Respiratory problems linked to tobacco smoke migrating through multiunit housing

Persistent respiratory symptoms in children could be due to tobacco smoke that migrates through the walls and ventilation systems of multiunit buildings, the lead author of a new report said.

Children who live in apartments have cotinine levels 45% higher than those of youths who reside in detached homes, according to the study published online Dec. 13, 2010, in Pediatrics. Cotinine is a metabolite of nicotine and indicates exposure to cigarette smoke. All of the studied children lived in households where family members did not smoke indoors.

The study follows a Dec. 9, 2010, report by the surgeon general that said there is no safe level of exposure to tobacco smoke.

Physicians treating youths with persistent respiratory problems, particularly those whose parents do not smoke, should ask what type of residence they live in and whether they smell tobacco smoke in or around their home, said pediatrician and lead study author Karen M. Wilson, MD, MPH.

For patients who live in multiunit housing, she encourages doctors to write a letter to the property owner stating that tobacco smoke in the building seems to be exacerbating the child's symptoms and that something needs to be done to lessen exposure to it.

"I'm cognizant of the burden on smokers and concerns that we're preventing people from doing something in their own home, but I also believe we need to protect children," said Dr. Wilson, assistant professor in the Dept. of Pediatrics at the University of Rochester School of Medicine and Dentistry in Rochester, N.Y.

Secondhand smoke exposure

Tobacco smoke exposure can cause asthma and respiratory infections in children, according to the study. It also has been associated with sudden infant death syndrome and cognitive problems among youths.

Researchers examined data on 5,002 children 6 to 18 who participated in the 2001-2006 National Health and Nutrition Examination Survey. Youths who said they smoked were excluded.

Participants were asked what type of housing they lived in -- apartment, single-family attached house or one-family detached house, which includes mobile homes. Each child's serum cotinine levels were measured.

Researchers found that 73% of the children studied had cotinine levels that indicated they were exposed to secondhand tobacco smoke. Exposure was greatest among children living in apartments.

More than 84% of such children had a cotinine level of .015 ng/mL or greater, which signifies recent tobacco smoke exposure. The figure was 80% among children living in an attached house and 70% for those in a detached house.

The study authors attributed exposure, in part, to family members who smoke outside the residence but carry in tobacco residue on their clothes. For children living in multiunit buildings, exposure also could be due to smoke seeping through walls and shared ventilation systems.

The report said smoking bans in multiunit housing might reduce children's exposure to tobacco smoke. The American Medical Association House of Delegates adopted policy in June 2010 that recommends prohibiting smoking in such buildings.