People often underestimate children's exposure to secondhand tobacco smoke and minimize its harmful effects on their lungs, hearts and brains.
"There's denial among the smokers that they don't smoke around children, they don't smoke in the house, they don't smoke in the car," said Dr. Geetha Raghuveer, a pediatric cardiologist at Children's Mercy Hospital in Kansas City, Missouri. "But that may not be something they can execute all the time."
She said the "intent" might be there to avoid smoking around others, but the reality often differs greatly — and "with the pandemic, at this point in time, people may have been indoors more."
A Centers for Disease Control and Prevention report on middle school and high school students said about 1 in 4 – or nearly 7 million – reported breathing secondhand smoke in their homes in 2019. That exposure came from the estimated 14% of U.S. adults – 34.1 million – who smoked cigarettes as of 2019. Millions more used cigars, pipes and other burning tobacco products.
The U.S. surgeon general has said there is no risk-free level of secondhand smoke, which contains hundreds of toxins such as nicotine, ammonia and carbon monoxide. Inhaling the smoke can contribute to a range of serious health conditions such as asthma, unhealthy blood vessels, hypertension and premature cardiovascular disease or death. According to the CDC, nonsmokers who are exposed to secondhand smoke at home or work have a 25% to 30% higher risk of heart disease and a 20% to 30% higher risk of stroke.
People often think of respiratory effects of secondhand smoke but either discount or don’t consider cardiovascular issues, experts said. And when it comes to children, there is a tendency to minimize long-term ramifications.
"It's just like high cholesterol or obesity; in a child, they are kind of silent – asymptomatic," Raghuveer said. "Fortunately, we don't have children who have a heart attack or a stroke because of hypertension, obesity or high cholesterol. But at the same time ... these risks only increase in magnitude and severity if exposures and poor lifestyle persist. So, it's important to recognize that there are lifelong cardiovascular consequences."
The choice to stop smoking – or never start in the first place – is undeniably the best solution, but it's admittedly a difficult process for smokers, Raghuveer said. Of key importance is offering support, encouraging them to be honest about their smoking habits, and emphasizing how those habits affect not only their own health but that of their loved ones.
We need to be there for them," she said. "Sometimes parents don't want to talk about this, and they just say, 'No, we don't smoke.' But I know I'm smelling smoke in that room."
There are many options for smokers who want to quit. First and foremost, they should consult with their health care professional, who can offer a range of options varying from nicotine replacement medications to cognitive behavioral therapy to avoiding triggering associated habits.
All 50 U.S. states have quit lines with coaches, resources and even weeks of free nicotine replacement therapy, said Dr. Surendranath S. Shastri, professor of health disparities research at the University of Texas MD Anderson Cancer Center in Houston.
But people need to access those services and others with a realistic outlook and the willingness to persevere, even after possible failed attempts. 1-800-QUIT-NOW is a toll-free telephone line that routes callers to their state quit lines.
"Quitting is not something that is a one-shot kind of thing," Shastri said.