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a> However&#44; a concern relays on the intersubject variability of FEF which originates from its dependency on the FVC&#46; As recommended in the literature&#44; we aimed to correct this drawback by dividing FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> to FVC&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> After doing this&#44; individuals belonging to all smoking trajectories showed lower values of FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio compared to those never exposed&#44; which also tends to suggest a small airway disease&#46; This finding can be related to an increased COPD risk in which airway calibre decreases &#40;decreased FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#41; but the lung volume increases &#40;increased FVC&#41; due to air trapping<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> or&#44; as stated previously&#44; due to dysanapsis&#46;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">In our study&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;&#44;</span> FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio were more sensitive than parameters of central obstruction like FEV<span class="elsevierStyleInf">1</span> in detecting PF impairment in young adults exposed to tobacco&#46; The FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio was decreased by 1&#46;37 pp &#40;95&#160;&#37; CI&#58; &#8722;2&#46;08&#59; &#8722;0&#46;66&#41;&#44; the FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> by 126&#160;ml &#40;95&#160;&#37; CI&#58; &#8722;225&#59; &#8722;27&#41; and the FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio by 3&#46;62 pp &#40;95&#160;&#37; CI&#58; &#8722;6&#46;43&#59; &#8722;0&#46;82&#41; if ten or more cigarettes were smoked daily compared to never smokers&#46; This finding relates the smoking burden to some extent of airflow limitation in our cohort&#46; An association between the number of cigarettes smoked and PF was previously observed in 10&#46;060 boys and girls aged 10 to 18 years&#46; When compared to never smokers&#44; those belonging to the light &#40;1&#8260;2 to 4 cigarettes per day&#41;&#44; medium &#40;5 to 14 cigarettes per day&#41; and heavy &#40;15 or more cigarettes per day&#41; subgroups of smokers presented lower values of both FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a></p><p id="para0033" class="elsevierStylePara elsevierViewall">Only individuals who kept smoking throughout adolescence and those who were also currently smokers at young adult age presented respiratory symptoms like wheezing&#44; dyspnea&#44; and cough&#46; These results add some clinical evidence of possible airflow inflammation related to PF loss among those currently exposed to tobacco noxious substances&#46; Our findings may suggest the silent beginning of lung damage developing in those very early exposed&#44; as shown by PF reduction and the appearance of some clinical respiratory symptoms&#44; even if they do not meet the standard threshold of PF impairment that define COPD &#40;such as FEV<span class="elsevierStyleInf">1</span>&#47;FVC below the lower limit of normal&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> Results from the COPDGene study revealed that accelerated FEV<span class="elsevierStyleInf">1</span> decline in COPD&#44; for instance&#44; was preceded by evident signs of radiographically small airways abnormalities at earlier ages&#44; even among individuals without classically defined airflow obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> This is particularly relevant as the at-risk population shifts younger whereas most COPD studies target individuals with mean ages older than 60 years&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> To effectively reduce the COPD burden related to tobacco exposure&#44; we strongly believe that strategies to promote lung health should include reducing maternal smoking and especially encouraging avoidance of personal smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> Despite PF reduction was related to ten or more cigarettes smoked daily in our study&#44; it does not imply that smoking less is a safe threshold of exposure&#46; Therefore&#44; any amount of cigarette consumption must be avoided&#46;</p><p id="para0034" class="elsevierStylePara elsevierViewall">Strengths of the present study include the evaluation of PF in the emerging adulthood&#44; a crucial period to track individuals who may be at risk of developing many disadvantaged health outcomes related to poor PF&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> The follow-up from birth to young adult age with high participation rates and the use of standardized spirometry tests are additional strengths&#46; A potential limitation of our study is the self-reporting of tobacco exposure&#44; especially regarding maternal smoking status&#44; that may have led to information bias&#44; with underestimation&#46; Self-reported smoking status during pregnancy underestimated the true prevalence of smoker mothers in a previous study&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a> Such a misclassification could minimize the effect of smoking patterns on PF&#46; We could not adjust our analyses for second hand smoking exposure nor could we analyse exposure to indoor&#47;outdoor pollution during infancy&#44; which is an important period of lung development&#46; We could not infer a dose response between cigarettes smoked daily and PF as our data were collected in a categorical way&#46; Besides&#44; missing data implied another limitation to our study&#46;</p></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Conclusions</span><p id="para0035" class="elsevierStylePara elsevierViewall">Smoking exposure may compromise lung development leading to reduced maximum attained PF and can also be related with respiratory symptoms like wheezing&#44; dyspnea and cough in early adulthood&#46; Although the exposure to maternal smoking alone also appears to longstanding effect on the lungs&#44; the perpetuation of smoking habit at 15&#44; 18 and 22 years is undoubtedly determinant for lower PF&#46; To guarantee that more individuals reach PF peak values and lifelong respiratory health&#44; smoking cessation policies must be encouraged in all lung growth phases&#46;</p></span><span id="sec0009a" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015a">CRediT authorship contribution statement</span><p id="para0035a" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">P&#46; Weber&#58;</span> Conceptualization&#44; Formal analysis&#44; Writing &#8211; original draft&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">A&#46;M&#46;B&#46; Menezes&#58;</span> Data curation&#44; Project administration&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">H&#46; Gon&#231;alves&#58;</span> Data curation&#44; Project administration&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">P&#46;D&#46; de Oliveira&#58;</span> Data curation&#44; Project administration&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">A&#46; Wendt&#58;</span> Formal analysis&#44; Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">R&#46; Perez-Padilla&#58;</span> Writing &#8211; review &#38; editing&#46; <span class="elsevierStyleBold">F&#46;C&#46; Wehrmeister&#58;</span> Conceptualization&#44; Data curation&#44; Project administration&#44; Formal analysis&#44; Writing &#8211; original draft&#44; Writing &#8211; review &#38; editing&#46;</p></span></span>"
