Environmental tobacco smoke is a major cause of morbidity and mortality among children in the United States. A recent study by Aligne and Stoddard (1997) analyzed the health care literature from 1980 to 1996 to determine the economic influence of pediatric disease associated with parental smoking.
The researchers found that between 40 and 50 percent of children are regularly exposed to tobacco smoke. Maternal smoking, estimated at 27%, is most strongly associated with increases in childhood diseases.
Aligne and Stoddard (1997) found that the estimated annual excess cases of childhood illness and death attributable to parental smoking include: low birth weight (46,000 cases, 2800 perinatal deaths), sudden infant death syndrome (2000 deaths), respiratory syncytial virus bronchiolitis (22,000 hospitalizations, 1100 deaths), acute otitis media (3.4 million outpatient visits), otitis media with effusion (110,000 tympanostomies), asthma (1.8 million outpatient visits, 14 deaths), and fire-related injuries (10,000 outpatient visits, 590 hospitalizations, and 250 deaths).
This study estimates that parental smoking results in annual direct medical expenditures in the United States of $4.6 billion, in addition to the high cost of loss of life. As much as 8% of total medical spending among children may be related to parental smoking.
It is essential that efforts be made to reduce the incidence of smoking among parents. For example, even temporary smoking cessation by pregnant women can lead to increased birth weight and decreased neonatal health care costs. Nurses need to inform parents about the dangers of environmental tobacco smoke and the availability of various smoking cessation methods.
Primary prevention of passive smoking requires the prevention of smoking by future parents. Despite the health consequences of smoking, large numbers of children and adolescents smoke. The American Academy of Pediatrics, Committee on Substance Abuse (1998), reports that among 8th graders, 1 in 10 smokes. By 10th grade the incidence is 1 in 6. The trend continues with high school seniors who smoke daily being 1 in 4. Besides the dangers of tobacco, there is the concern that tobacco use in children will progress to other types of substance abuse, such as marijuana.
The American Academy of Pediatrics (1998) recommendations for health care providers related to substance abuse includes:
Nurses are in a unique position to discourage the use of tobacco among children, adolescents, and parents. Childhood morbidity and mortality can be reduced through these efforts. Smoking is a major, but entirely preventable, source of health care problems.
Aligne C A and Stoddard J J: Tobacco and children: an economic evaluation of the medical effects of parental smoking, Archives of Pediatric Adolescent Medicine 151:648-653, 1997.
American Academy of Pediatrics, Committee on Substance Abuse: Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention and management of substance abuse, Pediatrics 101(1):125-128, 1998.
See Chapters 21 and 32 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapters 17 and 23 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002