Is it Secondhand Smoke Or Secondhand Addiction A Theory Based on Observation of Infants 6 19 months

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Is it Secondhand Smoke Or Secondhand
Addiction?A Theory Based on Observation of
Infants 6 19 months of age.
Kittie M. Weber, Ph.D. Presented February 24,
2006 Midwest Scholars Conference Indianapolis,
Indiana
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• Studies on the effects of secondhand or
  environmental tobacco smoke.
• nicotine and cotinine in mother and infant.
  (Peterson,
• Edward et al, 1997)
• in-utero and placenta
• (Pastrakuljic, A et.al, 1998)

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• hair analysis
• (Kalinic, N. et al, 2003)
• iodine deficiency
• In breast milk
• (Laurberg,
• Peter, et al, 2004)
• sleep apnea
• (Htoo, Aung, et al, 2004)

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• Infants not identified as ETS, did not have the
  same extreme reactions to activities as did the
  ETS infants.
• These behaviors may be an early identification of
  behaviors identified in older children as
  impulsive and ADHD.

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• School age ETS children have been identified with
• exhibiting similar behaviors which
• have been labeled
• as ADHD and learning
• disabilities, or other
• behavior problems.
• Batstra et al., 2003, states that
• ADHD is more prevalent in children
• of smoking mothers, more among
• boys and children of lower social classes.

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• Levin et al., 1996, reports,
  nicotine released when cigarettes are burned
  remediate's or partially treats symptoms of ADHD,
  including inattention and impulsivity.

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• Does this suggest that the symptoms of ADHD are
  only present as long as the child is routinely
  exposed to nicotine?
• Over time, would the behaviors decrease and the
  symptoms of ADHD ease?

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OKAY SO, WHAT AM I TALKING ABOUT?
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• Daycare facility
• Children ages
• 6 months 19 months
• 26 children observed
• 22 Caucasian
• 2 African American
• 2 Asian

4 identified as exposed to Environmental Tobacco
Smoke, (ETS or Secondhand)
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• PARENT PROFILE
• well-educated professionals
• small business owners
• educators

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• FAMILIES
• intact nuclear families
• middle/upper middle class

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• CHECKLIST OF BEHAVIORS
• Crying Time ___ Duration ___ Reason
  _________________________
• Aggressive Time ___ Duration ___ Reason
  _________________________
• Sleep Time ____ Duration ____ Reason
  _________________________
• Sustained Attention Time ___ Duration_____
  Activity ____________
• Seeking interaction Time ___ Duration ____
  Reason ______________
• Feeding Time___ Duration ____
  What Amount __________________
• Moods Time ___ Duration _____ Explanation
  ______________________

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RESULTS

• Within 2 2 ½ hours after arriving they would
  become agitated, jittery or more emotional than
  the other children.
• At snack and lunch times, they would become
  markedly more impatient than others
  while waiting to be fed, eating larger
• amounts more quickly.
• They were resistant to changes in
  routine and staff members.

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• These children presented less ability to
  self-soothe or calm.
• Temper tantrums were more common and lasted
  significantly longer than in other children.
• The cries of ETS infants tended to be more shrill
  and higher in pitch.

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• ETS infants tended to be more kinesthetic and
  physically active than non-ETS children, but did
  not demonstrate any more ability than non-ETS
  infants.
• Attention span never exceeded more than 2 minutes
  UNLESS it was a large motor activity with
  consistent reinforcements.

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There was no significant difference in napping
between ETS children and non-ETS children.
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• The rate of learning was slower for the ETS
  children.
• ETS children responded less to verbal or sign
  language cues, and responded more positively to
  physical touch and direction.

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• At the end of the day, ETS children became more
  restless and jittery, often having tantrums and
  emotional outbursts.
• The intensity of emotions was greater and more
  unstable than non-ETS children.

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• ETS children had harder stools and expressed more
  stomach discomfort than non-ETS children.

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• There was no significant difference in rate of
  ear infections or colds, although the severity
  and duration of illnesses tended to be more for
  the ETS children.

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• ETS children showed more attachment to comfort
  object (blankets, pacifiers, bottles) than
  non-ETS children when attempting to wean.

