The effects of second-hand and direct exposure to tobacco smoke on asthma and lung function in adolescence

doi:10.1016/j.prrv.2007.11.006

Paediatric Respiratory Reviews

Volume 9, Issue 1, March 2008, Pages 29-38

https://doi.org/10.1016/j.prrv.2007.11.006 Get rights and content

Summary

Cigarette smoking still is quite common in many parts of the world. In parallel, exposure to second-hand smoke continues to be common despite declines in smoking in developed countries and despite evidence of serious health effects in infants and children. This paper focuses on the effects of second-hand and direct exposure (personal smoking) on the respiratory health of adolescents, in particular effects on the occurrence of asthma and on lung function.

Published data indicate that, in addition to whatever effects direct and postnatal second-hand tobacco smoke exposure have on the occurrence of asthma and impaired levels and growth of lung function in adolescents, there is an underlying alteration in the prenatal and early postnatal development of the structural and mechanical characteristics of the lung that contribute substantially to these deficits. These developmental effects may be important contributors to the future risks for impaired pulmonary function.

Section snippets

Asthma (prevalence and incidence)

Although there have been several recent meta-analyses of the association between exposure to SHS and asthma,6, 10 these are based largely on data related to the prevalence of asthma in the pre-teen years. The 2006 Report of the Surgeon General on the health consequences of exposure to SHS⁶ identifies only two studies whose results can be related specifically to the teen years.11, 12 The study by Moyes et al. (available to this author only in abstract form) was derived from the ISSAC

Lung function

There is a substantial body of data to indicate that maternal smoking in pregnancy and childhood has a causal association with reduced lung function across childhood.⁶ Two studies in particular have established that maternal smoking during pregnancy adversely effects lung function at birth.

Tager and colleagues measured infant lung function at 2–6 weeks postpartum and at 6, 9, 12 and 18 months in 159 healthy, full-term infants by the ‘hug technique’.²⁵ Vmax_FRC (a measure of airway function) was

Comment on mechanisms and conclusion

Mainstream and sidestream tobacco smoke are well known for their capacity to stimulate inflammatory responses that are relevant to the immunopathogenesis of asthma.37, 38 Of equal importance may be the effect of nicotine on the development of the lung. Nicotine crosses the placenta freely³⁹ and, in animal models that include primates, has profound effects on fetal lung development that range through altered glucose metabolism, inhibition of fibroblast proliferation, damage to type I epithelial

Research directions

•
Define the mechanisms of the effects of smoking on airway structure.
•
Better understand the genetic and social factors associated with the commencement of smoking in adolescence.

Key point

•
Address smoking in adolescents for their own current and future health, and for that of the next generation.

Educational aims

•
To highlight the fact that exposure to maternal cigarette smoking in utero has a continuing impact through adolescence.
•
To stress that exposure to second-hand smoke and the uptake of active smoking in adolescence is a continuing public health issue.
•
To point out that the evidence is sufficient to infer an association between tobacco smoke exposure and respiratory symptoms in adolescence.
•
To show that there is sufficient evidence for an association of both in utero and postnatal exposure to tobacco

