Affecting approximately 5-6% of the primary school population, developmental coordination disorder (DCD) is a condition characterized by poor motor proficiency that interferes with a child’s activities of daily living. The cause of DCD is not yet understood; however, it is known that children with DCD are more likely to have other co-occurring developmental disorders such as attention-deficit hyperactivity disorder (ADHD). While there is a growing body of evidence linking ADHD to smoke exposure in utero, there is limited research investigating a similar link between smoke exposure in utero and DCD. The purpose of this study was to examine the effect of SHS exposure in utero in children with DCD and a group of typically developing (TD) children. Methods – A case-control study was conducted to compare children with DCD to TD children on their exposure to SHS in utero and other demographic variables. At baseline, participants included 63 DCD children and 63 healthy controls. All children were assessed for motor proficiency, intelligence, and ADHD. Mother’s SHS exposure during pregnancy and other demographic variables were obtained from a parent completed survey. Results – Multinomial logistic regression analyses revealed that children exposed to SHS in utero were significantly more likely to be at high risk for DCD than children who were not exposed to SHS in utero, even after adjusting for associated demographic variables. Furthermore, children exposed to SHS in utero were significantly more likely to be at moderate-high risk for DCD, whether or not ADHD was co-occurring. Conclusion – Results from this study suggest that exposure to SHS during pregnancy has negative effects on fetal development and appears to be a contributor for DCD. Further study is needed to examine the specific mechanisms linking SHS exposure in utero to motor coordination problems in children. / Thesis / Master of Science (MSc)

BACKGROUND: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. METHODS: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. RESULTS: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. CONCLUSIONS: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.