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It was an accident when we discovered a
connection between ETS and Tobacco Dependency
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• If we are looking at the rates and
• Dependence of older children on nicotine,
• OLoughlin, J. et al (2003) suggests,
• the need to take early nicotine dependence
  into account.

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• OLoughlin, describes
• Five Indicators of Nicotine Dependence
• 1) cravings
• 2) loss of control
• 3) persistence
• 4) self-perceived mental and physical addiction
• 5) withdrawal symptoms.

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OLoughlin, goes on to say subjects reported
feeling nervous, anxious, or tense on
stopping feeling a strong urge or need to
smoke smoking calms me down I function
better after I smoke
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1997 study, Tiffany suggests, craving may be
Characteristic of dependence in general, not just
withdrawal
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• Research concludes
• adolescent smokers might smoke
• more in response to the cravings
• to avoid withdrawal symptoms
• My Research suggests
• Symptoms appeared in the ETS infants without a
  way for the infants to communicate the needs or
  feelings described by the adolescents.

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• Examples of Infant Cravings
• Meal times, attempting to sooth by consuming
  comfort foods in large amounts, very quickly.

• Need for bottles more frequently and more
  resistant to weaning.

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• Researchers, suggest nicotine
• may be airborne
• be available through dust and
• residue on fabric, hair and skin
• may suggest less tolerance for dependence due to
  the tenderness of the functions of the infants
  body.
• (Page-Sharp, M. et al, 2003, Klien, J. Koren,
  G., 2000, Laurgerg, P. et al, 2004, Peterson,
  E.L., et al, 1997, Kalinic N. et al, 2003,
  Willers, S. et al, 2004, Klerman.L. 2004)

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• When a staff member, who is a smoker, would come
  into the room, the ETS children would bury their
  faces into the staffs clothing or hair and
  inhale, calming them down.

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• David Olds, (1997) cites at least a dozen sources
  that support in infants born to smoking mothers
• higher rates of neurobehavioral disturbances
• reduced habituation to a variety of stimuli
• lower arousal
• increased tremulousness
• reduced autonomic regulation
• reduced orientation to auditory stimuli
• cries with higher pitches

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• If the environment changed and the nicotine
  exposure completely disappeared, would the
  infants go through nicotine withdrawal?

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• Support of the detrimental effect on the unborn
  fetus from nicotine exposure.
• Nicotine is one of the most addictive substances
  available.
• The most difficult habit to break.
• (Page-Sharp, M. et al, 2003, Baststra, L.
  Hadder-Algra,M., 2003, Peterson, E.L. et al, 1997)

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• Think about the difficulty an infant would have
  to break the same habit that it has been exposed
  to throughout its development,
• in-utero and subsequently after birth.

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• The infant has never directly inhaled the
  tobacco but has had second hand exposure
  continuously.
• How can we be sure the
• infant does not have an addiction/dependence
  on the nicotine in the form it arrives to the
  infant?
• Pastrakuljic, A.et al, 1998, Page-Sharp, M. et
  al, 2003, Baststra, L. Hadder-Algra,M., 2003,
  Peterson, E.L. et al, 1997)

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• There is a need to begin studying the possibility
  that nicotine addiction does exist in infants.
• The symptoms of cravings and withdrawal are
  present in ETS infants.

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• Maybe we should
• look at the implications of the infants from
  the very beginning by doing more intense
• and focused study
• on the behaviors
• of ETS infants in
• the natural environment.

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• The question becomes
• Are behaviors due to the effects of nicotine
  in the blood from maternal smoking while
  in-utero,
• combined with the continuation
• of inhalation of nicotine from
• the environment, maintaining
• a nicotine addiction in the child?

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• The literature clearly supports the findings of
  the observations made of the ETS infants.
• It also questions the role of secondhand
  cigarette smoke in how much damage it actually
  does to the developing infant.

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• The implications of finding dependence of
  nicotine in infants may also suggest that
  exposing infants to any form of nicotine,
  in-utero, airborne, hair, cloth, or dust, may
  actually be subjecting infants to harmful
  elements, resulting in child endangerment.

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• It is urged that follow-up studies be done to
  confirm this theory.