US Children’s Exposure to Tobacco Smoke and its Effects

Forty million children in the US are exposed to environmental tobacco smoke (ETS) each year. The statistics are alarming. While the percentage of children without asthma exposed to ETS decreased from 57.3% to 44.2% during the years 1999 to 2010, there was no change in exposure for children with asthma with more than 1 in 2 children with asthma exposed to ETS, a higher percentage than children without asthma.
ETS exposure increases the risk for respiratory and middle ear infections and premature death. ETS is not associated with IgE sensitization to indoor allergens but is linked to respiratory disease. A study in Romania of 136 school children found a higher prevalence of respiratory disease in children exposed to ETS from parents, particularly a father who smoked.
ETS is hazardous, particularly to growing children whose lungs are growing too. Parents were asked to estimate the amount of ETS their children were exposed to; in every case, they underestimated the amount of ETS exposure.
A study published in Chest found that parents and caregivers do not see the link between asthma and cigarette smoke. Farber and colleagues measured cotinine levels in the urine of 519 children (aged 3 years to 12 years) who had asthma. They found a direct correlation between cotinine levels and the number of caregivers who smoked. Yet, over 58% of caregivers (including parents) felt that there was no connection between their smoking and the child’s asthma.
Even though parents and caregivers failed to see the connection between their smoking and the child’s asthma, many (61%) had tried to stop smoking and over 72% tried to keep their children away from a smoking environment.
Research has shown the transgenerational effects of smoking, and its harmful effects on the fetus, where lung function, once impaired, is never regained. A study on the effects of second-hand smoke  or ETS on infants shows an increased risk of hospitalization for infection.
Kwok and colleagues studied a birth cohort of 7402 children. Of these 3692 had, by age 8, at least one admission to a hospital for treatment of infection. 50% of the admissions were for a respiratory tract infection. The study results show that the risk of hospitalization for infection due to ETS was highest during the first six months of life and that exposure to  ETS within 3 metres was an independent risk factor for hospitalization for any infection. Infants with a low birth weight or who had a history of premature delivery were at particular risk for hospitalization due to ETS exposure.
An analysis of the 2003 –2010 data for nonsmoking children (6 to 19 years) with asthma from the National Health and Nutrition Examination Survey found that 53.3% of children with asthma were exposed to ETS.  This exposure was associated with the most adverse outcomes particularly for children with asthma in the 6 – 11 years group even if the ETS exposure resulted in low serum cotinine levels. Outcomes included sleep disturbance, missed school days, health care visits, limitation of activity and wheezing with exercise.



US Department of Health and Human Services; The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. 2006 Available at:
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