The New Straits Times, November 7, 1997
Question: My husband is a smoker who normally smokes in the house without considering the effect of secondhand smoke to our children. Can you please highlight the health effects of the smoke to our children?
A: As you have pointed out correctly, the secondhand smoke or environmental tobacco smoke (ETS) does constitute an important source of toxic air contaminants indoors.
It is a complex mixture formed from the escaping smoke of a tobacco product and smoke exhaled by a smoker. Chemicals include irritants and systemic toxicants such as benzo(a)-pyrene, formaldehyde and 4-aminobiphenyl and the reproductive toxicants, nicotine, cadmium and carbon dioxide. The characteristics of the ETS change as it ages and combines with other constituents in the air.
Despite an increasing number of restrictions on smoking and an increased awareness of health impacts as seen from the implementation of the Control of Tobacco Act, exposures in the home especially of infants and children, continue to be a public health concern.
Based on an extensive study conducted in the United State, ETS exposure has been associated with a number of health effects. Among these are the developmental, respiratory, carcinogenic and cardiovascular effects for which there is sufficient evidence for a cause-effect relationship as well as several end-point indicators such as sudden infant death (SID) syndrome, heart disease mortality and several chronic diseases such as childhood asthma.
In terms of development effects, ETS exposure was observed to adversely affect the fetal growth with elevated risks of low birth weight. Low birth weight is associated with many well recognised problems for infants and is strongly associated with perinatal mortality.
Based on an estimate carried out in the US, a total of 9,700 to 18,600 cases of low birth weight per year, would be encountered as a result of exposure to ETS.
On the other hand, ETS has been demonstrated for an increased risk of sudden infant death syndrome (SIDS) for postnatal manifestations of developmental toxicity. The contribution of SIDS by ETS in the US has been estimated to be in the range of 1,900 to 2,700 death cases per year.
With the respiratory system, ETS exposure produces a variety of acute effects involving the upper and lower respiratory tract. In children, ETS exposure can exacerbate asthma and increases the risk of lower respiratory tract illness and acute and chronic middle ear infection.
Regarding its chronic respiratory health effects, there is now a compelling evidence that ETS is a risk factor for the induction of new cases of asthma as well as for increasing the severity of disease among children with established asthma.
An estimate to evaluate on the induction of asthma cases in the US came up with a range of 8,000 to 26,000 new cases per year whereas asthma exacerbation would involve a rang of 400,000 to 1,000,000 children per year.
In addition, further epidemiological studies in the US have shown a direct relationship between chronic respiratory symptoms in children such as cough, phlegm and wheezing with parental smoking. From such studies, ETS was found to affect lung growth and development as determined by a decrease in lung function.
Therefore, an adequate assessment could be made on the harmful effect of ETS to the development and respiratory status of exposed children.
