Cardiovascular Consequences of Childhood Secondhand Tobacco Smoke Exposure

A recent scientific statement from the American Heart Association concludes that the epidemiological, observational, and experimental evidence accumulated to date demonstrates the detrimental cardiovascular consequences of secondhand smoke exposure in children. 

The statement recognizes that, although public health programs have been successful in decreasing the prevalence of tobacco smoking, the adverse health effects of tobacco smoke exposure still exists. In the United States, 4 of 10 school aged children and 1 of 3 adolescents are involuntarily exposed to secondhand tobacco smoke. Children who are disproportionately affected include ethnic minority children at 68% and those in low socioeconomic status households at 43%.

Children have little or no control over their home and social environments which makes them particularly vulnerable. The smoke that emanates from the burning end of a cigarette is known as sidestream smoke and is the main source of secondhand smoke. It contains higher concentration of some toxins than the smoke inhaled directly by the smoker, known as mainstream smoke. Secondhand smoke is potentially as dangerous, if not more dangerous, than direct smoking.

Animal and human studies show that secondhand smoke exposure during childhood is detrimental to arterial function and structure, resulting in premature atherosclerosis and cardiovascular consequences. Childhood secondhand smoke exposure is also related to impaired cardiac autonomic function and changes in heart rate variability. In addition, childhood secondhand smoke exposure is associated with cardiometabolic risk factors such as obesity, dyslipidemia, and insulin resistance. 

Individualized interventions to reduce childhood exposure to secondhand smoke and broader-based policy initiatives such as community smoking bans and increased taxation are shown to be effective. Increased awareness of the adverse lifetime cardiovascular consequences of childhood secondhand smoke may facilitate the development of innovative individual family-centered and community health interventions to reduce and ideally eliminate secondhand smoke exposure in the vulnerable pediatric population. This evidence indicates that a robust public health policy that promotes zero tolerance for childhood secondhand smoke exposure is needed. 

As healthcare providers focused on cardiovascular prevention, we can address this problem in several ways.

• Advocate in your community for public policy changes. 
• Using this evidence, appeal to your patients who are smokers to quit for the sake of their children, grandchildren or other young family members. 
• Participate in community health forums to provide education and raise awareness of the detriments of secondhand smoke exposure for children. 
• Look for every opportunity to spread information that could decrease the exposure and risks of secondhand smoke on our most vulnerable population.