Children’s Environmental Health in Michigan

Respiratory Health and Asthma: Second Hand Smoke (Repiratory Health)

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Indoor air quality is an important indicator of children’s environmental health. Children spend approximately 80-90% of their time indoors. Exposure to indoor air contaminants including second hand smoke, mold spores, and volatile organic compounds may result in adverse health impacts (AAP 2003). The following two sections of this chapter will investigate these pollutants, provide analysis of the effectiveness of policy measures in Michigan and other states and recommend best practices for addressing indoor air quality issues in Michigan.

Contents

Second Hand Smoke

“Secondhand smoke (SHS) contains at least 250 toxic chemicals, including more than 50 that can cause cancer (Harris et al. 2009).” The U.S. Environmental Protection Agency and the International Agency for Research on cancer have both classified SHS as a known human carcinogen. Second hand smoke exposure has been associated with an increased risk of lung cancer development for nearly three decades (Asomaning et al. 2007). Nearly 60% (22 million) of children in American, aged 3-11 years, are exposed to second hand smoke (Harris et al. 2009).

This section provides background information on the presence and potential health effects of second hand smoke and reviews existing Michigan policies related to environmental tobacco regulation. Best policy practices from other states are highlighted and recommendations are provided to further protect Michigan’s children from exposure to second hand smoke.

Secondhand smoke (SHS) causes numerous negative health effects, including neurotoxicity, respiratory disease and cancer. According to the U.S. Surgeon General exposure to SHS can cause lung cancer, heart disease, and respiratory effects in nonsmokers, and increase the risk of Sudden Infant Death Syndrome (SIDS), acute respiratory infections, ear problems, and more severe asthma in children (USDHHS 2006) and therefore will be discussed in all chapters of this report.

This section discusses the asthma and respiratory health effects of SHS exposure. Other sections detail the neurotoxic and respiratory effects of SHS exposure, present leading policy practices from other states (including laws and policies providing for smoke-free indoor air and tobacco prevention efforts), and provide policy recommendations on how to minimize childhood SHS exposure in Michigan.

Background Information

Sources of Second Hand Smoke

Secondhand smoke (SHS) consists of both “mainstream smoke,” the smoke exhaled from the person smoking and “sidestream smoke,” the smoke emitted from the burning end of a tobacco product (NCI 2007). SHS is also commonly referred to as “environmental tobacco smoke” (NCI 2007). In the U.S., cigarettes are the predominant source of SHS, followed by pipes and cigars (NCI 2007). Cigarette smoking releases a complex mixture of toxicants including nicotine, carbon monoxide, and cyanide (GBPSR 2000). Over 4,000 different compounds have been identified in tobacco smoke, and at least 250 of these chemicals are known to be toxic or carcinogenic (USDHHS 2006) The composition of SHS is influenced by many factors including the type of tobacco, the extent of chemical additives to the tobacco, the type of paper used to wrap the tobacco, and the way the tobacco is smoked (NCI 2007).

Asthma and Secondhand Smoke

Children are more vulnerable to the effects of secondhand smoke (SHS) because their bodies are still developing. Additionally, children breathe in significantly more air per unit body weight than adults, meaning that they may have higher rates of exposure to SHS than adults (Landrigan 2004). Exposure to SHS can cause asthma in children who previously did not show symptoms, and can also trigger asthma attacks and create more severe symptoms in children with existing asthma (EPA 2011). A 1992 report by the U.S. Environmental Protection Agency estimated that between 200,000 and 1,000,000 asthmatic children have had their condition worsened by exposure to SHS (EPA1992). There are a number of mechanisms through which SHS exposure might contribute to asthma, including SHS-mediated effects on the immune system, changes to neural reflexes controlling the airway, and induction of bronchial hyper-reactivity (USDHHS 2006). One study found that asthma severity in asthmatic children increased with parental smoking, and that children exposed to tobacco smoke in the home also had more allergic manifestations than those who were not exposed (Radic et al. 2011).

In addition to asthma, SHS exposure in infants and children under six has been linked to bronchitis and pneumonia (EPA 2011). Furthermore, babies whose mothers smoked during pregnancy or who are exposed to secondhand smoke after birth have weaker lungs than unexposed babies, increasing their risk for many respiratory health problems (USDHHS 2006). Children exposed prenatally may develop persistent respiratory problems due to morphologic and metabolic changes once SHS crosses the placenta, and also due to structural changes in the developing lung (USDHHS 2006). Moreover, SHS exposure has been causally associated with an increased risk of Sudden Infant Death Syndrome (SIDS) and evidence suggests an association between early-life SHS exposure and a variety of childhood cancers (USDHHS 2006).

