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Passive Smoking and Lung Disease Follow-up

  • Author: Timothy D Murphy, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
Updated: Jun 07, 2016

Further Outpatient Care

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  • The principal requirement of the care provider is to continue to assess for smoking in parents and to provide support and treatment for parents. Reiteration of the importance of not smoking in the home and provision of either smoking cessation information or referrals to the proper care providers are important.

Further Inpatient Care

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  • Prevention of the effects of environmental tobacco smoke (ETS) occurs through prevention of smoking; however, the effects of education regarding reducing ETS exposure to children in the family milieu are not well known.
  • A common clinical practice in pediatric and pediatric pulmonology offices is to counsel parents against smoking and, in particular, to focus on cessation of smoking in the home and in the car. Emphasis is placed on the importance of maintaining this rule at all times, not merely when the child is present; however, the efficacy of this approach has not been well studied.
  • Clearly, parental concerns for a child's health are motivating factors to change parental behavior, both during pregnancy and after birth.
  • Enactment of laws regarding ETS exposure in public spaces has significantly reduced exposures in many communities, but these laws vary in how aggressively they are enacted or enforced.[19]
    • Ordinances against smoking in public places first started to appear in the 1970s. In 1977, the first modern ordinance limiting smoking in restaurants and other public places was enacted in Berkeley, California.
    • Following the 1986 Surgeon General's report on the health consequences of involuntary smoking, the number of ordinances rapidly grew to nearly 400 by 1988.
    • Ordinances usually limit ETS in confined public spaces, workplaces, and restaurants.
    • Restrictions in restaurants are usually limited; a proportion of space or seating availability is usually required to be set aside for nonsmokers.
    • Special regulations regarding ventilation usually are not enacted.
    • After the release of the Environmental Protection Agency (EPA) draft report on Risk Assessment of ETS in 1990, more aggressive regulation started to appear, including ordinances banning any smoking in restaurants.
    • By 1992, the number of smoke-free ordinances passed into law began to significantly accelerate.
  • The tobacco industry has responded by attempting to push for enactment of state laws that are less restrictive and that limit the ability of local government to enact more aggressive ordinances.
    • The tobacco industry has legally challenged some ordinances on constitutional grounds, but state and federal courts have consistently upheld the constitutionality of local ordinances.
    • As of 1993, 543 city and county smoking ordinances were in effect.
  • The most rapidly growing population exposed to ETS (and the source of a significantly large proportion of ETS exposure in children) is children of young mothers of lower socioeconomic status. For this reason, prevention of smoking in the adolescent population should have a direct impact on ETS exposure in infants.
  • In the Surgeon General's report of 1994, entitled Preventing Tobacco Use Among Young People, the following major conclusions were reached:[20]
    • Almost all adult tobacco users began using during adolescence; this suggests that if adolescents were kept tobacco free, most would never start using tobacco.
    • Most young people who smoke are addicted to nicotine and report that they want to quit but are unable to do so. They experience relapse rates and withdrawal symptoms similar to those reported by adults.
    • Tobacco is often the first drug used by young people who use alcohol, marijuana, and other drugs.
    • Among young people, those with lower levels of school achievement, fewer skills to resist pervasive influences to use tobacco, friends who use tobacco, and lower self-images are more likely than their peers to use tobacco.
    • Cigarette advertising appears to increase young people's risks of smoking by affecting their perceptions of the pervasiveness, image, and function of smoking.
    • Community-wide efforts that include tobacco tax increases, enforcement of minor's access laws, youth-oriented mass media campaigns, and school-based tobacco-use prevention programs are most successful in reducing adolescent use of tobacco.
  • Currently, research is focused on determining which method of education will prove to be most effective in preventing tobacco use in adolescents and, increasingly, preadolescents.
  • Attention to the social status, educational level, race, and sex of the adolescent, with regard to which approach is best, is increasingly recognized as an important determinant of success.
  • Focusing on more than the health effects of smoking can lead to alterations in behavior. Looking instead at social issues such as the way in which the tobacco industry has attempted to addict children, or the role of the use of additives in enhancing addiction can serve to motivate adolescents to avoid tobacco, in some cases more effectively than information on negative health consequences alone.


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  • Complications associated with passive smoke exposure are related to the illnesses associated with it.


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  • Improvements in associated acute illnesses (ie, asthma, otitis media) are documented in association with cessation of passive smoke exposure.

Patient Education

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  • The principal task of the care provider is to provide information to allow the parent to stop exposing the child to ETS. Because understanding the effects of passive smoke exposure on children is one of the most powerful motivating factors in smoking cessation, such information should be available in all primary care physician offices. Validation and comparison of different interventions remains an area of research, but separate studies have demonstrated the efficacy of an "intensive counseling" strategy. The time required to optimally educate the parent regarding ETS is unknown, but this education is commonly performed during a routine office visit.
  • Ortega Cuelva et al conducted a multicenter, open, cluster-randomized clinical trial to determine the effectiveness of a brief primary care intervention directed at parents who smoke.[21] The purpose of the intervention is to reduce exposure to tobacco smoke in babies. The study included 83 primary health pediatric teams of the Catalan Health Service and 1,101 babies whose parents were smokers. The intervention group received a brief tobacco smoke pollution intervention; the control group received the usual care. Outcomes were measured by parents' reported strategies to avoid exposing their babies to tobacco smoke. Baseline clinical data and characteristics of each baby's tobacco smoke exposure were collected, along with infant hair samples and parents' tobacco use and related attitudes/behaviors. At 3-month and 6-month follow-up, behavioral changes to avoid infant tobacco smoke exposure were recorded. During follow-up, tobacco smoke avoidance strategies improved more in the intervention groupthan in the control group. Reduced nicotine concentration was associated with improved implementation of effective strategies reported by parents at home and in cars. The researchers concluded that the intervention produced behavioral changes to avoid babies' exposure to tobacco smoke.[21]
  • For excellent patient education resources, visit eMedicineHealth's Healthy Living Center, Lung Disease and Respiratory Health Center, and Children's Health Center. Also, see eMedicineHealth's patient education articles Cigarette Smoking and Sudden Infant Death Syndrome (SIDS).
  • For more information on the pharmacology of nicotine and smoking cessation, go to Medscape Reference article Nicotine Addiction: Treatment & Medication.
Contributor Information and Disclosures

Timothy D Murphy, MD Consulting and Attending Staff, Pediatric Pulmonary and Sleep Medicine, Mary Bridge Children's Hospital

Timothy D Murphy, MD is a member of the following medical societies: American Thoracic Society, American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.


Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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