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          "titulo" => "Abstract"
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          "titulo" => "Introduction"
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          "titulo" => "Material and methods"
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              "titulo" => "Study design and sample"
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              "titulo" => "Pulmonary function assessment"
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              "identificador" => "sec0005"
              "titulo" => "Smoking exposure"
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              "titulo" => "Data analysis"
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          "titulo" => "Results"
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          "titulo" => "Funding"
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          "titulo" => "References"
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    "fechaRecibido" => "2022-06-26"
    "fechaAceptado" => "2023-09-15"
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            0 => "Longitudinal studies"
            1 => "Smoking"
            2 => "Spirometry"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objectives</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">To investigate smoking trajectories and their association with pulmonary function &#40;PF&#41; and respiratory symptoms at age 22&#46;</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Methods</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Data from a population-based cohort study of 3350 individuals and their spirometries were analysed&#46; The outcomes were&#58; forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; forced vital capacity &#40;FVC&#41;&#44; forced expiratory flow at the mid expiratory phase &#40;FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#41;&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC and FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC ratio&#46; Smoking data were collected at perinatal follow-up &#40;gestational exposure&#41; and 15&#44; 18 and 22 years&#46; Group-based trajectory model was applied&#46;</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara012" class="elsevierStyleSimplePara elsevierViewall">Four groups were identified&#58; no exposure &#40;NE&#41;&#44; gestational &#40;GE&#41;&#44; gestational and adulthood &#40;GAE&#41; and continuous &#40;CE&#41; exposure&#46; Both CE and GAE trajectories were associated with lower values of FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#8722;1&#46;77pp&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;01 and &#8722;1&#46;58 pp&#59; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001 respectively&#41; and FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC ratio &#40;&#8722;7&#46;27pp&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;019 and &#8722;6&#46;04pp&#59; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001 respectively&#41; compared to the NE trajectory&#46; Lower FEV<span class="elsevierStyleInf">1</span> and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> values were also related to the GAE trajectory &#40;&#8722;68&#160;ml&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;03 and &#8722;253&#160;ml&#47;s<span class="elsevierStyleInf">&#59;</span><span class="elsevierStyleItalic">p</span>&#60;0&#46;001 respectively&#41;&#46; Compared to those who never smoked&#44; individuals who smoked 10 or more cigarettes daily presented a reduction in the FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio by 1&#46;37pp &#40;<span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41;&#44; FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span> by 126&#160;ml &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;012&#41; and FEF<span class="elsevierStyleInf">25&#8211;75&#160;&#37;</span>&#47;FVC ratio by 3&#46;62pp &#40;<span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;011&#41;&#46; CE trajectory showed higher odds of wheezing &#40;OR 4&#46;14&#59; <span class="elsevierStyleItalic">p</span>&#60;0&#46;001&#41; and cough &#40;OR 2&#46;39&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;002&#41; compared to the non-exposed group&#46;</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusions</span><p id="spara013" class="elsevierStyleSimplePara elsevierViewall">The in-uterus exposure to maternal smoking reduces PF later in life&#46; However&#44; the perpetuation of smoking behaviour throughout adolescence and early adulthood is determinant for PF main reduction and the emergence of respiratory-related symptoms&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="notep0001">Fernando C&#233;sar Wehrmeister&#44; Ana Maria Baptista Menezes and Helen Gon&#231;alves received scholarship for productivity in research from the Brazilian National Research Council for Scientific and Technological Development &#40;CNPQ&#41; during the conduct of the study&#46; Paula Duarte de Oliveira&#44; Andrea Wendt and Rogelio Perez-Padilla have nothing to disclose&#46;</p>"
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Smoking exposure trajectories&#58; the 1993 Pelotas birth &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
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          "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Mean differences in pulmonary function values measured at age 22 by smoking exposure trajectories&#46; Abbreviations&#58; &#40;A&#41; FEV<span class="elsevierStyleInf">1</span>&#58; forced expiratory volume in the first second&#59; &#40;B&#41; FVC&#58; forced vital capacity&#59; &#40;C&#41; FEV<span class="elsevierStyleInf">1</span>&#47;FVC ratio&#59; &#40;D&#41; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#58; forced expiratory flow mid at the expiratory phase&#59; &#40;E&#41; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC ratio&#59; GE&#58; gestational exposure&#59; GAE&#58; gestational and adulthood exposure&#59; CE&#58; continuous exposure&#46; Results expressed by regression coefficient &#40;&#946;&#41; and 95&#160;&#37; confidence interval&#44; with no exposure being the reference group&#46; Model 1 adjusted for sex and height&#46; Model 2 adjusted for sex&#44; height&#44; low birth weight&#44; prematurity&#44; family income&#44; maternal schooling&#44; partner and co-worker&#39;s smoking exposure during pregnancy&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years and household smoking exposure at age 22&#44; family history of asthma&#44; self-reported wheezing and medical diagnosis of asthma collected at 15&#44; 18 and 22 years &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