CME Section

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A home visit program for low-income African American children with asthma: Caregivers' perception of asthma triggers and a gap in action
2022, Journal of Pediatric Nursing
Citation Excerpt :
This raises the need for additional research to investigate the reasons for the lack of actions (e.g., lack of resources, power, and knowledge), advocacy for renters for proper housing management, and continued education and empowerment (Brouwer & Brand, 2008). The issue of secondhand smoking was also problematic (Tager, 2008). When asked, many were aware of smoking as a trigger of asthma, yet four out of five smokers answered that they were not interested in quitting.
The goals are to gauge caregivers' knowledge of at-home asthma triggers and identify the areas on which educational campaigns can focus to alleviate a child's asthma symptoms.
Families with children with moderate to severe asthmatic symptoms who had been recently hospitalized or in the emergency room were invited to participate in a home visit program. As part of the home visit, caregivers of the asthmatic children were asked a series of questions on asthma triggers and the measures for eliminating the triggers (N = 218).
Findings show a gap between caregivers' perception of asthma triggers and the actions to mitigate or avoid such triggers.
Overall findings show that home environments were suboptimal for the management and control of child asthma conditions. Knowledge about home triggers as well as the actions and efforts by caregivers and landlords to mitigate these was found to be inadequate. Even when caregivers are aware of the presence of at-home triggers, actions to minimize exposure to the trigger do not always follow due to a lack of power, resource, and knowledge.
The findings raise the need for additional research to investigate the reasons for the lack of actions, advocacy for low-income families to live in a healthy environment, continued education and empowerment, and patient/caregiver-doctor partnership. Additionally, the provision of community support through community advocacy and training of culturally competent healthcare providers are needed for the successful management of pediatric asthma among African American children.
Environmental exposures and sleep outcomes: A review of evidence, potential mechanisms, and implications
2021, Environmental Research
Citation Excerpt :
Furthermore, children and adolescents are particularly sensitive and susceptible to SHS exposure. In children, exposure can result in severe respiratory disturbances including asthma (Lewis et al., 2005), respiratory infection (Öberg et al., 2011), and impaired lung function (CDC, 2018b; Tager, 2008). The negative effects of SHS extend to sleep, causing poor sleep health and quality, which impairs cognitive function (Herrmann et al., 2008; Liu et al., 2012) and can lead to behavioral problems (Bauer et al., 2015; Liu et al., 2016).
Environmental exposures and poor sleep outcomes are known to have consequential effects on human health. This integrative review first seeks to present and synthesize existing literature investigating the relationship between exposure to various environmental factors and sleep health. We then present potential mechanisms of action as well as implications for policy and future research for each environmental exposure. Broadly, although studies are still emerging, empirical evidence has begun to show a positive association between adverse effects of heavy metal, noise pollution, light pollution, second-hand smoke, and air pollution exposures and various sleep problems. Specifically, these negative sleep outcomes range from subjective sleep manifestations, such as general sleep quality, sleep duration, daytime dysfunction, and daytime sleepiness, as well as objective sleep measures, including difficulties with sleep onset and maintenance, sleep stage or circadian rhythm interference, sleep arousal, REM activity, and sleep disordered breathing. However, the association between light exposure and sleep is less clear. Potential toxicological mechanisms are thought to include the direct effect of various environmental toxicants on the nervous, respiratory, and cardiovascular systems, oxidative stress, and inflammation. Nevertheless, future research is required to tease out the exact pathways of action to explain the associations between each environmental factor and sleep, to inform possible therapies to negate the detrimental effects, and to increase efforts in decreasing exposure to these harmful environmental factors to improve health.
Interaction of Glutathione S-Transferase M1, T1, and P1 Genes With Early Life Tobacco Smoke Exposure on Lung Function in Adolescents
2019, Chest
Citation Excerpt :
These findings are supported by strong biologic plausibility. Exposure to early life tobacco smoke, especially before 2 years of age, can damage the rapidly growing alveolar cells and stimulate inflammatory responses that may lead to development of impaired lung function and asthma in later life.1,2,23 GST genes generate enzymes that detoxify and catalyze the conjugation of glutathione with oxidant substrates, including tobacco-derived substances.
Glutathione S-transferase (GST) genes are involved in the management of oxidative stress in the lungs. We aimed to determine whether they modify the associations between early life smoke exposure and adverse lung health outcomes.
The Melbourne Atopy Cohort study (a high-risk birth cohort) enrolled 620 children and followed them prospectively from birth. We recorded perinatal tobacco smoke exposure, asthma, and lung function at 12 (59%) and 18 years (66%) and genotyped for GSTM1, GSTT1, and GSTP1 (69%).
GST genotypes were found to interact with tobacco smoke exposure on lung function outcomes (P interaction ≤ .05). Only among children with GSTT1 null genotypes was exposure to mother’s, father’s, or parental tobacco smoke in early life associated with an increased risk of reductions in prebronchodilator (BD) FEV₁ and FVC at both 12 and 18 years. These associations were not seen in children with GSTT1 present. Similarly, only among children with GSTM1 null genotypes was exposure to father’s or parental smoking associated with reductions in pre- and post-BD FEV₁ and FVC at 18 years. Only among children with Ile/Ile genotypes of GSTP1 was exposure to mother’s smoking associated with increased risk of reduced FEV₁ at 18 years, but this was not the case among children with Val/Val or Ile/Val genotypes.
