Second-hand smoking (SHS) occurs when a person breaths in the tobacco smoke of other people. It can also be referred to as environmental tobacco smoke exposure, involuntary or passive smoking. Approximately 40% of children globally have been estimated to be exposed to SHS. About 2 million children in the UK are suffer from SHS in their homes on a regular basis. An overall reduction in exposure to SHS has been realized due to the introduction of smoke-free legislation. Many parents are making their homes smoke-free. However, only modest reduction in exposure has been provided for children who live in smoking households. Children have been singled out as highly vulnerable to the effect of SHS exposure, which increases the risk of a wide range of diseases including wheezing invasive meningococcal diseases, sudden unexpected death during infancy, asthma, middle ear infection, and infections of the lower respiratory tract. SHS exposure has been determined as the major cause of asthma, particularly among young children. The paper focuses on showing how passive smoking increases the risk of asthma for children below the age of 16.
Statistics from the UK indicate that the disorders resulting from SHS exposure generate more 300,000 general practitioners (GP) consultations, and approximately 9,500 cases of hospital admission annually. The total annual cost of GP consultation and hospitalization is £23.3 million. The exposure to SHS has an adverse effect on the health of children even before birth due to SHS exposure during pregnancy and through maternal smoking. Smoking in cars is hazardous since SHS level are high due to enclosed space. It has been reported that in the UK, approximately 6.5% to 20% of children are exposed to SHS while riding in cars with adults. Restrictions on smoking in vehicles have recently received overwhelming public support. Children can be effectively protected from SHS if homes and cars are made completely smoke-free.
The most common chronic disease associated with childhood is asthma. It has been established that the exposure to SHS triggers asthma development and exacerbates its symptoms. A review of several research studies indicates that the exposure to pre- or post-natal SHS is linked to 30-70% increase in the risk of wheezing incidence, and 21%-85% increase in the risk of asthma incidence in children (Tager, 2008). An effective measure of asthma prevention is reducing SHS exposure.
Asthma refers to chronic diseases affecting the airways. An asthmatic attack is characterized by breathing difficulty due to the swelling of the airways of the lungs (Vork et al., 2007). When the airways are swollen, they become narrow, making it difficult for air to get in and out of the lungs. Breathing becomes more difficult when the cells of the airway produce more mucous. An asthmatic attack is associated with the following symptoms: wheezing, coughing, shortness of breath and pain in the chest. The attack can either be mild, moderate or serious to the level of being life threatening. An asthmatic attack occurs when the airways become irritated (Vork et al., 2007).
The main trigger of asthma is tobacco smoke. Tobacco smoke includes second-hand smoke which is a health hazard to everyone, especially individuals with asthma. Second-hand smoke comprises a mixture of gasses and fine particles that are composed of the following: smoke emanating from burning cigarettes and smoke exhaled by a smoker (McCarville et al., 2013). Asthmatic individuals should always avoid being exposed to second-hand smoke. Asthma can be managed by avoiding triggers such as staying away from tobacco smoke. It has no cure but can be controlled by taking the right medication and staying away from triggers exposure (McCarville et al., 2013).
Children are more susceptible to SHS exposure due to their rapid rate of breathing that makes them inhale more pollutants per pound of their body weight than adults. Children have a higher relative ventilation rate as compared to adults. They also tend to ingest high quantities of tobacco smoke pollutants due to their habit of putting things in their mouth. Research findings show that children have 70% higher cotinine levels as compared to adults after the two groups have been exposed to similar amount of tobacco smoke (Jarvis & Feyerabend, 2015). Cotinine is a metabolite of nicotine utilized in measuring the exposure to SHS.