Childhood Exposure to SHS

Please see: Neurotoxicity: Second Hand Smoke

Policy Summary and Analysis

Please see: Neurotoxicity: Second Hand Smoke

Summary of Policy Recommendations for SHS in Michigan

Please see: Neurotoxicity: Second Hand Smoke

Section References

References

American Lung Association (ALA). State of Tobacco Control 2009: National Grades. http://lungaction.org/reports/rank-states06.html.

American Academy of Pediatrics (AAP). 2003. Pediatric Environmental Health, 2nd ed. American Academy of Pediatrics. ISBN: 1-58110-111-2.

The Annie E. Casey Foundation. Kids Count Data Center. 2012. Retrieved from: http://datacenter.kidscount.org/data/bystate/Rankings.aspx?state=MI&ind=5383.

Carpenter C, Cook PJ. 2008. Cigarette taxes and youth smoking: New evidence from national, state, and local youth risk behavior surveys. Journal of Health Economics 27(2):287-99.

Campaign for Tobacco-Free Kids. (2006, July 27). Smoke-free laws encourage smokers to quit and discourage youth from starting (Fact sheet). Retrieved August 28, 2009, from http://www.tobaccofreekids.org/research/factsheets/pdf/0198.pdf

Campaign for Tobacco-Free Kids (2008, July 14). Enforcing laws prohibiting cigarette sales to kids reduces youth smoking. Retrieved August 28, 2009, from http://www.tobaccofreekids.org/research/factsheets/pdf/0049.pdf

Campaign for Tobacco-Free Kids. The Toll of Tobacco in Michigan. 2012. Retrieved from:http://www.tobaccofreekids.org/reports/settlements/toll.php?StateID=MI.

(Campaign For Tobacco-Free Kids. 2009. Retrieved from: http://www.tobaccofreekids.org/research/factsheets/pdf/0097.pdf)

Centers for Disease Control and Prevention (CDC). 2007. Best Practices for Comprehensive Tobacco Control Programs. http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm

Centers for Disease Control and Prevention (CDC). 2012. Michigan Smoking & Tobacco Use Highlights. Retrieved from: http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2012/pdfs/states/michigan.pdf.

DiFranza JR, Savageau JA, Fletcher KE. 2009. Enforcement of underage sales laws as a predictor of daily smoking among adolescents - A national study. BMC Public Health 9:107

Greater Boston Physicians for Social Responsibility (GBPSR). In Harm’s Way: Toxic Threats to Child Development. May 2000.

Lai H, Hedley AJ, Repace J, So C, Lu Q, McGhee SM, et al. 2011. Lung function and exposure to workplace second-hand smoke during exemptions from smoking ban legislation: An exposure - response relationship based on indoor PM 2.5 and urinary cotinine levels. Thorax 66(7): 615-23.

Landrigan PJ. 2004. Children as a vulnerable population. International Journal of Occupational Medicine and Environmental Health 17(1):175-177.

Lexis Nexis. Legislative Database.

Menzies D, Nair A, Williamson PA, Schembri S, Al-Khairalla MZH, Barnes M, et al. 2006 Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. Journal of the American Medical Association 296(14): 1742-1748.

Michigan Department of Treasury. 2007. Tobacco Tax Information. http://www.michigan.gov/taxes/0,1607,7-238-43542_43547---,00.html.

National Cancer Institute (NCI). 2007. Second Hand Smoke: Questions and Answers. Reviewed 8/1/07; accessed 11/15/08 at: http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS.

Radic SD, Gvozdenovic BS, Pesic IM, Zivkovic ZM, Skodric-Trifunovic V. 2011. Exposure to tobacco smoke among asthmatic children: Parents' smoking habits and level of education. International Journal of Tuberculosis and Lung Disease 15(2):276-80.

Repace JL, Jiang R, Acevedo-Bolton V, Cheng K, Klepeis NE, Ott WR, et al. 2011. Fine particle air pollution and secondhand smoke exposures and risks inside 66 US casinos. Environmental Research 111(4): 473-484.

United States Department of Health and Human Services (USDHHS). 2006. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

United States Environmental Protection Agency (EPA). 1992. Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Retrieved from: http://oaspub.epa.gov/eims/eimscomm.getfile?p_download_id=36793.

United States Environmental Protection Agency (EPA). 2008. Health Effects of Exposure to Secondhand Smoke. Retrieved from: http://www.epa.gov/smokefree/healtheffects.html.

United States Environmental Protection Agency (EPA). 2011. Health Effects of Exposure to Secondhand Smoke. Retrieved from: www.epa.gov/smokefre/healtheffects.html.

Wakefield M, Banham D, Martin J, Ruffin R, McCaul K, Badcock N. 2000. Restrictions on smoking at home and urinary cotinine levels among children with asthma. American Journal of Preventive Medicine 19(3): 188-192.

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