Invisible health villain for children: Thirdhand smoke

'What's he doing these days?" I ask the mother of a 10-month-old boy.

"He's crawling all over the place, chasing the family dog around in circles on the living room carpet," she states, smiling at the image of her son and dog going through their daily routine.

We go through the visit and I discover that there are smokers in the home, including his mother, but she adamantly states "we never smoke around" her son.

As he sits steadily on the exam room table, his hand almost completely inside his drooling mouth, massaging his swollen teething gums, I imagine the toxins that his imprinted fingertips are distributing into his developing body: arsenic, cyanide, and lead, just to name a few of the hundreds of toxins that are within my little patient's fingerprints, potentially causing harm that could last a lifetime.

The culprit: cigarettes. Cigarettes that were smoked earlier in the day over morning coffee. Cigarettes that were smoked earlier in the week after a hard day's work.

It's a controversial concept that has caused a news frenzy: thirdhand smoke exposure.

Thirdhand smoke is the contamination left on surfaces after a parent's cigarette is extinguished. It is the contamination that leaks through shared air ducts and ventilation from neighbors in an apartment building that a low income family cannot afford to move away from.

Recently released Philip Morris Company data from the tobacco settlement case showed that after a cigarette has been extinguished, a highly carcinogenic, tobacco-specific substance known as 4-(methylnitrosamino)-I-(3-pyridyl)-1-butanone (NNK) is present for hours, where it can be inhaled by tiny lungs and touched by tiny hands.

In fact, starting in the mid-1900's, as the landmark Times Square Camel smoke ring billboard blew 12-foot-wide smoke rings above thousands of onlookers, scientists were already discovering the link between smoking and lung cancer, and the battle between the tobacco lobbyists, advertisers, politicians and scientists had begun.

Now 58 years after the Marlboro Man advertising campaign first originated, considered one of the most brilliant of all time, and 20 years after one of the original Marlboro men died of lung cancer at 52 years old, the deadly effects of smoking and secondhand smoke are irrefutable.

In fact, smoking causes more deaths than AIDS, alcohol, motor vehicle accidents, homicide, and suicide combined - 430,000 deaths a year in the U.S. Estimates are that more than 50,000 preventable deaths are caused by secondhand smoke exposure.

But how prevalent is cigarette smoke exposure in kids?

Secondhand and thirdhand smoke is omnipresent in many children's lives. A recent report demonstrated that 18 percent of children are regularly exposed to secondhand smoke. That's 32 million children. The same study also looked at levels of cotinine, a byproduct of nicotine exposure from secondhand or thirdhand smoke, in children's hair. Fifty-four percent of children tested had detectable levels.

We know that secondhand smoke exposure is devastating to children's health. It contributes to more asthma, poor asthma control, sudden infant death syndrome and dental cavities. It leads to increased ear, sinus, and lung infections and more hospitalizations - not to mention the deaths and injuries children suffer in fires caused by cigarettes. Children exposed to secondhand smoke have more developmental delays, more sleep problems, and worsening school performance.

The average cost of a pack-per-day habit is more than $2,000 a year, and for families from Philadelphia, living in one of the most impoverished large cities in the United States, this deepens the cycle of poverty. Also, children who are exposed to smokers are much more likely to be smokers themselves.

Most smokers know that their habit is not healthy for their children.

As reported in the journal Pediatrics ("Beliefs about the Health Effects of Thirdhand Smoke and Home Smoking Bans," 2009), 95.4 percent of nonsmokers and 84.1 percent of smokers agreed that secondhand smoke harms the health of children, and 65.2 percent of nonsmokers and 43.3 percent of smokers agreed that thirdhand smoke harms children.

As I gaze wondrously at my little patient now chewing on his barefoot toes, I ask the mother whether she would like to get some help to quit smoking. "Yes," she states, "I've been trying for years."

After we discuss a quit date and identify a few supportive members of her family to help her, I fax a referral to the Quit Line that is found on the www.cap4kids.org/philadelphia website, and give her information about quit options through the Smoke Free Philly hotline at 215-683-5483 (215-683-LIVE, or (www.smokefreephilly.org).

We agree on a follow-up visit in a month where I will address her effort to quit smoking and see how her son is progressing. I'd love to hear he's now chasing the family dog while taking his first steps in a smoke-free home.