Faculty Bibliography

OBJECTIVE: To investigate the hypothesis that second-hand smoke (SHS) exposure is associated with sensorineural hearing loss (SNHL) in adolescents. DESIGN: A complex, multistage, stratified geographic area design for collecting representative data from the noninstitutionalized US population. PARTICIPANTS: Cross-sectional data from National Health and Nutrition Examination Survey (2005-2006) were available for 1533 participants 12 to19 years of age who underwent audiometric testing, had serum cotinine levels available, and were not actively smoking. MAIN OUTCOME MEASURES: SNHL was defined as an average pure-tone level greater than 15 dB for 0.5, 1, and 2 kHz (low frequency) and 3, 4, 6, and 8 kHz (high frequency). RESULTS: Secondhand smoke exposure, as assessed by serum cotinine levels, was associated with elevated pure-tone hearing thresholds at 2, 3, and 4 kHz, a higher rate of unilateral low-frequency SNHL (11.8% vs 7.5%; P < .04), and a 1.83-fold increased risk of unilateral low-frequency SNHL in multivariate analyses (95% confidence interval, 1.08-3.41). The prevalence of SNHL was directly related to level of SHS exposure as reflected by serum cotinine levels. In addition, nearly 82% of adolescents with SNHL did not recognize hearing difficulties. CONCLUSIONS: Secondhand smoke is associated with elevated pure-tone thresholds and an increased prevalence of low-frequency SNHL that is directly related to level of exposure, and most affected individuals are unaware of the hearing loss. Thus, adolescents exposed to SHS may need to be closely monitored for early hearing loss with periodic audiologic testing

Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Nationally representative data from the 2000-2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n = 18,810) was assessed, comparing those living with one or more smokers (n = 3,344) to those living in households with no adult smokers (n = 14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers in the USA are non-smokers and 17.4% of them live with >/=1 adult smokers: 14.2% with 1 and 3.2% with >/=2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11% (95% CI = 0.80-0.99) lower odds of scoring at or above the mean MCS score and a 19% (95% CI = 0.73-0.90) lower odds of scoring at or above the mean PCS score compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (P < 0.001). These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers

This article focuses on nicotine as the primary determinant of addiction to tobacco and on the biological pathways that are affected by nicotine intake to cause addiction. Addiction to tobacco involves an interaction between many biological and environmental factors, including genetics, conditioned learning, and social stimuli. Pharmacological uses of tobacco include perceived enhancement of mental and physical functions and enhancement of mood (either directly or through relief of symptoms associated with nicotine withdrawal). Nicotine addiction occurs when smokers rely on the effects of smoking to improve mood and arousal, to relieve withdrawal effects, or both. Occasional smokers use cigarettes mainly for the positive perceived effects in certain situations. The development of addiction to nicotine is largely mediated through both specific genes and different nicotinic acetylcholine receptors (nAChR) subtypes. There is an increased risk for addiction to smoking among people with substance abuse or mental health disorders.

This issue of The International Journal of Mental Health is devoted to what is one of the greatest and most urgent public health problems worldwide: children's exposure to prenatal tobacco and secondhand smoke and their uptake of the use of tobacco. Tobacco use is the leading preventable cause of death in the developed world, and, as developing nations are increasingly targeted by the tobacco industry, tobacco is taking an ever-increasing toll on populations worldwide. Unfortunately, tobacco use and exposure are still far too often seen as adults' rather than children's problems, although the vast majority of smokers begin to smoke as children and adolescents, and prenatal and childhood exposure to tobacco smoke has multiple pernicious effects on those exposed during their childhood and continuing across their lifespans. One of the articles in this issue summarizes our current knowledge of nicotine addiction and its consequences; another deals with the assessment of nicotine addiction in adolescents; and a third deals with behavioral and school functioning characteristics of adolescents who do in fact become smokers.

The deleterious effects of smoking have been publically implicated for almost a century but were not popularized until the Surgeon General issued the famous 1964 publication Smoking and Health: Report of the Advisors-Committee to the Surgeon General of the Public Health Service. Since the release of this influential document, many of the pathological, teratogenic, and carcinogenic effects of exposure to secondhand smoke (SHS) and nicotine have been elucidated by the research community. More recently, the 2006 Surgeon General's Report stated that there is no safe level of cigarette smoke exposure. Yet, with this knowledge, as well as the volumes of information now known and soon-to-be discovered about the consequences of smoking, 60 percent of children in the United States show evidence of recent exposure to SHS, and 30 percent of children live in a household with at least one smoker. The exact nature of the relation between maternal prenatal and postnatal smoking and childhood behavioral and cognitive problems has not yet been fully elucidated; the reliability of much of the data known now is adversely affected by confounding variables and methodological challenges that make it impossible to pinpoint an exact causal relation.

Background: Numerous human epidemiologic and animal studies indicate that children's secondhand smoke exposure (SHS) is associated with increased rates of child behavior problems. Objective: To investigate the relation between children's exposure to SHS in their homes and rates of child behavior problems in Slovakia, an area where such investigation has not been previously investigated and where rates of adult smoking are substantially higher than they are in the United States. Setting and Method: Surveys were administered to parents of 1,478 children ages 6 to 15 years throughout Slovakia. Information was collected about child and family sociodemographic characteristics (child age and gender, household income and residence, and maternal and paternal educational and smoking status), and child behavior problems were assessed using the well-utilized parent-reported Child Behavior Problem Index. Bivariate and multivariate analyses were conducted. Results: The response rate was 73 percent, and girls and children from more affluent families were less likely to have behavior problems (in multivariate analyses the adjusted odds ratio f o r behavior problems and the 95 percent confidence interval (CI) f o r girls was 0.438 (95 percent CI = 0.286-0.669) and f o r those living in households earning more than the average income was 0.395 (95 percent CI = 0.260-0.599). In contrast, there was no evidence in bivariate or multivariate analyses of increased rates of behavior problems in children living in households with smokers. Conclusion: Children exposed to household SHS in Slovakia were not found to have increased rates of behavior problems, possibly due to the substantially higher rate of smoking in this country than in the United States and the lack of regulations limiting smoking in public settings.

CONTEXT: Although maternal smoking has been associated with child emotional and behavioral problems, to our knowledge, no study has evaluated the association between overall household smoking and such problems. OBJECTIVES: To investigate whether children who live with smokers are more likely than children who do not live with smokers to have emotional or behavioral problems and to explore this association in households with nonsmoking mothers. DESIGN, SETTING, AND PARTICIPANTS: Nationally representative data from the 2000 to 2004 medical expenditure panel surveys, involving 30,668 children aged 5 to 17 years, were used. Associations between child emotional or behavioral problems and household smoking, and child, maternal, and family characteristics were examined. SUDAAN software was used to adjust for complex sampling design. MAIN OUTCOME MEASURES: Overall score on the Columbia Impairment Scale, a 13-item parent-report measure of child emotional or behavioral functioning (range, 0-52, >or=16 indicates a child with such problems). RESULTS: Children in smoking versus nonsmoking households were significantly more likely to have behavioral problems (17.39% vs 9.29%, p < .001). After adjusting for all covariates, male sex, older age of child, younger age of mother, unmarried mother, maternal depression, and below average maternal physical and mental health, each were independently associated with increased likelihood of emotional and behavioral problems, as was the presence of one or more adult smokers in the household (adjusted odds ratio 1.42; 95% confidence interval: 1.26-1.60). The odds of Columbia Impairment Scale score >or=16 increased with increasing number of smokers in the household, even among children whose mothers did not smoke. CONCLUSION: Children living with smokers are at increased risk for emotional or behavioral problems, and rates of such problems increase with increasing numbers of smokers in the household, even in the absence of maternal smoking

This study investigated a potential independent association between hypovitaminosis D and suspected nonalcoholic fatty liver disease (NAFLD) in a nationally representative sample of the US adolescents. Data from 1630 subjects 12-19 years of age were examined using the National Health and Nutrition Examination Survey, 2001-2004. The vitamin D status of subjects was categorized into quartiles of serum 25-hydroxyvitamin D. Subjects with serum ALT > 30 U/L were classified as having suspected NAFLD. Data regarding age, sex, race, BMI, and poverty level were also analyzed in bivariate and multivariate analyses using SAS and SUDAAN software. Suspected NAFLD was identified in 12.1% of adolescents in the lowest quartile compared to 6.9% of adolescents in the second quartile, 8.0% in the third quartile, and 13.17% in the highest quartile of serum 25(OH)D concentrations (P = .05). In analyses utilizing vitamin D as a continuous variable, no independent association was found between Vitamin D levels and rates of elevated ALT levels. In multivariate analyses, higher risks for suspected NAFLD were observed in males and overweight adolescents; however, vitamin D status was not found to be independently associated with suspected NAFLD after adjusting for obesity.