The main source of tobacco smoke for children is smoking in vehicle and homes by parents and other members of the households. Maternal smoking remains to be the largest SHS source due to the cumulative effect of exposure during pregnancy and the proximity of a child to a mother in the early years. Examples of little protection against SHS exposure are opening windows or restriction of smoking to a specific room. Research findings show that is possible for cigarette smoke to linger in a given area for two and a half hours even when there is good ventilation (Mackay et al., 2010). Other mechanisms that have been adopted by households with the aim of reducing the exposure to tobacco smoke have proven to be ineffective. Such measures include smoking next to an extractor fan or smoking out of a window. Evidence from research studies indicates that there is no significant difference in the level of SHS exposure between homes with less harm reduction strategies and homes with no such smoking restrictions (Mackay et al., 2010).
SHS is capable of lingering on walls, furnishings and carpets. The materials have the capacity of absorbing toxins in tobacco smoke and release them gradually into the air. Therefore, they pose additional risk to exposure. The phenomenon is known to as a third-hand smoke. It is believed that children tend to be more vulnerable to it. The amount of dust particles ingested by children is two times larger as compared to adults. The following factors make younger infants more predisposed to SHS exposure (Polosa & Thomson, 2013):
- Their breathing zone is closer to the floor
- Young children tend to lick and put non-food items in their mouths.
- As the mobility of infants increases, they become increasingly exposed to particles from carpets and upholstery.
- Common cleaning methods and ventilation cannot eradicate tobacco pollution within enclosed spaces.
Children are mostly exposed to SHS at home since they spend most of their time indoors. Children have little control over the exposure to SHS, unlike adults who can decide whether or not be in a smoky environment. They are less likely to quit a smoke-filled room since they may not have the capacity to ask. Some children may not have the confidence to raise the subject. Some adults may not allow children to leave the polluted environment even if they ask (Cheraghi & Salvi, 2009).
According to Britton (2005), passive smoking is associated with the exacerbation of asthma. Extensive literature review shows that there is a correlation between passive smoking and increased risk of asthma in both adults and children. Observational evidence indicates that the exposure to passive smoke exacerbates symptoms in people who have asthma (Britton, 2005). These findings have been supported by experimental studies, which indicate that the exposure to passive smoking has an adverse effect on asthma. Individuals who are highly exposed to nicotine tend to have more severe asthma and are more likely to get hospitalized (Britton, 2005).
Inhaling SHS cannot be avoided if an individual is in a smoke-filled environment. SHS includes side stream smoke from the tip of a burning cigarette and the mainstream smoke exhaled by a smoker (American Cancer Society, 2015). There are more than 4000 chemicals in the mainstream smoke inhaled by smokers. The chemicals comprise of irritants and carcinogens. Although side-stream smoke has similar composition to the mainstream smoke, it is more dangerous due to the higher concentration of toxins and carcinogens. In 2003, more than 11,000 people were reported to have died in the United Kingdom due to SHS exposure (Polosa & Thomson, 2013). SHS has emerged to be the issue of great public health concern in the UK and all over the world since it is associated with both long-term and short-term harm to others. The concern particularly focuses on children since they are still on the verge of growth and development, and the exposure to SHS leads to serious adverse effects on their health. The fact that passive smoke is a major health hazard to millions of children globally cannot be disputed. The situation is worse for children from socio-economically challenged families since they are heavily exposed to SHS (Polosa & Thomson, 2013).
The implementation of smoke-free legislation is one of the major public health interventions for addressing the problem. Many countries have adopted smoke-free legislation with the aim of curbing the problem. In 2006, smoke-free legislation was adopted in Scotland; the rest of the regions of the UK implemented the policy in 2007 (Been et al., 2014). The legislation prohibits smoking in workplaces, enclosed public places, and work vehicles. The legislation did not cover private dwellings and private vehicles. The main concern that was raised before the introduction of the legislation is that the health of children could adversely be affected since smokers may shift their smoking habit to their homes. There is still no research evidence to substantiate the claim that smoke-free legislation may contribute to an increase in smoking in households (Been et al., 2014).
