How can you reduce your child’s exposure to tobacco smoke?

A recent study examined popular strategies to reduce children’s exposure to tobacco smoke to determine which, if any, work. Only one strategy effectively reduced, but did not eliminate, exposure in children: banning smoking inside homes and cars. Other strategies, such as hand washing or wearing a smoking shirt, were not effective. To protect children from toxic second- and thirdhand smoke, never allow smoking in your home or car.

April 7, 2021

By: Katherine Greiner

Most of us realize that tobacco smoke is unhealthy and, as parents, do everything we can to protect our children from exposure to secondhand smoke. Despite our best efforts, children are still far more likely to be exposed to secondhand smoke than are adults. In addition, children who are exposed to secondhand smoke also are exposed to thirdhand smoke, the toxic chemical residue that remains in the environment after smoking stops.

We know that most people who smoke use a variety of strategies to reduce children’s exposure to secondhand smoke, for example: washing hands, brushing teeth, wearing a smoking jacket or hat, using breath mints, or using an air purifier. What we don’t know is how effective those strategies are at reducing children’s exposure to tobacco.

A group of researchers led by Jessica Gambino from Children’s Hospital Colorado decided to put these strategies to the test and determine if, and how well, any of them actually work to reduce children’s exposure to tobacco smoke. One of the researchers on the team, Dr. Karen Wilson of the Icahn School of Medicine at Mount Sinai and Mount Sinai Kravis Children’s Hospital, spoke with us about their work. “One of the things that we were very interested in was this concept that you can help protect your child by doing these activities. Pediatricians will often recommend washing your hands, or the classic is the smoking jacket, those sorts of things… we were getting cotinine levels on these kids, we had a biological marker of tobacco smoke. And what we wanted to do was see whether, if you did one or more of these strategies, would the cotinine level be lower compared to somebody who’s smoking the same amount around their kids.”

Most of the 213 families in the study were familiar with tobacco smoke as a risk for children and their families and took steps to prevent their children from being exposed. More than 80% of families believed the protective measures they used were successful, and that their children were less exposed. However, that was not the case. Researchers measured children’s cotinine levels (a proven method of detecting nicotine in the body), and those children whose families took these protective steps were no lower than children whose families did not. Dr. Wilson continued, “It’s smoking only outside, which is why we recommend having a smokefree home and car, that was the one thing that was associated with a lower cotinine level. I think the thing we really wanted to highlight on this was it wasn’t perfect – so you did not have a level of zero cotinine if you smoked outside only. It reinforces that this is something that should not be done around the child. The one thing that we know will make a difference is only smoking outside and having a completely smokefree home and car. An advantage of that is that if you have this completely smokefree home and car, you’re more likely to go on and quit yourself, and so this helps them get down that road towards quitting completely. But I think that we need to, as healthcare providers, really be stressing that the most effective way to protect your child and yourself, is to quit smoking entirely.”

Dr. Wilson points out that although this study focused on combustible tobacco smoking, she has similar recommendations for electronic cigarettes. “We started this study in 2016, so we didn’t get into a lot of detail about electronic cigarette use and I just want to remind people that that also contains chemicals and particulates and nicotine that can be deposited as thirdhand residue and certainly can be aerosolized into the air that a child is inhabiting.” The team does not recommend the use of electronic cigarettes around children, nor do they recommend them as a smoking cessation device. Rather, they encourage parents to use an FDA approved smoking cessation strategy.

Dr. Wilson concludes with a comment on marijuana smoke exposure. “This [study was done] in Colorado. Some of the samples were approved for future research, and we tested them for marijuana. We found that about 46% of these kids in the study also had detectable metabolites of marijuana in their urine. This is consistent with other studies that we’ve done, including here in New York City, and there’s a pretty high rate, particularly in children of parents who smoke combustive tobacco, of marijuana smoke exposure as well. And we really don’t know what the consequences of that are. … We don’t know now that marijuana smoke exposure is bad, but I find it hard to believe that it’s good. People will say to you, well, we don’t know it’s bad; I’m like ‘well, okay, then let’s find out’.”

Click here to read the research study.

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