Our study provides evidence of interaction between early tobacco smoke exposure and GST genotypes on lung function. Carriers of GST null mutations and GSTP1 Ile/Ile alleles may be more susceptible when exposed to tobacco smoke in early life. These findings support stronger recommendations to protect all infants from tobacco smoke exposure.
Australian and New Zealand Clinical Trials Registry; No.: ACTRN12609000734268; URL: http://www.anzctr.org.au/
Smoke-free homes among single-parent families: Differences associated with parental race/ethnicity and smoking behaviors
2018, Preventive Medicine Reports
Citation Excerpt :
Exposure to secondhand smoke (SHS) during infancy and childhood can lead to reduced lung function (Tager 2008), respiratory infections (Öberg et al. 2011), invasive meningococcal disease (Murray et al. 2012), and other health problems (King et al. 2016).
We assessed differences in the rates of smoke-free homes among single-parent households with regard to parental race/ethnicity and smoking status. We identified two cohorts representative of the U.S. single-parent households with underage children (children under the age of 18) based on the Tobacco Use Supplement to the Current Population Survey: 2010–11 (n = 6474) and 2014–15 (n = 6114). The interviews were conducted by phone and in-person. Statistical analysis was performed in 2017. The overall rate of smoke-free homes was 82% in 2010–11 and 86% in 2014–15. The rate of a smoke-free home was highest for Non-Hispanic (NH) Asian (94%) and Hispanic (92%) parents and lowest for NH Multiracial (77% in 2010–11 and 82% in 2014–15) in both survey periods. However, 2014–15 model-based comparisons relative to NH Whites indicated only one significant difference: the rate was lower for NH Blacks (OR = 0.46, 99% CI = 0.32:0.66). The smoke-free homes were least prevalent among daily smokers, followed by occasional smokers, followed by former smokers, and most prevalent among never smokers in each survey period. The 2010–11 and 2014–15 rates were 45% and 54% for daily, 64% and 72% for occasional, 89% and 91% for former, and 93% and 94% for never smokers. The gap in the rates of smoke-free homes for diverse parental racial/ethnic groups observed in 2010–11 decreased by 2014–15. While smoke-free homes became more prevalent in 2014–15, the rates remain drastically different among families with different parental smoking behaviors. Exposure to secondhand smoke at home remains common among single-parent households where the parent smokes.
Never-Smoking Adolescents’ Exposure to Secondhand Smoke in Africa
2016, American Journal of Preventive Medicine
Citation Excerpt :
Study data were obtained from GYTS administered in 25 African countries during 2006–2011. GYTS has been administered more than once; however, to provide the latest estimates, the most recent survey for countries that have conducted the survey more than once was used.8,11,12 Only countries with national-level data were included.
Though Africa is in Stage 1 of the tobacco epidemic, lack of effective public smoking laws or political will implies that secondhand smoke (SHS) exposure may be high in youth. The study objective is to estimate prevalence and identify determinants of SHS exposure among never-smoker adolescents in Africa and make cross-country comparisons.
Pooled data from the Global Youth Tobacco Surveys conducted in 25 African countries during 2006–2011 were used. Based on the venue of exposure in past 7 days, SHS was categorized into exposure inside, outside, and overall exposure (either inside or outside of the home), respectively. Data were analyzed in 2015 using logistic regression models to identify factors related to SHS exposure in three venues.
About 21% and 39% of adolescents were exposed to SHS inside or outside of the home, with overall exposure of 45%. In all 25 African countries, parental smoking was significantly associated with SHS exposure inside the home (ORs ranging from 3.02 [95% CI=2.0, 4.5] to 14.65 [95% CI=10.0, 21.5]). Peer smoking was associated with SHS exposure outside the home in 18 countries (ORs ranging from 1.45 [95% CI=1.0, 2.1] to 3.00 [95% CI=1.8, 5.1]). Parental smoking, peer smoking, and anti-smoking messages in media were identified as three major factors associated with SHS exposure.
A significant proportion of never-smoking adolescents in Africa are exposed to SHS, suggesting the need for countries to adopt policies to protect never smokers through the implementation of the WHO Framework Convention on Tobacco Control.
The Peer and Family Smoking Index: A Valid Measure of Secondhand Smoke Exposure in Adolescents
2016, Journal of Adolescent Health
Nearly half of all adolescents in the United States are exposed to secondhand smoke (SHS) daily, primarily at home, resulting in respiratory infections, asthma exacerbations, and reduced lung function. A concise self-report measure is needed to identity adolescents exposed to SHS. The purpose of this study was to test whether nonsmoking adolescents who reported exposure to peer and/or family smoking on the Peer and Family Smoking Index had higher salivary cotinine levels than those reporting no exposure to either peer or family smoking.
A convenience sample of 135 English-speaking adolescents ages 15–18 years was recruited from two high schools. Those who reported use of nicotine replacement therapy, cigarette smoking (past 30 days), smokeless tobacco use (past 30 days), or who self-reported pregnancy were excluded. Salivary cotinine and self-report data from the Peer and Family Smoking Index were collected after obtaining parental consent and assent from the adolescent.
Mean salivary cotinine levels differed by exposure group (none, family, peer, or family and peer), F (3, 130) = 5.44, p = .001. The post hoc analysis identified a significantly higher mean cotinine level among those exposed to SHS from both family and peers than among those with no exposure (p = .001).
Known groups validity of the index was supported. Adolescents who reported family smoking or a combination of family and peer smoking had significantly higher salivary cotinine levels than unexposed adolescents. The Peer and Family Smoking Index is a concise and valid self-report measure for SHS exposure in adolescents.