Research studies in the UK indicate that there is a significant decrease in the level of SHS exposure among children following the adoption of the smoke-free legislation (Been et al., 2014). In fact, the ban on smoke has encouraged many parents to follow the same trend by making homes smoke-free. The adoption of smoke-free home policies among smoking parents in England increased from 16% in 1998 to 48% in 2008 (Been et al., 2014). The adoption of smoke-free legislation has contributed to reduced child SHS exposure across the various sectors of the UK society. Other nations that have adopted the smoke-free legislation have also reported that this move has contributed to no smoking at homes (Been et al., 2014).
Research findings indicate that no level of exposing individuals to second-hand smoke is safe. Children are more exposed to SHS as compared to adults. Second-hand smoke has a significant impact on children since they are still growing and developing, and exposure to the poison from second-hand smoke makes them susceptible to the development of severe respiratory diseases, which impedes the growth of lungs (Kuehni & Barben, 2015). Second-hand smoke is associated with various undesirable outcomes such as middle ear infection, sudden infant death syndrome (SIDS), asthma, bronchitis, pneumonia, low birth weight and other diseases. The strongest risk factor that contributes to SIDS is maternal smoking (Kuehni & Barben, 2015).
High concentrations of nicotine in the lungs have been reported to be the main cause of death due to SIDS in case-control studies. Second-hand smoke is associated with cognitive impairment. The learning ability of a child can be impaired by the exposure to second-hand smoke. The smoke remains neurotoxic even at minute levels. Being exposed to higher levels of second-hand smoke, children are attributed to higher deficits in visuospatial reasoning and math. Second-hand smoke leads to low birth weight, thereby contributing to high infant mortality and severe health complications. Non-smoking mothers who are exposed to SHS have a high likelihood of giving birth to low-weight babies. The percentage of cases of low birth weight is higher among mothers who are exposed to second-hand smoke (Been et al., 2014).
Exposure to second-hand smoke was attributed to behavioral problems. The children of both non-smoking and smoking mothers exposed to second-hand smoke are more likely to suffer from conduct disorder and attention deficit hyperactivity disorder (ADHD). Despite the fact that girls tend to be more exposed to second-hand smoke, boys are affected more severely and may have depression, aggression, hyperactivity and other behavioral complications. Respiratory disorders remain to be the major problem associated with the exposure to second-hand smoke. The exposure to it raises the risk of contracting infections of the lower respiratory tract like bronchitis and pneumonia. According to the US Environmental Protection Agency (EPA) (1992), there are approximately 150,000 to 300,000 annual cases of lower respiratory tract infections in children within the age bracket of up to 18 months, what happens mainly due to exposure to second-hand smoke. Infants of smoking mothers have a 50% more likelihood of being hospitalized with a respiratory infection in their first year as compared to infants of non-smoking mothers. The risk increases to 56% if the mother smokes in the same room (Kuehni & Barben, 2015).
The impacts of SHS on the health of children are well documented, and public awareness of the health risk is on the rise. SHS is the main trigger of asthma. It also exacerbates its symptoms. Children are at an increased risk of SHS exposure due to their physiology, behavior and the inability to make choices that can be respected by adults. As a result, they are more likely to suffer from an asthmatic attack. A significant proportion of children are still exposed to SHS despite public awareness of its risk to health. Although the exposure to tobacco smoke has effectively been reduced due to the adoption of smoke-free legislation in various parts of the world, children are still exposed to SHS in private homes and vehicles. The legislation does not cover private homes and vehicles. Making homes and vehicles completely smoke-free is the only effective way of reducing SHS exposure. It should be noted that sufficient protection cannot be provided by ventilation or limiting smoking to particular areas. The concern of protecting children from SHS exposure is on the rise. Although legislation that regulates smoking in home and cars has received strong support from the public, it remains to be an unattainable approach. Some countries have successfully introduced legislations that prohibit smoking in the care while children are present. Educational programs should be executed with the aim of reminding adult smokers that they are responsible for protecting children from SHS exposure.
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