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We assessed the influence of 1) maternal smoking during pregnancy (in utero exposure), 2) childhood parental smoking, and 3) years lived with smokers since age 18. Incident RA and serostatus were determined by medical record review. Using the marginal structural model framework, we estimated the controlled direct effect of each passive smoking exposure on adult incident RA risk by serologic phenotype, controlling for early\u2010life factors and time\u2010updated adulthood factors including personal smoking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 90,923 women, we identified 532 incident RA cases (66% seropositive) during a median of 27.7 years of follow\u2010up. Maternal smoking during pregnancy was associated with RA after adjustment for confounders, with a hazard ratio (HR) of 1.25 (95% confidence interval [95% CI] 1.03\u20131.52), but not after accounting for subsequent smoking exposures. Childhood parental smoking was associated with seropositive RA after adjustment for confounders (HR 1.41 [95% CI 1.08\u20131.83]). In the controlled direct effect analyses, childhood parental smoking was associated with seropositive RA (HR 1.75 [95% CI 1.03\u20132.98]) after controlling for adulthood personal smoking, and the association was accentuated among ever smokers (HR 2.18 [95% CI 1.23\u20133.88]). There was no significant association of adulthood passive smoking with RA (HR 1.30 for \u226520 years of living with a smoker versus none [95% CI 0.97\u20131.74]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We found a potential direct influence of childhood parental smoking on adult\u2010onset incident seropositive RA even after controlling for adulthood personal smoking.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.41939","type":"journal-article","created":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T10:25:22Z","timestamp":1629282322000},"page":"2219-2228","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Passive Smoking Throughout the Life Course and the Risk\u00a0of Incident Rheumatoid Arthritis in Adulthood Among\u00a0Women"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2030-3549","authenticated-orcid":false,"given":"Kazuki","family":"Yoshida","sequence":"first","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Wang","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Malspeis","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8281-681X","authenticated-orcid":false,"given":"Nathalie","family":"Marchand","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital and Harvard Medical School  Boston 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