Impact Of Secondhand Smoke Exposure Research Articles

A history of second hand smoke exposure: are we asking the right questions?

A history of second hand smoke exposure: are we asking the right questions?

Reducing secondhand smoke exposure at home

Children's secondhand smoke (SHS) exposure remains a significant public health concern. In the UK, over half of children who live with smokers are regularly exposed to SHS at home. School nurses are well placed to raise the issue of SHS exposure, explain the benefits of creating smoke-free environments, and help with practical advice. This article looks at the impact of secondhand smoke exposure and a training module available to school nurses, which aims to help them acquire the knowledge and skills required to intervene effectively with anyone who smokes and cares for children.

Children and Secondhand Smoke: Clear Evidence for Action

* Abbreviations: AAP — : American Academy of Pediatrics SHS — : secondhand smoke Smoking rates in the United States have dropped since the first Surgeon General's report on the health effects of smoking was published in 1964.1 Decades of declining prevalence have slowed, however, with some 19.3% of US adults still smoking,2 and 53.6% of children showing biochemical evidence of exposure to secondhand smoke (SHS).3 It is well known that tobacco use leads to disease,4 and that SHS exposure is also harmful; indeed, there is no known safe level of exposure.5 According to the most recent estimates from the World Health Organization, >600 000 people worldwide die prematurely every year of exposure to SHS.6 Of these deaths attributable to SHS, 28% occur in children.6 This number excludes the millions of children worldwide who experience morbidity from SHS exposure. Although the impact of SHS exposure on the severity of pediatric lung diseases such as asthma and bronchiolitis is well known,5 we are only beginning to understand the long-term effects of SHS exposure on cardiovascular health and the pediatric antecedents of adult heart disease. Data from a study by Geerts et al7 in this issue of Pediatrics document that the harmful effects of SHS are found even earlier than expected, with in … Address correspondence to Susanne E. Tanski, MD, MPH, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Hinman Box 7925, Lebanon, NH 03756. E-mail: Susanne.E.Tanski{at}hitchcock.org

The Effect of Secondhand Smoke Exposure on Bronchiolitis Severity in Infants With and Without Familial Atopy

RATIONALE: Both secondhand smoke exposure (SHS) and familial atopy are risk factors for asthma; however, studies have been inconsistent regarding an association of atopy with bronchiolitis severity. METHODS: Among 618 mother-child dyads enrolled in the Tennessee Children's Respiratory Initiative at the time of infant acute viral respiratory illness (ARI), 2004-2008, we examined the association of both familial atopy (first degree relative with asthma, allergic rhinitis, or atopic dermatitis) and SHS on severity of infant ARI using an ordinal bronchiolitis severity score (BSS) with higher values indicating more severe disease, and length of hospitalization (LOS) among those hospitalized. Multiple linear regression analysis was used for adjusted effects of SHS and familial atopy on infant outcomes. RESULTS: Demographics of infants exposed to SHS vs. those without SHS included lower birth weight, higher Medicaid enrollment, and less breastfeeding (p < 0.01). In the subset with bronchiolitis (N = 455), infants with SHS had a higher BSS (Median [Interquartile range] 7.0 [4.5,9.0] than infants without SHS 6.0 [IQR: 3.5,8.5], p = 0.016). Among hospitalized infants with familial atopy, those with SHS had an increased LOS compared to those without SHS (3 [2,6] vs. 2.5 [2,4], p = 0.007). There was no difference in LOS by SHS among infants without familial atopy (p = 0.658). CONCLUSIONS: SHS is an important risk factor for infant bronchiolitis severity, and the impact of SHS on bronchiolitis morbidity is greater among infants with familial atopy.

Secondhand Smoke and Respiratory Symptoms Among Adolescent Current Smokers

No study has ever reported the association between persistent respiratory symptoms and exposure to secondhand smoke (SHS) in adolescent smokers. The impact of SHS exposure on child health could be largely underestimated by not taking into account such effects. We investigated the association between exposure to SHS and respiratory symptoms among adolescent current smokers. A total of 32506 students aged 11 to 20 years from 85 randomly selected secondary schools in Hong Kong completed a self-administered questionnaire that included persistent respiratory symptoms (for 3 consecutive months in the past 12 months), number of days of SHS exposure per week at home and outside home, smoking status, amount of active smoking, and other basic demographic characteristics and socioeconomic status. Adolescent current smokers who were exposed to SHS at home 1 to 4 and 5 to 7 days/wk were 50% (95% confidence interval [CI]: 3%-121%) and 77% (95% CI: 5%-199%) more likely, respectively, to report respiratory symptoms compared with those who were unexposed (P = .01 for trend). The corresponding figures for exposure outside home were 41% (95% CI: 3%-94%) and 85% (95% CI: 31%-161%; P = .004 for trend). Such associations were also observed among never-smokers, but they were weaker than those among current smokers (P < .01 for interaction). This is the first evidence that SHS exposure is associated with increased risks for persistent respiratory symptoms among adolescent current smokers. Health promotion programs should aim at SHS reduction as well as smoking cessation among adolescent smokers.

Longer term exposure to secondhand smoke and health outcomes in COPD: Impact of urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol

Secondhand smoke (SHS) contains respiratory irritants and has the potential to adversely affect adults with chronic obstructive pulmonary disease (COPD), but few studies have evaluated the impact of SHS on COPD. We used data from 72 nonsmoking participants in a cohort study of COPD. Urine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) was measured as an indicator of longer term SHS exposure, whereas urine cotinine was assessed as a measure of more recent exposure. The impact of SHS exposure on COPD-related health status was examined using multivariate linear regression (controlling for age, sex, race, educational attainment, and smoking history). Health status was measured using a validated COPD severity score, reported dyspnea, a standard health status measure (Short Form-12), and activity restriction. The urine NNAL-to-creatinine ratio (per interquartile increment) was associated with greater COPD severity (mean score increase 1.7 points; 95% CI 0.6-2.8; p = .0003). Higher urine NNAL was also related to greater dyspnea, poorer physical health status, and more restricted activity (p < or = .05 in all cases). When considered simultaneously, longer term exposure (NNAL) had a greater negative impact on COPD status than shorter term exposure (cotinine). Urine NNAL can be used to estimate longer term SHS exposure and negatively affects a number of health outcomes among adults with COPD. Screening for and prevention of SHS exposure among persons with COPD may be beneficial.

The impact of SHS exposure on health status and exacerbations among patients with COPD

Secondhand smoke (SHS) is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD). We used data from nonsmoking members of the FLOW cohort of COPD (n = 809) to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization). SHS exposure was measured by a validated survey instrument (hours of exposure during the past week). Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL) by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement -1.78 points; 95% confidence interval [CI] -3.48 to -0.074 points) after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25) and less distance walked during the Six-Minute Walk test (mean decrement -50 feet; 95% CI -102 to 1.9). Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED) visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13). Lower level and higher level SHS exposure were associated with a greater risk of hospital-based care for COPD, which was a composite endpoint of either ED visits or hospitalizations for COPD (HR 1.52; 95% CI 1.06 to 2.18 and HR 1.40; 95% CI 0.94 to 2.10, respectively). In conclusion, SHS was associated with poorer health status and a greater risk of COPD exacerbation. COPD patients may comprise a vulnerable population for the health effects of SHS.

Secondhand smoke and respiratory ill health in current smokers

Background: Numerous studies have concluded that secondhand smoke (SHS) is harmful to non-smokers but controversy persists regarding its effects on smokers. The impact of SHS exposure on the acute respiratory...