More Evidence Secondhand Smoke Bad for Kids’ Mental Health

Children and adolescents in the United States exposed to secondhand smoke (SHS) are at risk of developing major depressive disorder (MDD), generalized anxiety disorder (GAD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder, new research suggests.
In a national survey study of more than 2000 nonsmokers between the ages of 8 and 15 years, investigators found that serum cotinine levels, signifying SHS exposure, were positively associated with symptoms of all these disorders — and were especially correlated for boys.

“Our results have important public health implications,” write Frank C. Bandiera, MPH, from the Department of Epidemiology and Public Health, Miller School of Medicine at the University of Miami, Florida, and colleagues.

“Given the critical developmental period of childhood and adolescence, the effects of policy to reduce or ban smoking in public places and in the home may help prevent or reduce the progression of illness in at-risk individuals and alleviate the heavy burden…attributable not only to tobacco use but also to mental disorders,” they write.

Although the findings are in line with previous research showing a link between mental health outcomes and SHS exposure, the investigators note that this study did not “establish the biological or psychological mechanisms of association.”

Still, the investigators note that this new research does provide “critical and much-needed data.”

The study is published in the April issue of Archives of Pediatrics and Adolescent Medicine.

High Rate of Exposure

According to the researchers, 66% of all children between the ages of 3 and 11 years have been exposed to SHS.

“Because many mental disorders have an onset in youth at a time when SHS exposure is high, it is critical to consider how SHS may be affecting the mental health of children and adolescents so that appropriate preventive measures can be implemented,” they write.

In a recent study reported by Medscape Medical News, investigators from the United Kingdom found that a higher level of salivary cotinine was significantly associated with hyperactivity and conduct disorder in adolescents participating in the Scottish Health Survey. That study, which was published online first December 6 in Archives of Pediatrics and Adolescent Medicine, is also published in the journal’s current print issue.

For this study, investigators evaluated data on 2901 nonsmoking US adolescents (51% male; 61.9% non-Hispanic white; 14.8% non-Hispanic black; 12.2% Mexican American; 11.1 other races/ethnicities) who participated in the National Health and Nutrition Examination Survey between 2001 and 2004.

Symptoms of MDD, GAD, panic disorder, ADHD, and conduct disorder were assessed during 12 months using the National Institute of Mental Health’s Diagnostic Interview Schedule for Children Version IV.

Results showed that the participants had a mean of 4.93 MDD symptoms, 3.94 ADHD symptoms, 2.86 GAD symptoms, 1.34 conduct disorder symptoms, and 0.29 panic disorder symptoms.

When looking at associations among all participants, investigators found that serum cotinine levels were significantly correlated with symptoms of MDD, GAD, ADHD, and conduct disorder — but not with panic disorder.

“After adjusting for all covariates, serum cotinine level was most strongly associated with ADHD symptoms,” report the researchers. Although not quite as strong, the association remained significant for symptoms of MDD, conduct disorder, and GAD after adjustment.

Although there was a significant association in males between cotinine level and MDD, GAD, ADHD, and conduct disorder symptoms, the association for females was only significant with symptoms of GAD.

Finally, a significant association between SHS and MDD, GAD, and ADHD was found for white participants, but only with conduct disorder for the Mexican American group. There were no statistically significant associations with any of the disorders in black participants.

Need to Butt Out

The investigators note that only 26 states currently ban smoking in all public places.

“Efforts to ban smoking in places where children and adolescents are present, including all child care settings and schools, should continue, as well as increased efforts to develop interventions targeted directly at parents and designed to prevent SHS exposure in the homes of children and adolescents,” they write.

“To date, there has been little parallel research; thus, the findings of this new study cannot be placed into a larger body of literature to gauge consistency,” writes Jonathan M. Samet, MD, from the Department of Preventive Medicine in the Keck School of Medicine, Institute for Global Health, at the University of Southern California, Los Angeles, in an accompanying editorial.

“Consequently, the provocative findings of Bandiera and colleagues need replication and an expanded foundation of mechanistic understanding. Further research on exposure to SHS might also provide insights into neurodevelopmental effects of inhaled pollutants, a topic of rising interest,” adds Dr. Samet.