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CME ArticleThe effects of second-hand and direct exposure to tobacco smoke on asthma and lung function in adolescence

Summary

Section snippets

Asthma (prevalence and incidence)

Lung function

Comment on mechanisms and conclusion

Research directions

Key point

Educational aims

CME Section

Prev Chronic Dis

J Allergy Clin Immunol

J Pediatr

Use of cigarettes and other tobacco products among students aged 13–15 years – worldwide, 1999–2005

MMWR

Cigarette use among high school students –United States, 1991–2005

MMWR

Exposure to secondhand smoke among students aged 13–15 years – worldwide, 2000–2007

MMWR

Mortality associated with respiratory function and symptoms in advanced age. The Framingham Study

Am Rev Respir Dis

Health effects of passive smoking. 3: Parental smoking and prevalence of respiratory symptoms and asthma in school age children

Thorax

Respiratory symptoms and environmental factors in schoolchildren in the Bay of Plenty

N Z Med J

The impact of parental smoking on asthma and wheezing. SIDRIA Collaborative Group. Studi Italiani sui Disturbi Respiratori nell’Infanzia e l’Ambiente

Epidemiology

In utero and postnatal maternal smoking and asthma in adolescence

Epidemiology

Regular smoking and asthma incidence in adolescents

Am J Respir Crit Care Med

Effects of in utero and environmental tobacco smoke exposure on lung function in boys and girls with and without asthma

Am J Respir Crit Care Med

The adult incidence of asthma and respiratory symptoms by passive smoking in uterus or in childhood

Am J Respir Crit Care Med

Asthma phenotypes, risk factors, and measures of severity in a national sample of US children

Pediatrics

Incidence of asthma in Swedish teenagers: relation to sex and smoking habits

Thorax

J Asthma

Respiratory symptoms due to active and passive smoking in junior secondary school students in Hong Kong

Int J Epidemiol

Prevalence and incidence of asthma and rhinoconjunctivitis in Swedish teenagers

Allergy

CME Article
The effects of second-hand and direct exposure to tobacco smoke on asthma and lung function in adolescence