Environmental tobacco smoke and children's health

Abstract

Passive exposure to tobacco smoke significantly contributes to morbidity and mortality in children. Children, in particular, seem to be the most susceptible population to the harmful effects of environmental tobacco smoke (ETS). Paternal smoking inside the home leads to significant maternal and fetal exposure to ETS and may subsequently affect fetal health. ETS has been associated with adverse effects on pediatric health, including preterm birth, intrauterine growth retardation, perinatal mortality, respiratory illness, neurobehavioral problems, and decreased performance in school. A valid estimation of the risks associated with tobacco exposure depends on accurate measurement. Nicotine and its major metabolite, cotinine, are commonly used as smoking biomarkers, and their levels can be determined in various biological specimens such as blood, saliva, and urine. Recently, hair analysis was found to be a convenient, noninvasive technique for detecting the presence of nicotine exposure. Because nicotine/cotinine accumulates in hair during hair growth, it is a unique measure of long-term, cumulative exposure to tobacco smoke. Although smoking ban policies result in considerable reductions in ETS exposure, children are still exposed significantly to tobacco smoke not only in their homes but also in schools, restaurants, child-care settings, cars, buses, and other public places. Therefore, more effective strategies and public policies to protect preschool children from ETS should be consolidated.

Keywords: Child; Cotinine; Hair; Nicotine; Tobacco smoke pollution.

Fig. 1

Comparative box plots of nicotine concentrations (ng/mg) in (A) neonatal, (B) maternal, and (C) paternal hair by smoker group, Korea, 2005 to 2007. Y-axes in each of the 3 parts are scaled differently depending on the distribution of nicotine concentration in each group. Asterisks denote outliers. The vertical line indicates the range of concentrations observed within each group; the box indicates the 25th and 75th percentiles; and the horizontal line in each box indicates the median concentration in each group (Reprinted from Seong MW, Hwang JH, Moon JS, Ryu HJ, Kong SY, Um TH, et al. Am J Epidemiol 2008;168:1140-4, with permission of Elsevier) [3].

Fig. 2

Nicotine concentrations (ng/mg hair) of nonsmoking household members in the indoor-smoker group. The box plots from left to right denote preschool children, school children, mothers of preschool children, and mothers of school children, respectively (Reprinted from Seong MW, Moon JS, Hwang JH, Ryu HJ, Kang SJ, Kong SY, et al. Clin Chim Acta 2010;411:72-6, with permission of Elsevier) [62].