Smoking and children

Tobacco use by children and adolescents is a major health threat. A number of carcinogens and other harmful compounds have been identified in tobacco smoke. The major component, nicotine, is highly addictive. In India, approximately 5500 children and adolescents start using tobacco products daily, some as young as 10 years old. The majority of users have first tried tobacco prior to age 18. Children and adolescents are exposed to the harmful effects of nicotine from smoking or second hand smoke from others; and from use of smokeless tobacco. There is increased prevalence of respiratory disease, ear and sinus infections, asthma, oral disease, and many long-term complications such as cardiovascular disease and cancers due to tobacco use. Prevention and treatment strategies include behavioural approaches and pharmacotherapy. There is an increased urgency especially, for countries like India to address the problem of tobacco use by children and adolescents as the tobacco industry faces legal and public opinion obstacles in Western countries like United States. The medical practitioner can play an important role by implementing the preventive and treatment strategies in his or her practice.     

Smoking in parents of children with asthma and bronchiolitis in a pediatric emergency department

OBJECTIVES: To determine smoking habits, levels of nicotine-addiction, readiness to quit, and beliefs about the effects of environmental tobacco smoke (ETS) of parents of children with bronchiolitis and asthma who present to a children's emergency department (ED). DESIGN/METHODS: This was a cross-sectional prevalence study of parents or legal guardians of children with asthma or bronchiolitis presenting to a pediatric ED. RESULTS: Two hundred forty-nine parents/legal guardians comprised the study group. The mean age (+/-SD) was 30.0 (+/-8.9) years; 88% were female; 51% were nonwhite; 37% were educated beyond high school. The self-reported smoking prevalence was 41% (95% CI = 32-51). Smoking prevalence among parents of wheezing children varied according to education, income, and race, but not according to gender, age, or employment status. Of the 102 smokers in the sample, 84 (82.4%, 95% CI = 73-88) reported that they wanted to quit; 78 (76.5%, 95% CI = 68-84) stated that they wanted to quit within the next month. Forty-nine percent (95% CI = 39-59) scored above 4 on the Fagerstrom Test for Nicotine Dependence and were considered nicotine-dependent. The majority of smokers admitted to smoking around their children (66.7%, 95% CI = 57-75). Many parents knew that ETS might contribute to the development of the following illnesses: colds/upper respiratory tract infections - 77.5%, otitis media - 68.6%, pneumonia - 50%, wheezing/asthma attacks - 86.3%, and SIDS - 31.4%. CONCLUSION: The prevalence of smoking and nicotine addiction among parents of children with asthma or bronchiolitis who bring their children to a pediatric ED is high. Many parents have some knowledge about the effects of ETS, and the majority would like to quit. Future studies to help determine the best way to deliver advice to parents on ETS exposure reduction and smoking cessation are warranted.     

Smoking patterns of household members and visitors in homes with children in the United States

BACKGROUND: Environmental tobacco smoke (ETS), also called passive smoking, has been shown to have adverse effects on the health of children. OBJECTIVE: To determine the prevalence and pattern of ETS exposure in US homes with children younger than 18 years. DESIGN: We analyzed data from the 1994 National Health Interview Survey and Year 2000 Objectives supplement. A multistage sample design was used to represent the civilian, noninstitutionalized population of the United States. MAIN OUTCOME MEASURES: Frequency of smoking by household residents and visitors in homes with children. RESULTS: Thirty-five percent of children in the United States-21 million children-live in homes where residents or visitors smoke in the home on a regular basis (> or =1 d/wk). From the household perspective, regular smoking by residents and visitors occurs in 36% of homes in which children reside. In 92% of homes with children where residents smoke at home, they do so every day of the week. Sixteen percent of nonsmoking respondents with children report that other residents or visitors smoke in the home. In 6% of the homes where no residents smoke, there is nevertheless regular smoking by visitors. In multivariate regression analysis, the prevalence of regular smoking in homes with children varies by age of youngest child, race/ethnicity, number of parents in the home, parental educational level, income, and region of the country. CONCLUSIONS: Many children live in homes with ETS. Most respondents who smoke report that smoking occurs in the home every day. Visitors are an additional source of ETS in homes, including some homes where residents do not smoke. Clinicians who take care of children can advise parents, whether or not they smoke, on how to limit their children's ETS exposure.     

Smoking habits in survivors of childhood and adolescent cancer.

Because of their increased risk for second cancers, childhood cancer survivors are people who really should not smoke, but available evidence suggests that they do. We studied the smoking habits of long-term childhood cancer survivors in data collected from 1289 adult survivors of childhood cancer and 1930 of their sibling controls. Survivors were diagnosed with cancer between 1945 and 1974 when they were less than 20 years old. Using matched analyses that controlled for the influence of family, survivors were 8% less likely than controls to be current smokers, 13% less likely to be ever-smokers, but 12% less likely to have quit smoking; these differences were not statistically significant. In a logistic regression analysis there was a significant difference by year of diagnosis for current smoking rate ratios (RR); survivors were less likely to be current smokers if diagnosed in recent years (RR = 0.76; 95% confidence intervals = 0.58-0.98, between 1965-74) and quite similar to controls if diagnosed in earlier years (RR = 1.05 between 1945 and 1954). In our group of long-term cancer survivors, the reduction in current smoking came about because survivors were more inclined never to start smoking than controls. Once addicted to tobacco, they were less likely to quit. While the fact that survivors are less likely to start smoking is encouraging, the persistence of smoking habits strongly suggests the need for continuing efforts to prevent smoking in this most vulnerable group.     

Smoking habits of parents attending a children's hospital.

This exploratory study surveyed 418 parents attending a paediatric hospital in order to establish their smoking habits and preparedness to quit. We found that 27% were current smokers, of whom 81% were willing to try and quit in the near future. These and the parent's other responses to a questionnaire will be used to develop a programme of smoking cessation for parents attending a children's hospital.     

Smoking rates and the state of smoking interventions for children and adolescents with chronic illness

Engaging in smoking is particularly risky for children and adolescents with chronic illness whose health status is already compromised because of disease- and treatment-related complications. Yet, some of these youngsters smoke at rates at least comparable to those of their healthy peers. To date, few randomized smoking-prevention and cessation trials have been conducted in children with chronic medical problems. In this review we report on the smoking rates among youngsters with chronic illness, identify specific disease- and treatment-related complications that can be exacerbated by smoking, examine risk factors associated with tobacco use among medically compromised youngsters, and review smoking interventions that have been conducted to date with pediatric populations in the health care setting. The following chronic illnesses are included in this review: asthma, cystic fibrosis, cancer, sickle cell disease, juvenile-onset diabetes, and juvenile rheumatoid arthritis. Objectives for a tobacco-control agenda and recommendations for future tobacco studies in chronically ill pediatric populations are provided. Finally, tobacco counseling strategies are suggested for clinicians who treat these youngsters in their practices.