SMOKING : SLOWLY TAKING YOUR BREATH AWAY
( continued from page 11 ) Death Syndrome , recurrent otitis media , lower respiratory tract infections and asthma . 6 Adverse growth outcomes have also been reported . 7 Secondhand tobacco smoke exposure has also been associated with a spectrum of mental health disorders in teenagers including major depressive disorder , generalized anxiety disorder , attention-deficit / hyperactivity disorder and conduct disorder after adjusting for multiple confounders . 8 This association was stronger in males and persons of non-Hispanic white race / ethnicity . Screening for and addressing secondhand exposures from birth ( and before ) is essential to mitigate these risks .
A 2015 study from the CDC found that only 21.5 % of adults believed that secondhand aerosol from e-cigarettes caused “ a lot of harm ” to exposed children , with 5.3 % stating they caused “ no harm ,” 39.9 % “ little harm ” or “ some harm ” and 33 % stating they didn ’ t know . 9 Data is limited on how perceptions may have changed since that time , but it is important for families to understand that secondhand aerosol from these products contain numerous harmful chemicals including carcinogens , heavy metals , nicotine , ultrafine particles and volatile organic compounds ( VOCs ). 10 Certain chemicals have been linked to adverse cardiovascular outcomes and VOCs are known asthma triggers and , indeed , secondhand exposure to secondhand aerosol has been linked to an increased risk for asthma exacerbations . 11 While the long-term health consequences of secondhand aerosol exposure have not yet been fully quantified , it is crucial that physicians ensure children live in environments with clean air , free of toxins , for optimal health . It is also important for physicians to remind users that e-cigarettes are not FDA approved smoking cessation devices and are instead designed to prolong addiction to nicotine .
While the direct and secondhand adverse effects of tobacco smoke have been well researched and documented , less is known about health consequences related to secondhand inhalation of marijuana . Marijuana smoke contains many of the same toxic and carcinogenic chemicals found in tobacco smoke as well as fine particulate matter ( PM2.5 ) which can result in airway inflammation . Studies have shown particulate matter levels in marijuana smoke are actually higher than that in tobacco smoke , with one study finding 3.5 times higher levels of PM2.5 with smoked marijuana compared to Marlboro tobacco cigarettes . 12 This would be expected to have significant cardiovascular and respiratory consequences , especially for children at high risk with conditions such as asthma . While more research is needed , waiting for extended data should not delay screening in health care settings .
The COVID-19 pandemic has brought increased public attention to respiratory health and there has been much discussion about the impact of smoking and related behaviors on COVID-19 outcomes . Use of e-cigarettes has been linked to higher rates of COVID-19 in teenagers , likely due to an increased level of disease severity and thus disease identification . 13 E-cigarette or vaping use-associated lung injury also mimics many symptoms of COVID-19 , 14 so screening for use of these products is essential in any person with acute respiratory symptoms . Likewise , smoking tobacco is a risk factor for developing symptomatic COVID-19 and increased disease severity . 15 , 16 The exact impact of secondhand exposures on COVID-19 risk remains undetermined . However , air pollution , including increases in PM2.5 , have been associated with worse outcomes in multiple studies . 17 , 18 Extrapolation of this available data suggests an adverse impact from secondhand smoke and e-cigarette aerosol .
Once secondhand exposures are identified , it is crucial that physicians understand how to communicate the need to quit and have the resources to empower families to accomplish this goal . Regarding communication strategies , parents identified framing the need for cessation in a manner that emphasizes the impact on the child ’ s health as especially important in motivating them to quit . 19 Multiple resources are available to help with this challenging process . The Kentucky Cabinet for Health and Family Services provides access to several free programs for both teens and adults addressing both cigarettes and e-cigarettes ( https :// chfs . ky . gov / agencies / dph / dpqi / cdpb / Pages / quit . aspx ). For teenagers , Norton Children ’ s Prevention & Wellness offers “ N-O-T : Not on Tobacco ,” an American Lung Association program conducted locally by trained facilitators . This program is a series of seven weekly sessions , currently being done virtually , specifically designed for teenagers to aid in cessation . Interested families can sign up here : https :// nortonchildrens . com / prevention-wellness / classes-events /. Finally , the American Lung Association has an extensive set of resources for families and providers to assist in quitting ( https :// www . lung . org / quit-smoking ).
In summary , smoking and related activities continue to be a challenging public health issue with significant implications for children who are secondarily exposed . Ongoing screening , education , support for cessation programs and public health / legal policies can help reduce this burden in the future and help achieve the goal whereby all children grow up in an environment with clean air .
References
1
Initiative T . Tobacco use in Kentucky 2020 2020 [ 9 / 25 / 2021 ]. Available from : https :// truthinitiative . org / research-resources / smoking-region / tobacco-use-kentucky-2020 .
2
Park-Lee E , Ren C , Sawdey MD , Gentzke AS , Cornelius M , Jamal A , et al . Notes from the Field : E-Cigarette Use Among Middle and High School Students - National Youth Tobacco Survey , United States , 2021 . MMWR Morb Mortal Wkly Rep . 2021 ; 70 ( 39 ): 1387-9 . Epub 2021 / 10 / 01 . doi : 10.15585 / mmwr . mm7039a4 . PubMed PMID : 34591834 .
3
Yu B , Chen X , Chen X , Yan H . Marijuana legalization and historical trends in marijuana use among US residents aged 12 – 25 : results from the 1979 – 2016 National Survey on drug use and health . BMC Public Health . 2020 ; 20 ( 1 ): 156 . doi : 10.1186 / s12889-020-8253-4 .
4
Abuse NIoD . What is the scope of marijuana use in the United States ? 2021 [ updated 20 April 2021 ; cited 2021 October 1 ]. Available from : https :// www . drugabuse . gov / publications / research-reports / marijuana / what-scope-marijuana-use-in-united-states .
5
Tsai J , Homa DM , Gentzke AS , Mahoney M , Sharapova SR , Sosnoff CS , et al . Exposure to Secondhand Smoke Among Nonsmokers - United States , 1988- 2014 . MMWR Morb Mortal Wkly Rep . 2018 ; 67 ( 48 ): 1342-6 . Epub 2018 / 12 / 07 .
12 LOUISVILLE MEDICINE