Exposure to secondhand smoke (SHS) is declining in the United States, but approximately 40 percent of children have biochemical evidence of SHS exposure. There are persistent disparities in the levels of exposures.
Health effects
•Combustible tobacco
Established health effects of SHS in children include prematurity and perinatal mortality, fetal growth restriction, sudden infant death syndrome, respiratory symptoms and illnesses (including asthma), earlier initiation of atherogenesis and future risk of cardiovascular disease, renal function impairment, and middle ear disease.
•Electronic cigarettes (e-cigarettes)
Health effects of exposure to vapor from e-cigarettes are less well established, but it is clear that vapor exposes bystanders to significant concentrations of aerosolized nicotine and that high levels of fine and ultrafine particles similar to tobacco smoke particles can be observed in indoor environments where e-cigarettes have been used.
●Strategies to reduce SHS exposure
Recommended strategies to reduce SHS exposure include:
•Screening
Ask about SHS exposure at all visits. Ask about the home smoking policy and the presence of household smokers.
•Counseling
Counseling should include specific and personalized messages to parents and caregivers about risks of SHS and strategies for smoking cessation. These messages are particularly important and may be more effective during important life events, such as pregnancy, birth of a child, or early childhood. A majority of smoking parents report that they want to quit and are open to smoking cessation advice from their child’s pediatrician.
•Smoking cessation for household members
The home environment is the most important source of exposure to SHS for children. Smokers should be supported in quitting smoking for the benefit of their own health as well as the health of those around them. Clinician support for smoking cessation includes direct counseling, referral, and, sometimes, pharmacotherapy.
•Household smoking bans
In homes of smokers who are unable or unwilling to quit, a complete ban on indoor smoking is helpful; partial restrictions on smoking in the home are less effective. Air cleaning devices are generally not effective in ameliorating SHS exposure and should not be recommended.
●Thirdhand smoke (THS)
THS exposure refers to contact with smoke components and their metabolic byproducts on surfaces that have adsorbed smoke as well as off-gassed components. Although direct health effects from THS have not been established, many of the toxins that are deposited on surfaces are carcinogens, raising concerns about chronic exposure through dermal exposure, dust inhalation, and ingestion.
●Public smoking bans
Policies that ban all indoor smoking in workplaces and public places are highly effective in reducing smoke exposure and are an important goal of health advocacy. For workers exposed to SHS during the workday, the degree of smoke exposure may be comparable with sharing a home with a smoker. Only complete bans of indoor smoking are effective; simply segregating smokers and nonsmokers within the same airspace may reduce the exposure of nonsmokers to SHS but does not eliminate it.