He notes that longitudinal data are needed “to bolster arguments for potential causality, to separately assess maternal smoking during pregnancy and SHS exposure after pregnancy, and to characterize the relationship between exposure at various ages and risk.”

With that said, Dr. Samet writes that there is now sufficient evidence of an association with poor health outcomes to “mandate reduction” of SHS exposure in public places.

However, because these bans do not cover homes, clinicians “should motivate parents to protect their children, beginning with prenatal care and continuing during childhood,” he opines.

“Pediatricians and other healthcare providers can help eliminate exposure of infants and children to SHS, even while the evidence on mental health continues to evolve,” concludes Dr. Samet.

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Ukraine cigarettes remain among the cheapest in the world

In March 2009, parliament discussed proposals to increase tobacco excise tax from Hr 1 to Hr 2 per pack of 20 cigarettes.
Representatives of transnational tobacco companies were very critical about the proposals and alleged that Ukrainians would not smoke less, but would just switch to cheaper smuggled cigarettes while government revenues would decline.
Since that time, the excise tax rate was increased even more and, at present, the average excise tax is more than Hr 3 per pack. The figures show what eventually has happened.
In 2007, when the tax rate was just Hr 0.5 per pack, the government collected Hr 2.5 billion from excise tobacco taxes. Then the rate was raised several times and the revenues increased to Hr 3.5 billion in 2008, to Hr 9 billion in 2009, and to Hr 13 billion in 2010, more than five-fold in three years.
In neighboring Russia, tax rates were also raised in those years, but not so fast as in Ukraine, and the revenues also increased, but only twice: from 50 billion rubles in 2007 to 108 billion rubles in 2010.
Tobacco consumption trends are even more indicative. In the mid-2000s, daily smoking prevalence in Russia and Ukraine was very similar – about 35 percent. In 2009, the Global Adult Tobacco Survey was conducted in both countries and daily smoking prevalence was 33.8 percent in Russia and 25.5 percent in Ukraine.

Ukrainians smoke less, a main reason why cigarette production in Ukraine decreased from 129 billion in 2007 to 102 billion in 2010.
It is worth mentioning that, in 2001, only 70 billion cigarettes were produced in Ukraine and the sharp production increase was mainly pushed by the huge smuggling of Ukrainian cigarettes to the neighboring countries where cigarette prices were higher.
British member of parliament Charles Tannock stated that, out of 80 billion cigarettes illegally smuggled into the European Union in 2008, 30 billion came from Ukraine. The World Customs Organization issued a report on customs and tobacco with data on large (more than 100,000 cigarettes each) seizures.
The country of cigarette departure was identified for 2,688 such seizures, and in 1,020 cases it was Ukraine. However, in 2008, there were 573 seizures of Ukrainian cigarettes and only 447 in 2009, while seizures of Russian cigarettes increased from 48 to 84.
So while Ukraine keeps the position as a world leader in cigarette smuggling, smuggling became less profitable after the tobacco tax increases and it is on the decline. This is the second reason why cigarette production in Ukraine decreased in recent years.
The tobacco industry tries to create the impression that cigarette smuggling into Ukraine is more important than smuggling out of Ukraine. Indeed, currently prices of cheap cigarette brands are higher in Ukraine than in Moldova and Russia (while Marlboro cigarettes is still more expensive in Moscow compared to Kyiv).
To measure consumption of smuggled cigarettes in Ukraine during the Global Adult Tobacco Survey, smokers were asked to show the pack.
Only 1.5 percent of them smoked Moldavian or Russian cigarettes. It means that, in 2009, about 1 billion smuggled cigarettes were consumed in Ukraine, while more than 30 billion cigarettes were produced in Ukraine just to be smuggled out of it.
The recent tobacco taxation policy was really a success in Ukraine. Tax rates increased by six times and this caused a five-fold increase in revenues. Cigarette production declined by 21 percent due to the decrease of both tobacco consumption and smuggling out of the country.
However, currently the average price of Ukrainian cigarettes is just Hr 8 per pack, while in Poland it is 9 zlotys – three times higher.
In 2011, Russia increased the tobacco tax rate much higher than Ukraine. Since April 2011, cigarette tax rates in Moldova will be raised by 50 percent. These are all reasons that justify continuing with a successful policy and increasing tobacco taxes in Ukraine again.

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