Children and Secondhand Smoke: Clear Evidence for Action

aAAP Tobacco Consortium and AAP Julius B. Richmond Center of Excellence, Elk Grove Village, Illinois
PEDIATRICS (Impact Factor: 5.47). 12/2011; 129(1):170-1. DOI: 10.1542/peds.2011-3190
Source: PubMed
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    • "Of all deaths attributable to second-hand tobacco smoke, 31% occur among children(WHO 2009).Second hand smoking significantly contributes to morbidity including bronchitis, middle ear disease, impaired endothelial function and acute respiratory illness and asthma illness. Children as a group have shown the strongest evidence of harm attributable to SHS(Singh and Lal 2011, White et al 2012, Sims et al 2012, Lin et al 2010, Moritsugu 2007, Tanski and Wilson2012).Second-hand tobacco smoke is present in virtually all public places where smoking is permitted, and there is no safe level of exposure. With the widespread establishment of smoke-free workplaces and public venues, the home is becoming the predominant source of exposure to second-hand smoke (SHS) among children in the household. "

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    ABSTRACT: Polycyclic aromatic hydrocarbons (PAHs) are generated during pyrolysis of organic material. Exposure to these ubiquitous environmental contaminants is a public health problem in cities with high industrial activity and vehicular traffic as well as in rural areas due to biomass combustion. An estimate of 90% of rural populations in developing countries uses biomass as energy source, where PAH exposure can be extremely high by means of their main exposure biomarker, 1-hydroxipyrene (1-OHP) in urine. Critical scenarios in children have shown PAH levels as high as 17 µmol 1-OHP/mol creatinine. Another disturbing PAH source for children is indoor exposure to smoke from smoking parents. PAHs are human carcinogen compounds and infant populations are most vulnerable to their toxicity, highlighting the risk at which they are exposed. The genotoxic properties of PAHs are mediated by their metabolism generating reactive metabolites that interact with DNA. Several biomarkers of DNA damage such as increased frequencies of chromosomal aberrations and micronucleus, and hemoglobin and DNA adducts have been reported in children and newborns exposed to airborne pollutants. Furthermore, epidemiological studies have found increased risk of leukemia and nervous system tumors in children with high exposure to environmental pollution and research has suggested that cancer susceptibility is higher if the exposure to carcinogenic compounds occurs during fetal and childhood periods. To date, there are no PAH exposure limits to protect general population´s health, and unfortunately, in most developing countries there are no strict regulations to control environmental pollutants that additionally put at risk children´s health.
    Handbook of Polycyclic Aromatic Hydrocarbons: Chemistry, Occurrence and Health Issues, 01/2012; NOVA., ISBN: 978-1-62257-473-5
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    ABSTRACT: Objective To assess the impact of an electronic health record (EHR) modification and brief clinician training on tobacco smoke exposure (TSE) management in pediatric primary care. Methods Within a teaching hospital-based, urban primary care setting, we modified the EHR to include TSE screening prompts, decision support, educational literature, and simplified referral to the state quit line (QuitWorks). A brief training was conducted for the 48 clinic physicians (34 residents and 14 attendings). We collected cross-sectional, independent, random samples of EHR data from well-child visits for children ≤12 years old seen 3 months before (2024 visits) and 3 months after (1895 visits) the intervention and pooled client data from QuitWorks to evaluate TSE screening, counseling, and quit-line referrals. A needs assessment questionnaire examined preintervention attitudes and practice around TSE management; follow-up questionnaires explored satisfaction and subjective changes in skills. Results The baseline needs assessment revealed that although most clinicians agreed that it is appropriate for pediatricians to conduct TSE screening, counseling, and referral during well-child visits, only about half screened, 42% counseled, and 28% routinely offered to refer smoking parents. In pre–post analyses of 117 and 112 EHR-documented positive screens, the intervention was associated with a 16-fold greater likelihood of counseling among positive screens (adjusted odds ratio 16.12; 95% confidence interval 7.28, 35.68). Referrals to QuitWorks increased from 1 before to 31 after the intervention. Conclusions Implementation of EHR modifications and a brief training to support TSE management was associated with higher rates of counseling and quit-line referrals for parents who smoke.
    Academic Pediatrics 10/2014; 14(5):478–484. DOI:10.1016/j.acap.2014.03.017 · 2.01 Impact Factor
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