Clearing the Air: Children's Respiratory Risks Associated with Secondhand Smoke Exposure

Alabama Nurse, Jun-Aug 2005 by Turner-Henson, Anne

Secondhand smoke exposure has been cited as the most common and preventable environmental respiratory irritant for children, resulting in increased risks for acute respiratory infections (bronchitis, pneumonia), otitis media and exacerbations in chronic respiratory conditions (asthma, cystic fibrosis) (IOM, 2000). Economic costs associated with secondhand smoke exposure have been estimated to be over $157 billion annually and over 440,000 premature deaths due to secondhand smoke (CDC, 2002). Household exposure to secondhand smoke is particularly high among children and estimates of exposure in US children's homes range from 11.7 to 34.2% based on number of homes with an adult smoker (CDC, 2000).

Neonatal and health consequences during infancy have been strongly linked to early secondhand smoke exposure, such as SIDS (CDC, 2002), decreases in lung function, and in utero exposure has been associated with a 23 gram decrease in birthweight (Windham, Eaton & Waller, 1995). Secondhand smoke exposure has been clearly linked to asthma exacerbations in preschool children (IOM, 2000), and recovery from acute asthma exacerbations in children can be impaired significantly by secondhand smoke exposure. Annual direct medical expenditures for childhood respiratory illness attributable to maternal smoking have been estimated to total $661 million for children under the age of 6 years (Taggart & Fulwood, 1993). Coupled with the impact of pediatric asthma and secondhand smoke on family budgets, out-of-pocket expenditures result in the largest single indirect cost of childhood asthma, approaching $1 billion in 1990.

While smoking rates have dropped in general, smoking prevalence is increasing among adults who are of low socioeconomic status, young adults of childrearing age and minorities (CDC, 2000); which equate with an increased risk of secondhand smoke exposure for children. Household secondhand smoke exposure among children has been strongly linked to maternal and paternal smokers, although some studies have demonstrated that children may be exposed to secondhand smoke by other sources, including other relatives, family friends, or at other homes such as relative's or family friend's homes. Many previous studies have misclassified children's exposure status (i.e., using only parental exposure), thus reducing the disparity in disease rates between exposed and unexposed groups, and resulting in an underestimate of the true magnitude of the risk (Hovell, Wahlgren, Zakarian & Matt, 2001).

While smoking cessation is generally agreed to be the most desirable health outcome, there is increasing evidence that home smoking restrictions may be more attainable as an immediate intervention to reduce children's exposure to secondhand smoke. Emmons and colleagues (2001) conducted a literature review and found only four studies that examined interventions to reduce children's exposure to secondhand smoke. These interventions targeted women in the immediate postpartum period, with self-help materials provided after delivery and during well-child care by pediatricians. Recently, behavioral focused studies with children under the age of 3 years have resulted in significant deceases in secondhand smoke exposure over a six-month period (Emmons, Wong, Hammond, Velicer, Fava & Monroe, 2001). Some studies have examined secondhand smoke exposure in children with asthma, though these studies focused primarily on parental sources (Hovell, Melter, Zakarian, Wahlgren, Emerson, Hofstetter, et al, 1994), failing to recognize other household or secondary residential settings where children may be exposed.

Alabama nurses can play a pivotal role in reducing children's exposure to secondhand smoke. As nurses we should focus on reducing exposure through' both interventions directed not only at individuals but also promoting public awareness of the dangers of secondhand smoke exposure for children. Nurses can play an instrumental role in promoting public policy changes for smoke free places (public places like restaurants, malls, etc.). Public policy information related to tobacco control and restrictions for individual Alabama communities may be found at: http://www.adph.org/tobacco/admin/Default.asp?action=policy.

Nursing interventions to reduce children's exposure can include clinical advice, counseling, referral to smoking cessation, and policy changes. While most nurses may conduct these interventions in health-related settings, attention must be directed to other settings that serve children, such as preschool programs, schools, recreational programs, community settings, and others. National health objectives, Healthy People 2010, calls for a reduction in secondhand hand smoke exposure among nonsmokers from 65% (1988-94) to a goal of 45% in 2010.

Reducing secondhand smoke exposure should focus on promoting smoke-free homes and cars. The five A's has been found to be a useful technique both in tobacco cessation and sometimes applied to secondhand smoke reduction (DHHS, 2000). These strategies are usually used with individuals who express a willingness to quit or smoke outside. The five A's consists of: