White Coat Notes

Kids in apartment buildings exposed to more tobacco smoke

December 13, 2010

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Children who lived in apartments with non-smokers had higher levels of a tobacco byproduct in their blood than children from smoke-free single-family homes, according to a new study that suggests multiunit housing is a significant source of second-hand smoke.

This is the first study to show increased tobacco exposure in the blood of children who live in multiunit housing, even if no one smokes in their apartment, said Dr. Jonathan Winickoff of MassGeneral Hospital for Children, senior author of the article published online today in the journal Pediatrics.

“No matter how careful a parent you are, you will not be able to protect your child against tobacco smoke exposure if you live in multiunit housing that isn’t smoke-free,’’ he said in an interview.

The authors analyzed data from the 2001-2006 National Health and Nutrition Examination Survey. Parents of children from 6 to 18 years old answered questions about smoking and where they lived. More than 5,000 children had physical exams during which they gave blood and urine samples.

Eighty-five percent of children living in apartments had levels of cotinine that indicated recent tobacco exposure compared with 80 percent of children living in attached houses and 70 percent of children in single-family homes. Cotinine is a byproduct of nicotine found in the blood.

The children may have been exposed to smoke outside their homes, at school or day care, the authors say. Adults who smoke outside the home could also have brought back inside the house tobacco contaminants that cling to their clothes, a phenomenon called “third-hand smoke.’’

Second-hand smoke has been associated with illnesses such as asthma and ear infections as well as sudden infant death syndrome, according to research cited in the study. Children are more vulnerable because their smaller lungs are still developing and they tend to spend more time inside their homes. Winickoff said other people in multiunit housing, including elderly or disabled people who may not get outside very often, are also at risk of tobacco exposure.

The researchers suspect that smoke seeps between walls or through common air ducts in apartment buildings.

“For people who don’t smoke in their own units, this is the final link in the chain,’’ he said. “This is getting not only into the air we see, but into the blood of children.’’

Winickoff hopes private and public landlords will make their buildings smoke-free.

“Landlords are faced with a new decision based on this research: not whether their buildings should go smoke-free but exactly how soon to begin that process,’’ he said.

The Boston Housing Authority has proposed to make all 64 of its public housing developments smoke-free by 2013. Under the proposal, about 27,000 residents in 12,000 units would be prohibited from smoking in common areas and their own apartments. ELIZABETH COONEY

Teen dating violence linked to peer violence

Many teens who said they recently slapped, hit, choked, or kicked romantic partners were also violent with peers and siblings, according to a survey of Boston high school students reported in the Archives of Pediatrics and Adolescent Medicine.

Emily Rothman of the Boston University School of Public Health asked a random sample of almost 1,400 students at 22 public high schools if they had been violent with peers, siblings, or people they were dating or had sex with during the past 30 days. About one-fifth said yes about dating violence. Among these boys, 75 percent reported both dating and peer violence and 56 percent reported both dating and sibling violence. Among these girls, 60 percent said they had also been violent with peers and 50 percent said they had also been violent with siblings. E.C.

If drugs fail, don't assume patients are bipolar

A common theory is that people who don’t respond to antidepressants may have other mental illnesses, including bipolar disorder, defined by mood swings.

A team led by Boston researchers say in the Archives of General Psychiatry that unrecognized bipolar disorder is not a significant reason that antidepressant treatments fail. Their study found that antidepressants did not work as well for people if they had irritability — one symptom of bipolar disorder. But those with other risk factors, such as manic symptoms or a family history, were not different from other participants in response to antidepressants.

Dr. Roy Perlis of Massachusetts General Hospital and colleagues analyzed information from the STAR*D study, a clinical trial of more than 4,000 people testing four depression treatments in sequence. Those with at least one psychotic symptom did worse through all four treatments. E.C.

Children will eat low-sugar cereal

Given the chance, children eat — and like — cereals lower in sugar, according to a study from Yale.

Jennifer Harris, lead author of the study in today’s Pediatrics journal, tested cereals among 91 day campers in New England who were 5 to 12 years old. Randomly divided into two groups, half were offered three high-sugar cereals and half were offered three low-sugar cereals. The children could have as much milk, orange juice, bananas, and strawberries as they wanted; they could also sprinkle sugar on top.

After breakfast the children rated the cereals and researchers calculated how much food and calories they consumed. In both groups, the children said they “loved’’ or “liked’’ the breakfast. The low-sugar group ate a little more than a standard 35-gram serving of cereal; the high-sugar group consumed almost twice as much cereal and calories from sugar, even though more children in the low-sugar group added sugar to their cereal. A little more than half of the low-sugar group put fruit on top compared to 8 percent of the high-sugar group. E.C.

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