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          "leyenda" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>&#58; forced expiratory volume in the first second&#59; FVC&#58; forced vital capacity&#59; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#58; forced expiratory flow at the expiratory phase&#46; All information collected at perinatal follow-up&#44; except smoking status at ages 15&#44; 18 and 22 years which were collected at the respective ages&#46; The student&#39;s <span class="elsevierStyleItalic">t</span>-test and ANOVA determined p-values&#46; Results are shown as mean and standard error &#40;SE&#41;&#46; Bold values indicate <span class="elsevierStyleItalic">p</span>&#60;0&#46;05&#46; &#42;Missing information &#40;maximum of 354 missing for prematurity&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">N &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">FEV<span class="elsevierStyleInf">1</span> &#40;L&#41; Mean &#40;SE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">FVC &#40;L&#41; Mean &#40;SE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;&#37;&#41; Mean &#40;SE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">FEF<span class="elsevierStyleInf">25&#8211;75</span> &#40;L&#47;s&#41; Mean &#40;SE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0007"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">FEF<span class="elsevierStyleInf">25&#8211;75</span> &#47;FVC &#40;&#37;&#41; Mean &#40;SE&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0008"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Sex</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1607 &#40;48&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;24 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;92 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;26 &#40;0&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5&#46;12 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">105&#46;10 &#40;0&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1743 &#40;52&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;01 &#40;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;52 &#40;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;61 &#40;0&#46;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;94 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">113&#46;16 &#40;0&#46;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Family income &#40;tertiles&#41; &#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;359&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;011</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;461&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1378 &#40;42&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;58 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;13 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;92 &#40;0&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;47 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;92 &#40;0&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">974 &#40;29&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;61 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;17 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;79 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;46 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;73 &#40;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">933 &#40;28&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;74 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;30 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;16 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;60 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;85 &#40;0&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Birth Weight &#40;grams&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;473&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;870&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;2500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">291 &#40;8&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;30 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;81 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;94 &#40;0&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;15 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;13 &#40;0&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;2500&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3059 &#40;91&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;67 &#40;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;23 &#40;0&#46;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;96 &#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;54 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;91 &#40;1&#46;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0078"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Prematurity</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0081"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;006</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0085"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0086"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2675 &#40;89&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;66 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;22 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;0 &#40;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;53 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0091"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;19 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0092"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">321 &#40;10&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;51 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;07 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0096"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;6 &#40;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;36 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;83 &#40;1&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0099"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Maternal education &#40;years&#41;&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0101"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0102"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0103"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;857&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0104"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0105"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;380&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0106"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">883 &#40;26&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;49 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;03 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;89 &#40;0&#46;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0111"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;37 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;14 &#40;0&#46;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0113"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>5&#8211;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1578 &#40;47&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0116"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;20 &#40;0&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;95 &#40;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;53 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;49 &#40;0&#46;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0120"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>9&#8211;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0121"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">612 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;77 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;35 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;97 &#40;0&#46;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;61 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0126"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">107&#46;99 &#40;1&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0127"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">272 &#40;8&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;78 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;35 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0131"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;24 &#40;0&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;61 &#40;0&#46;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">108&#46;27 &#40;1&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0134"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Gestational smoking exposure</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0136"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;004</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;004</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2257 &#40;67&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;67 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;22 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;23 &#40;0&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0146"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;57 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;10 &#40;0&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0148"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1093 &#40;32&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;56 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0151"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;13 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">86&#46;40 &#40;0&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;37 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">107&#46;61 &#40;0&#46;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0155"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Smoking exposure at age 15</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0156"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;010</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0161"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0162"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2981 &#40;94&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#40;0&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;20 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0166"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;03 &#40;0&#46;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;52 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;51 &#40;0&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0169"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">173 &#40;5&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0171"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;44 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;03 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;77 &#40;0&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;14 &#40;0&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&#46;76 &#40;1&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0176"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Smoking exposure at age 18</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;426&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;873&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0181"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;005</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0183"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2727 &#40;86&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;64 &#40;0&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0186"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;19 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0187"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;14 &#40;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0188"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;53 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0189"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">109&#46;95 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0190"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0191"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">418 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0192"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;63 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;25 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;75 &#40;0&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0195"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;38 &#40;0&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0196"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&#46;56 &#40;1&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0197"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Smoking exposure at age 22</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0198"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;973&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;998&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0201"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span></span>&#160;<span class="elsevierStyleBold">&#61;</span>&#160;<span class="elsevierStyleBold">0&#46;048</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">p</span>&#60;0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0204"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0205"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2772 &#40;82&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0206"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;63 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0207"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;17 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0208"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">87&#46;22 &#40;0&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0209"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;52 &#40;0&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0210"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">110&#46;38 &#40;0&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0211"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0212"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">575 &#40;17&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0213"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3&#46;69 &#40;0&#46;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0214"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;32 &#40;0&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0215"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">85&#46;73 &#40;0&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0216"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4&#46;43 &#40;0&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0217"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">104&#46;08 &#40;1&#46;04&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">Description of the sample with pulmonary function data at age 22 according to socio-demographic characteristics and smoking exposure &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
