OTHER EFFECTS OF TOBACCO ON CHILDREN ’ S HEALTH

1. OTHER EFFECTS OF TOBACCO ON CHILDREN’S HEALTH Mini Lecture 2 Module: Tobacco and Children’s Health

2. Objectives of the Mini-Lecture GOAL OF MINI-LECTURE: Provide students with knowledge about how tobacco affects non-respiratory health in children. LEARNING OBJECTIVES: Students will be able to: • Explain at least two ways that tobacco harms children’s health, other than respiratory health. • Describe the doctor’s role in protecting children from the harm of secondhand smoke through parental education.

3. Contents Core Slides Developmental Consequences of Prenatal Tobacco Exposure (PTE) Maternal Smoking and Gastrointestinal Disease Cardiovascular Function in Infants Exposed to Tobacco Smoke Tobacco Smoke and Cot Death Thirdhand Smoke Tobacco, Poverty, and Children Doctors’ Role in SHS Exposure

4. Developmental Consequences of Prenatal Tobacco Exposure (PTE) • Nicotine crosses the placenta and concentrates in fetal tissue. • Studies of infants suggest PTE leads to deficits in information processing and self-regulation. • Studies of school-aged children found associations of PTE with: • Increased activity and attention problems • Behavior problems • Aggression • Other studies did not find these associations. • MRI studies found PTE associated with reduced brain volume. Cornelius and Day 2009

5. Maternal Smoking and Gastrointestinal Disease • Maternal smoking may harm children’s digestive tract function. • Infant exposure to tobacco smoke is linked to elevated blood motilin levels. • Maternal smoking is associated with increased incidence of infant colic. • Increased motilin may be the mechanism underlying the increased risk of colic in infants exposed to tobacco smoke. Shenassa and Brown 2004

6. Cardiovascular Function in Infants Exposed to Tobacco Smoke In a prospective study of infants born to smoking mothers and non-smoking mothers: • Infants were followed soon after birth, at 3 months, and at 1 year. • Measured heart rate and blood pressure reactivity. • Exposed infants had: • Exaggerated BP response at baseline. • Persisted at 3 months and 1 year. • Suggests maternal smoking had long-term negative reprogramming effect on CV responsiveness. • Unknown if this predicts future hypertension. Cohen 2010

7. Tobacco Smoke and Cot Death • A systematic review of 39 studies found maternal smoking doubles risk of cot death (sudden infant death syndrome). • Newer studies suggest the risk is even higher—3 to 6 times. • Dose response relationship. • If the mother quits smoking during pregnancy, risk decreases. DiFranza 2004

8. Thirdhand Smoke • Thirdhand smoke (THS): residual smoke on surfaces. • Nicotine from THS: • Reacts with other indoor pollutants. • Gets converted to carcinogens: tobacco-specific nitrosamines (TSNAs). • TSNAs last a long time in the environment. • Children are at greatest risk from THS. • Closer to floor = more exposure to house dust (including tobacco smoke particles). • Smaller body size = higher dose/weight. 1. Dreyfuss 2010; 2. Sleiman et al. 2010

9. Tobacco, Poverty, and Children Economic studies in India show households with a smoker: • Spend significant household income on tobacco. • Have less to spend on household necessities.2 • Even homeless children spent their income purchasing tobacco, prioritizing it over food.3 In a study in Bangladesh, the poorest households: • Were twice as likely to smoke. • Male smokers spend more on tobacco than on clothing, housing, health, and education, combined. • Spend up to 10 times more on tobacco than they do on education.1 1. Efroymson et al. 2001; 2. WHO and World Bank Report 2003; 3. Shah and Vaite 2002

10. Doctors’ Role in SHS Exposure • All children should be screened for exposure to SHS as a routine part of pediatric care. • All parents should be advised to protect their children from SHS. • If a child is exposed to SHS: • Parents should be strongly encouraged to implement a complete ban against smoking in the home. • Because of the risks of thirdhand smoke, even if the child is not present in house during smoking, there needs to be a complete ban on smoking in the household. • Any family member who smokes should be strongly encouraged to quit (the best way to protect children).

11. Stop smoking for the health of your family!