Childhood predictors of smoking in adolescence: a follow-up study of Montréal schoolchildren

Environmental Tobacco Smoke (ETS) contains toxic substances, over 40 of which cause cancer. Some of these substances are in stronger concentrations in second-hand smoke than they are in the smoke that goes directly into smokers’ lungs. Environmental Tobacco Smoke is a real and substantial threat to child health, causing death and suffering throughout the world. (1)

The vast majority of children exposed to tobacco smoke do not choose to be exposed. This involuntary and harmful exposure can be seen as a human rights violation, given the provisions of Article 6 and 24 of the 1989 United Nations Convention on the rights of the Child. (1) Preventing children’s exposure to tobacco smoke will lead to improved child, adolescent, and ultimately adult health, resulting in reduced mortality and substantial savings in long term/short term health care and other direct costs. New strong regulations are necessary to protect children from exposure to tobacco smoke. These regulations should aim to ensure the right of every child to grow up in an environment free of tobacco exposure.

In Canada all children under the age of 15, some 2.8 million children, are exposed to second-hand smoke on a regular basis. (2) ETS exposure causes a wide variety of adverse health effects in children, including lower respiratory tract infections such a pneumonia and bronchitis, coughing and wheezing, worsening of asthma, and middle ear disease. Asthma is the most common chronic disease of childhood, and environmental factors play an important role in determining both onset and severity. Children’s exposure to ETS may also contribute to cardiovascular disease in adulthood and to neurobehavioral impairment.

Maternal smoking during pregnancy is a major cause of sudden infant death syndrome (SIDS) and other well-documented health effects, including reduced birth weight and decreased lung function. ETS exposure among nonsmoking pregnant women can cause a decrease in birth weight and that infant exposure to ETS may contribute to the risk of SIDS. A British study found that SIDS deaths could be reduced by two thirds if parents did not smoke. (3) Maternal smoking doubles the risk of sudden infant death syndrome. The relationship is almost certainly causal. (4)

The published literature reports a 20% to 30% smoking rate among pregnant women. (5, 6) Smoking during pregnancy is a significant public health problem worldwide. Strong medical and legal interventions must be adopted for the women to stop smoking before pregnancy. A major, preventable exposure remains for infants throughout the world and health care providers should redouble counseling efforts toward reducing this exposure. The low success rate of smoking cessation among pregnant women in the literature suggests that efforts to reduce the complications of pregnancy attributable to tobacco use by pregnant women should focus on preventing nicotine addiction among youth and adolescents.

Despite support from professional organizations and federal government groups, many pediatricians and family physicians do not routinely engage in intensive efforts to reduce children's ETS exposure. Training in techniques for reducing tobacco dependence should be included in professional education programs. Public and private insurance should reimburse providers for efforts in this area. (7) As a result of an effective intervention by pediatrics and family physicians in Sweden, maternal smoking during pregnancy has decreased from 24% to 10% during 1994-2004. (8)

References:

(1). Desapriya, E.B.R and Nobutada I., Shimizu, S., Political economy of tobacco control policy on public health in Japan. Japanese Journal of Alcohol Studies & Drug Dependence 38(1):15-33(2003).

(2) Health Canada Environmental Tobacco Smoke (ETS) in home environments, Health Canada-Ottawa-Canada (1996).

(3). Peter B., et al; Smoking and the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry in to stillbirths and deaths in infancy.

BMJ 313:195-198 (1996)

(4).Anderson HR, Cook DG: Passive smoking and sudden infant death syndrome: review of the epidemiological evidence. Thorax 52:1003- 1009(1997).

(5). DiFranza JR, Lew RA: Effect of Maternal Cigarette Smoking on Pregnancy Complications and Sudden Infant Death Syndrome. J Family Practice 40(4):385-394(1995)

(6). Cnattingius S, Haglund B, Meirik O: Cigarette smoking as risk factor for late fetal and early neonatal death. BMJ 297:258-261(1988).

(7). Klerman L.Protecting children: reducing their environmental tobacco smoke exposure. Nicotine Tobacco Res. 6 Suppl 2:S239-53(2004).

(8). Alm B, Wennergren G, Erdes L, Mollborg P, Pettersson R, Aberg N, Norvenius SG. [Parents have accepted the advice on how to prevent sudden infant death] Lakartidningen. 1; 101(14):1268-70 (2004). (Article in Swedish)

Conflict of Interest:

None declared