AHA calls for elimination of childhood exposure to secondhand smoke

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Children exposed to tobacco smoke are at an increased risk of developing cardiovascular health problems later in life, according to a policy statement from the American Heart Association (AHA).

The statement was published online in Circulation Sept. 12.

In the U.S., more than 45 million adults (18 percent of the population) smoke cigarettes, down from approximately 40 percent of adults in 1964. Still, the AHA noted that an estimated 24 million nonsmoking children and youths in the U.S are exposed to secondhand smoke.

“Parents should consider making their children’s environment smoke free because cigarette smoke exposure is harmful to children’s long-term heart health and may shorten life expectancy,” Geetha Raghuveer, MD, MPH, pediatric cardiologist and chair of the AHA’s expert panel, said in a news release. “Children exposed to cigarette smoke may develop early heart disease as adults due to poorly functioning, stiffer blood vessels. Some babies who were exposed to cigarette smoke while still in the womb may be at risk for sudden death during infancy.” 

Approximately 40 percent of school-aged children and 33 percent of adolescents are involuntarily exposed to secondhand tobacco smoke. Children from 3 to 11 years old have the highest exposure to secondhand smoke (41 percent), as do children of minority ethnic backgrounds (68 percent) and children living in low socioeconomic status households (43 percent).

The estimates for secondhand smoke exposure have significantly decreased since the National Health and Nutrition Examination Survey III from 1988 to 1994, according to the statement. The report’s authors also mentioned that 34 percent of nonsmoking middle school and high school aged adolescents reported they were exposed to secondhand smoke in 2009, down from 59 percent in 2000.

Still, the researchers wrote that the “prevalence remains strikingly high.” The statement mentioned that secondhand smoke was associated with an increased rates of respiratory infections, an increased frequency and severity of asthma exacerbations and a greater risk of sudden infant death syndrome.

“Although the pulmonary consequences of [secondhand smoke] exposure are clinically apparent in childhood, the cardiovascular effects of [secondhand smoke] exposure are occult but long-lasting and substantial,” the authors wrote. “Existing evidence suggests that [secondhand smoke] exposure in children and youth is detrimental to their cardiovascular health and that consequences attributable to [secondhand smoke] exposure may persist into adult life.”

The authors mentioned that smoking bans, increasing taxes on tobacco products and educational and behavior modification programs have been effective at reducing smoking prevalence and improving awareness. However, despite the declining number of children and adolescents exposed to secondhand smoke, the AHA called for a zero tolerance policy for adults smoking in front of their children and other children.

“Healthcare providers need to emphasize and promote heart-healthy behaviors in caretakers of children at every encounter and encourage parents and caretakers to cease smoking for their own and their child’s well-being,” the authors wrote. “Interventions that include mass media campaigns, cigarette price increases, including those that result from tax increases, school-based policies and programs, and statewide or community-wide changes in smoke-free policies are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults and may substantially decrease [secondhand smoke] exposure. The evidence presented in this statement calls for a robust public health policy that embraces zero tolerance of childhood [secondhand smoke] exposure.”