Research Allied Health

Fall 2006

Dr. Masini

Paula Widner

The effects of secondhand smoke of the developing child.

Abstract

            Ear infections are usually presumed to be caused by a bacteria or virus. This study is intended to show that secondhand smoke can also cause ear infections. It also will show the statistics of how many children live with smokers. The reasons some do not stop smoking around developing children is because the lack of education about the topic and others just do not care. There are several mentioned articles in the paper that coincide. These authors have all came to similar conclusions that secondhand smoke does affect the developing child’s health. More specifically this study focuses on how the secondhand smoke can and does cause chronic ear infections and problems.  

Introduction

Imagine having dizziness, fever, and unbearable pain inside your ear. Now imagine that you are 5 years old trying to explain to a doctor what is hurting while one or both of your parents are outside smoking. Many people do not realize the effects that secondhand smoke causes. Secondhand smoke can cause different health problems in growing children’s bodies. However most probably do not know that secondhand smoke can cause chronic ear infections, sometimes the damage is irreversible. Granted at some point in time a child is going to get an ear infection regardless of whether or not they are exposed to secondhand cigarette smoke.  The point is that people who smoke do not realize really what they are putting in their mouth and exposing children to. Studies show that secondhand smoke causes chronic inner ear infections for the developing child and prove that it can be prevented.

I chose this topic because I am a child of smoking parents and relatives. I know what it is like to wake up in the middle of the night with excruciating pain in your ear. I feel that letting parents, friends, and everyone possible know how much secondhand smoke affects children is important. These affects are not always temporary, permanent damage can be done.

I believe there is a link between secondhand smoke and the occurrence and severity of ear infections in the developing child. I believe that the occurrence is increased also the severity of the problem increases.  This research paper is going to address two main questions. One question will be how much second hand smoke are young children exposed to?  Also what affect is the secondhand smoke having on the child’s developing ears? In this study the dependent variables are the number of ear infections that occur in children younger than age ten and the severity, whereas the independent variable is if they live with at least on smoker.           

Review of Literature

            How much secondhand smoke are children coming in contact with? Angela Spivey (2006) mentioned in an article that “In the most recent time period studied, 2001 through 2002, the median exposure level for children aged 4 to 11 was almost twice that of adults.” That is too much for the developing body of a child. Timothy Jordan, James Price, Joseph Dake, and Sapna Shah (2005) relay the statistics that “More than one third of children in the United States live in homes where residents or visitors smoke regularly, and 28% (>19 million) live in a home in which a resident smokes daily.” Keith King, Rebecca Vidourek, Stephanie Creighton, and Stephanie Vogel (2003) mention, “Among children, secondhand smoke contributes to low birth weight, chronic middle ear infections, sudden infant death syndrome, asthma, and respiratory illnesses such as coughing and excess phlegm. The most common place of secondhand exposure is in the home. Between 29% and 43% of US households with young children allow smoking in the home.” Sue Randall (2006) correlates to the previous statistics when she mentions, “a staggering 42 per cent of British children live in households where at least one person smokes.” Sharon Sheahan and Teresa Free (2005) convey the fact that “Children are exposed to a variety of ETS sources including childcare workers, relatives, and other household visitors who may leave tobacco smoke chemicals and irritating odors on their clothing. Parents who smoke in the car do not realize the increased exposure that exists for their children when smoke is confined in a small area.” Soheil Soliman, Harold Pollack, and Kenneth Warner (2004) reinforce this question with this statement, “ Children of smokers are particularly susceptible because many are exposed to ETS for extended periods in the home and because children have little recourse in removing themselves from such environments.”

What affect is the secondhand smoke having on the child’s developing ears? Linda Carlson (2005) recognizes that secondhand smoke is a factor that could cause ear infections. She implies that avoiding secondhand smoke would be beneficial. Nancy Fickert (2006) also agrees because she urges people not smoke around their kids or allow other people to either. Timothy Jordan and his colleague’s (2005) article also applies to this question. He states “Exposure to ETS also may increase children’s risk of otitis media (i.e., middle ear infections). These adverse health effects increase the risk of school absenteeism and impede academic progress.” Sue Randall (2006) also conveys that “In 1999 the World Health Organization Conference on Secondhand Smoke and Child Health … concluding that secondhand smoke is: 'a real and substantial threat to child health'. The conference outlined the health effects as: decreased lung function; increases in bronchitis, coughing and wheezing, pneumonia, asthma attacks, middle ear infections (which increase by 20 to 40 per cent in children whose parents smoke).” Allen Shaughnessy (2005) concludes “Exposure to secondhand smoke is associated, in a dose-related manner (the amount of smoking by the parents), with children developing meningococcal disease. Otitis media occurs more frequently in children of smoking parents (OR = 1.9; 95 percent CI, LO to 3.5), although the clinical course is similar between the two groups. In another study, smoking during pregnancy predicted subsequent ear infections in children in a dose-related fashion.” Sharon Sheahan and Teresa Free (2005) also emphasize more on how children are exposed to environmental tobacco smoke and its relation to adverse health. The article by the Journal of Environmental Health (2006) reinforces what other authors previously stated. 

Methods

            The participants for this study were found at local elementary schools. The participants consist of parents with children ages 4 to 11. I replicated a study done by Timothy Jordan, James Price, Joseph Dake, and Sapna Shah (2005) and made it fit to my study’s needs. The HIPPA regulations were followed by keeping the participants information confidential. The ETSU IRB approved this study because the participants signed a release form, were informed of the risks and benefits, and their information would be kept confidential. The researchers had also scored a passing grade of 85% or above on the Collaborative Institutional Training Initiative program. This program is necessary to maintain the ethical boundaries for the researchers and to keep everyone safe.

