Second-hand smoking causes learning difficulties

Active and passive smoking in adolescents and children

It is well known that more young people smoke in Austria than in any other European country. Passive smoke exposure, third-hand smoking and active smoking threaten the health of children and adolescents in a wide variety of ways. This also applies to pre-partum damage in the sense of fetal tobacco syndrome and the postpartum consequences.

Tobacco smoke contains more than 4,800 chemicals that are potentially toxic to humans. 250 substances are known to be harmful, at least 50 of which are carcinogenic. Damage is caused by the direct irritative, immunological and mutagenic effects of the released substances. Nicotine increases the heart and respiratory rate, constricts the blood vessels, leads to circulatory disorders, disrupts the transport of oxygen and quickly leads to withdrawal symptoms. The numerous additives in cigarettes also increase the potential for addiction and mask the irritating effects on the respiratory tract.

Second-hand smoking or second-hand smoking (SHS): Secondhand smoke was designated a Class A carcinogen by the US Environmental Protection Agency in 1992. Damage to child health caused by passive smoking has been known for half a century, but children and adolescents are still not legally protected. According to the Tobacco Atlas Germany, between 2003 and 2006, up to 45% of parents of 14 to 17-year-olds smoked repeatedly or daily in their homes.

Effects of passive smoke exposure: The most common negative consequence of postpartum passive smoking is lower respiratory tract infections in children under 5 years of age. Acute respiratory infections are directly dose-response to tobacco exposure. A combination with atopy tripled the risk. The severity of RSV (respiratory syncytial virus) infection is also associated with exposure to tobacco smoke, and the risk of developing asthma is also increased.
Children aged 3–8 years had significantly more often otitis media with effusion and recurrent otitis with simultaneously increased cotinine levels in the urine, a sign of secondhand smoke exposure. In a large epidemiological study, children from families in which smokers were more likely to show behavioral problems.
A meta-analysis showed a significant increase in risk for tobacco exposure and invasive meningococcal diseases of 2.02 (95% CI 1.52–2.69) and 1.21 (95% CI 0.69–2.14) for invasive pneumococci -Diseases.
A retrospective study showed that passive smoking was more common in diabetic children (30 vs. 10%, p = 0.001), and the authors suspect that it could induce or accelerate the onset of type 1 diabetes. One study in adolescents showed that tobacco smoke exposure was associated with metabolic syndrome regardless of other influencing factors (OR 4.7; 95% CI 1.7 to 12.9; active smoking: OR 6.1; 95% CI 2.8 to 13.4).
Tobacco smoke exposure increases the incidence of atopic dermatitis in children. Overall, the connection between postpartum passive smoking and malignant diseases is not very well documented.

Third-hand tuxedo: Tobacco toxins get stuck on carpets, curtains, clothing, food and furniture and are still detectable weeks to months later; this is known as third-hand smoke. Small children in particular are particularly at risk, as they also ingest more contaminated dust not only by inhalation, but also orally.

Fetal Tobacco Syndrome - Effects of Tobacco Smoke During Pregnancy: A summary of the fetal tobacco syndrome as a statement of the Austrian Societies for General and Family Medicine (ÖGAM), Gynecology and Obstetrics (ÖGGG), Hygiene, Microbiology and Preventive Medicine (ÖGHMP), Pediatric and Adolescent Medicine (ÖGKJ) and Pneumology (ÖGP) was recently published published.
Even in the earliest phase of pregnancy, tobacco smoke can disrupt the transport of the ovum. Consequence: ectopic, extrauterine pregnancy. A meta-analysis from 2004 indicates an increase in risk for a growth restriction (“small for gestational age”) of 1.5–2.9 relative risk (RR). Above all, maternal smoking in the first trimester is likely to be associated with an increased risk of cleft formation (cleft lip, cleft lip and palate). The risk of premature birth is increased by an average of 1.27 (95% CI 1.2–1.3), the risk of extremely premature birth (<32nd week of pregnancy) is likely to be even higher.
Most of the birth complications described are due to direct damage to the feto-placental unit by substances contained in tobacco smoke: premature placental detachment (increased risk 1.4–2.4) and placenta previa (increased risk 1.5–3.0). In several studies, a connection to stillbirths (fetal death> 20th week of gestation) was found.
Smoking during and after pregnancy is a major risk factor for sudden infant death syndrome (SIDS) and is likely to be responsible for up to a third of all cases. Smoking during pregnancy has significant effects on fetal lung development. In particular, the lower lung function, predisposition to bronchitis, pneumonia and bronchial hyperreactivity as well as bronchial asthma should be mentioned here.
A clear dose-response relationship was also shown depending on the number of cigarettes smoked during pregnancy and the frequency of otitis media. Obesity is just as common after tobacco exposure in utero as type II diabetes mellitus. Behavioral disorders, psychiatric illnesses and attention deficit disorder are associated with maternal smoking in a number of carefully carried out studies. Learning difficulties were increasingly observed in children exposed in utero. The data on an increased risk of tumor diseases is inconsistent.

Active smoking: There are more young smokers in Austria than in Germany and Switzerland. Since the mid-1980s, the proportion of 15-year-olds who smoke daily in Austria has doubled among boys and even tripled among girls. 3.5% of 11-year-old Austrians state that they smoked a cigarette in the last month, compared to 26% of 15-year-olds. In Switzerland, 11.1% of children aged 14 smoke regularly.
The effects of active smoking in adolescents are extensive and are in principle similar to those in adults; however, the development of addiction is quicker and more severe, since the developing organism is particularly vulnerable at the neuronal level.

Addiction - primary and secondary prevention: Among the social factors influencing smoking behavior, the (non-) smoking of parents, siblings and friends, integration in school and leisure time behavior play an important role. Personal factors are poor knowledge of the short- and long-term effects of tobacco consumption and poor ability to withstand peer pressure to smoke. Among the environmental factors, easy accessibility, aggressive advertising, low cigarette prices as well as few restrictions and rules in the family, school and leisure area are to be emphasized.

Summary for practice: The number of children and adolescents exposed to tobacco is high. Even more worrying is the high number of active smokers among adolescents. Clear rules with a ban on smoking, at least in all public places, in restaurants, at clubbing and in discos, are essential to protect children and young people. Advertising bans must be better anchored in law, and the sales age must be raised significantly from the current 16 years. Preventive measures for young people are of crucial importance in order to prevent the particularly dangerous early entry and to contain the impending tobacco epidemic.


Literature from the author