Secondhand smoke and vapor exposure in youths: challenges facing physicians in addressing this complex problem
Bueno, Brian Thomas
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The dangers of secondhand smoke (SHS) exposure on the human body were initially reported in 1972, just eight years after the negative effects of smoking on smokers was reported. The Surgeon General of the United States systematically expanded (and continues to expand) the warnings over time, as new scientific evidence becomes available. Warnings, which began to incorporate youths in 1975, emphasized the need to pay particular attention to fetuses, newborns, infants, children, adolescents, and young adults since they rely on parents, guardians, and other adults to keep them safe. Although fewer in number than adults, the diseases that are causally linked to smoking and exposure to SHS in youths are also complex and can result in death (i.e., sudden infant death syndrome). The introduction of new tobacco products, such as low nicotine cigarettes and electronic cigarettes, prompted the Surgeon General to release additional warnings. In 2016, the Surgeon General advised the nation that more information will become available as the electronic cigarette manufacturers comply with new Tobacco Control Act requirements to report harmful vapor constituents. Physicians need to keep abreast of the vast and growing body of knowledge related to the biological and chemical components of SHS and vapor, as well as the dangers that SHS and vapor cause. To ease the burden on physicians, the federal government and medical professional societies created clinical practice guidelines which summarize the literature related to the dangers of SHS and make recommendations for medical management. Guidelines recommend that physicians and other clinicians should offer smoking cessation advice and intervene to limit youth exposure to SHS. Although the approach recommended for use with patients in a physician’s office is clear and attempts to streamline the processes have been made, the identification and counseling process for smoking cessation and eliminating SHS exposure remains time consuming. Barriers to payment make it difficult for physicians to be adequately reimbursed for their efforts to keep their patients safe from the dangers of SHS and vapor exposure. More work is needed to be able to continue to reduce the percentage of youths exposed to SHS in their environments. Additional attention is needed to address the racial and ethnic disparities that are evident in the scientific literature.