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      3 => array:8 [
        "identificador" => "tbl0002"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "alt0004"
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          "leyenda" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">1</span>&#58; forced expiratory volume in the first second&#59; FVC&#58; forced vital capacity&#59; FEF<span class="elsevierStyleInf">25&#8211;75</span>&#58; forced expiratory flow at the mid expiratory phase&#46; Results are shown as regression coefficient &#40;&#946;&#41; and their respective confidence interval &#40;CI&#41;&#59; pp&#58; percentage points&#46; Note&#58; the changes in outcomes are relative to a comparation between smoking groups and non-smokers as the reference group &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;2324&#41;&#46; Model adjusted for sex&#44; height&#44; family income&#44; prematurity&#44; low birth weight&#44; maternal schooling&#44; partner and co-worker&#39;s smoking exposure during pregnancy collected at the perinatal follow-up&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years and household smoking exposure at age 22&#44; family history of asthma and self-reported wheezing and medical diagnosis of asthma collected at 15&#44; 18 and 22 years&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0218"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0219"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">1&#8211;9 cigarettes &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;924&#41;</th><a name="en0220"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">&#8805;10 cigarettes &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;328&#41;</th></tr><tr title="table-row"><a name="en0221"></a><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0222"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#946; &#40;95&#160;&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0223"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&#946; &#40;95&#160;&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0225"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV<span class="elsevierStyleInf">1</span> &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0227"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">0&#46;810&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FVC &#40;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0232"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;5 &#40;&#8722;37&#59; 24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;737&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">51 &#40;&#8722;7&#59; 94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;pp&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;26 &#40;&#8722;0&#46;22&#59; 0&#46;67&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;322&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0239"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;1&#46;37 &#40;&#8722;2&#46;08&#59; &#8722;0&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0240"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEF<span class="elsevierStyleInf">25&#8211;75</span> &#40;ml&#47;s&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;34 &#40;&#8722;99&#59; 32&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;312&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;126 &#40;&#8722;225&#59; &#8722;27&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0246"></a><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top">FEF<span class="elsevierStyleInf">25&#8211;75</span>&#47;FVC &#40;pp&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">&#8722;3&#46;62 &#40;&#8722;6&#46;43&#59; &#8722;0&#46;82&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spara008" class="elsevierStyleSimplePara elsevierViewall">Logistic regression adjusted to sex&#44; family income&#44; prematurity&#44; low birth weight&#44; maternal schooling&#44; partner and co-worker&#39;s smoking exposure during pregnancy collected at the perinatal&#46;</p><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">follow-up&#44; mother and father&#39;s smoking exposure at ages 11 and 18 years and household smoking exposure at age 22&#44; family history of asthma and self-reported medical diagnosis of asthma collected at 15&#44; 18 and 22 years&#46; Results are shown as Odds Ratio &#40;OR&#41; and their respective confidence interval &#40;CI&#41;&#46; <span class="elsevierStyleSup">&#43;</span> Bold values indicate Heterogeneity p-values addressed by Chi-squared test across trajectories&#46;</p>"
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">OR &#40;CI95&#160;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0262"></a><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Gestational exposure</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">0&#46;628&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;72 &#40;0&#46;30&#59; 1&#46;77&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0266"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">0&#46;481&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0267"></a><td class="td" title="\n
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                  \t\t\t\t</td><a name="en0268"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">2&#46;92 &#40;1&#46;87&#59; 4&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">2&#46;54 &#40;1&#46;23&#59; 5&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><a name="en0274"></a><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleBold">0&#46;011</span><span class="elsevierStyleSup">&#43;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">Adjusted associations of smoking trajectories with respiratory-related symptoms at age 22&#58; the 1993 Pelotas birth cohort&#44; Brazil &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;3350&#41;&#46;</p>"
        ]
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The natural history of chronic airflow obstruction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Fletcher"
                            1 => "R&#46; Peto"
                          ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br Med J"
                        "fecha" => "1977"
                        "volumen" => "1"
                        "numero" => "6077"
                        "paginaInicial" => "1645"
                        "paginaFinal" => "1648"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung-function trajectories leading to chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Lange"
                            1 => "B&#46; Celli"
                            2 => "A&#46; Agusti"
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Pulmonology

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