 Researchers developed a 30-item survey instrument to measure the parents’ smoking-related behaviors, attitudes, and perceptions regarding ETS. Items measured the following variables: exposure to ETS (9 items), perceived health effects of ETS on their children (1 item), whether or not their children had recurrent ear infections (more then 6 a year)(10 items), and whether or not the parents felt their smoking habit had an affect on their child’s health (8 items). All items were closed-format questions that required the respondent to select from a range of potential responses. Response formats varied from categorical type responses (e.g., "yes," "no," "not sure") to 5-point, Likert-type responses ("strongly agree" to "strongly disagree").

To establish the face validity of the survey instrument, a thorough literature review was conducted regarding ETS and adults. Instrument content validity was established by having the survey instrument critiqued by 3 health professionals with expertise in family health, tobacco, and survey research. Based on feedback received from the expert panel, the survey instrument was modified prior to pilot testing. Administering the survey to a sample of 26 (some smokers and some not hopefully) parents as they drop their child off for school in a high volume elementary school in Tennessee assessed instrument stability-reliability. Obviously parents who do not smoke are going to have low exposure rates. Stability-reliability of the instrument was r = .71. Internal reliability of the instrument, calculated on responses to the instrument was r = 0.72.

Data analyses were done using SPSS 12.0 (SPSS Inc., Chicago, Ill.). Level of significance for all statistical tests was set at 0.05. Descriptive statistics were used to describe respondents. Appropriate statistics, frequencies, means, and standard deviations described participants' responses on the survey instrument. Researchers used the Mann-Whitney U tests and Kruskal-Wallace tests for analysis of variance because the data was ordinal but would show the needed differences between the data. Chi-square tests and odds ratios were conducted to determine if support for clean indoor air ordinances differed across such variables as gender, race, age, level of education, perceived health effects of ETS, smoking status, and acceptability of ETS. With all the data, we were able to support our hypothesis. There is a link between secondhand smoke and the occurrence of ear infections in children ages 4-11.

Discussion

            With the conclusion of this study and research I have been able to support my hypothesis. There is a connection between secondhand smoke and ear infections. When brainstorming research topics I felt there was a connection but now I know that there is some correlation. All of the authors mentioned above had a new tidbit of information that I had not previously considered. I had not realized that there was so many children age 4- 11 that were living in homes with smokers. I also was relieved to find out that the problem is not only in the U.S. Sue Randall’s article focused on the British population. There were not any surprises in my research but more information confirming my suspicions.

Conclusion

            There is a connection between the exposure to secondhand smoke and ear infections that occur in children. The made the assumptions I had viable. With the completion of this research I now know that I am not the only person who thinks that ear infections and secondhand smoke are related. This research also broadens the research studies dealing with secondhand smoke. A researcher could focus on how ETS affect adults. Researchers could also try to narrow down what specific ingredients in the tobacco smoke causes what affect on the body. This research could have been narrowed down if a researcher had the time and applications necessary to do that. They could focus on just how the ETS affected the tympanic membrane.  I think the list would be long if researchers focused on the separate parts of the ear. Then if researchers focused on two parts and added each time they did the research or sub-grouped the research.

 Bibliography

Carlson, Linda. Otitis media: new information on an old disease. Nurse Practitioner. Mar2005, Vol. 30 Issue 3, p31-32, p35-37, p39-43.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=c8h&AN=2005072203&site=ehost-live>

Fickert, Nancy. Health maters: promoting health and wellness. Taking a closer look at acute otitis media in kids. Nursing. Apr2006, Vol. 36 Issue 4, p20-21.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=c8h&AN=2009154526&site=ehost-live>

Jordan, Timothy and James Price, Joseph Dake, Sapna Shah. Adolescent exposure to and perceptions of environmental tobacco smoke. Journal of School Health; May2005, Vol. 75 Issue 5, p178-186.        

<http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=17087724&site=ehost-live>

King, Keith and Rebecca Vidourek, Stephanie Creighton, Stephanie Vogel. Smokers’ Willingness to Protect Children From Secondhand Smoke. American Journal of Health Behavior. Sep/Oct2003, Vol. 27 Issue 5, p554.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=10838661&site=ehost-live>

Randall, Sue. Children and secondhand smoke: not just a community issue. Paediatric Nursing; Mar2006, Vol. 18 Issue 2, p29-31.

           <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=20258534&site=ehost-live>

Secondhand Smoke Linked to Health Risks in Children and Women. Journal of Environmental Health; Jan/Feb2006, Vol. 68 Issue 6, p78-79.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=19570071&site=ehost-live>

Shaughnessy, Allen. Smoking Increases the Risk of Infection. American Family Physician. Mar. 15,2005. Vol. 71 Issue 6, p1184-1186.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=16682540&site=ehost-live>

Sheahan, Sharon and Teresa Free. Counseling Parents to Quit Smoking. Pediatric Nursing. Mar/Apr2005, Vol. 31 Issue 2, p98-109.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=16755149&site=ehost-live>

Soliman, Soheil and Harold Pollack, Kenneth Warner. Decrease in the Prevalence of Environmental Tobacco Smoke Exposure in the Home During the 1990s in Families with Children. American Journal of Public Health. Feb2004, Vol. 94 Issue 2, p314-320.            <http://search.ebscohost.com.ezproxy.etsu.edu:2048/login.aspx?direct=true&db=nyh&AN=12149809&site=ehost-live>

Spivey, Angela. The Public Health Payoff of “No Smoking Allowed”. Environmental Health Perspectives; Jun2006, Vol. 114 Issue 6, pA370-A370.