The Impact of Secondhand Smoke

on Children

Michael Warren, MD MPH FAAP Division of Family Health and Wellness

Tennessee Department of Health

Take-Home Points

Children who have never smoked die from tobacco smoke.

Children who have never smoked suffer serious morbidity from tobacco smoke.

What Is Secondhand Smoke?

“Smoke inhaled by nonsmokers that contaminates indoor spaces and outdoor environments”1

Two components:

Sidestream smoke: Smoke produced by burning end of cigarettes, pipes, cigars

Mainstream smoke: Exhaled by smoker

Sources: 1. Surgeon General’s Report, 2006. “The Health Consequences of Involuntary Exposure to Tobacco Smoke.

Secondhand Smoke Exposure in Children

Hopper et al (2000) 76% Detroit, MI

Cornelius et al (2003) 71% 79% (Cotinine)

Pittsburgh, PA

Chilmonczyk et al (1990) 40% 64% (Cotinine)

Portland, ME

Kum-Nji et al (2004) 71% Clarksdale, MS

Overpeck and Moss (1991)

49% National

NHIS (2002) 35% National

NHANES II (1996) 43% National

NHANES III (1998) 38% National

Secondhand Smoke is Dangerous

>4,000 identifiable chemicals in secondhand smoke1

Some of these chemicals also found in wood varnish, the insect poison DDT, arsenic, nail polish remover, and rat poison

Detectable amount of chemicals can be found in body fluids of exposed non-smokers2

No safe level/duration of exposure for children3

Sources: 1. CDC: http://www.cdc.gov/tobacco/campaign/tips/quit-smoking/guide/whats-in-cigarette.html 2. Matt GE, et al. Households contaminated by environmental tobacco smoke: sources of infant exposures. Tobacco Control 2004;13:29–37. 3. Surgeon General’s Report, 2004 and 2006.

Secondhand Smoke: Health Consequences for Children Increased risk of SIDS1

Increased incidence of respiratory illnesses1

Ear infections Asthma Wheezing episodes Cough Bronchiolitis Pneumonia

Sources: 1. UpToDate, “Secondhand Smoke Exposure: Effects in Children. Accessed 09/11/2013. 2. DiFranza JR, Aligne CA. Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics. 2004; 113; 1007.

Asthmatics exposed to secondhand smoke have more flare-ups, more ED visits, & more likely to be intubated2

Secondhand Smoke: Medical Costs

Illness attributable to secondhand smoke1: 150,000-300,000 cases of lower respiratory tract

infections per year in infants and young children 800,000 visits for ear infections per year Up to 1 million asthma flare-ups

Parental smoking related to: $4.6 Billion per year in health care costs for children2

19% of all expenditures for childhood respiratory3 conditions

Sources: 1. California Environmental Protection Agency: Air Resources Board. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant.

Published 06/24/2005. 2. Aligne CA, Stoddard JJ. Archives of Pediatric and Adolescent Medicine. 1997. Oct; 151(10): 988. 3. Stoddard JJ, Gray B. Maternal smoking and medical expenditures for childhood respiratory illnesses. American Journal of public Health. 1997. Feb;

87(2): 205-209.

Limiting Exposure to Secondhand Smoke

Only effective way to eliminate secondhand smoke is to stop smoking

Air filtration or purification systems do not completely eliminate secondhand smoke

Ventilation systems do not completely eliminate secondhand smoke

Source: Asthma & Allergy Foundation of America. Available at: http://www.aafa.org/display.cfm?id=8&sub=16&cont=37. Accessed 09/11/2013.

Would You Jump In?

Peeing Section

Non-Peeing Section

Limiting Exposure to Secondhand Smoke

Cotinine is frequently measured nicotine metabolite

Urinary cotinine levels reduced in children when smoking bans in place

Source: Wakefield, et al. Restrictions on smoking at home and urinary cotinine levels among children with asthma. American Journal of Preventive Medicine, 2000. 19(3): 188-192.

Take-Home Messages for Parents

Do not allow anyone to smoke near your child.

Do not smoke or allow others to smoke in your home or car. Opening a window does not protect your children from smoke.

Use a smoke-free day care center.

Do not take your child to restaurants or other indoor public places that allow smoking.

Teach children to stay away from secondhand smoke.

Source: CDC. Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/index.htm#children

Take-Home Points For Public Health Professionals

Children who have never smoked die from tobacco smoke.

Children who have never smoked suffer serious morbidity from tobacco smoke.