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Link between secondhand marijuana smoke and respiratory infections in children

According to the most recent US national survey on Drug Use and Health, an estimated 58.8 million Americans aged 12 years or older had used tobacco, and an estimated 27.7 million Americans aged 12 years or older used marijuana in the past 30 days.

Nationally, tobacco use is declining, yet marijuana use is on the rise. Despite US federal status of marijuana as a Schedule 1 substance, more states are legalising marijuana for medical and recreational use. States with legalised recreational use of marijuana tend to have the highest rates of utilisation. According to a study published in Nature Pediatric Research, before Colorado legalised the recreational use of marijuana (2012), 10.4% of the population aged 12 years or older had used marijuana in the last 30 days. The most recent survey data show this percentage is now up to 17.3%.

People often view marijuana as a harmless pleasure, yet studies investigating the two substances have found marijuana smoke and tobacco smoke contain many of the same toxic chemicals and carcinogens. Tobacco smoke and its negative health effects on both adults and children have been extensively studied: secondhand tobacco smoke is clearly linked to several known significant health risks, including otitis media, impaired lung function, respiratory illness, and sudden infant death syndrome.

Secondhand tobacco smoke exposure is also associated with caregivers more frequently seeking medical care for their children, including increased emergency department (ED) visits.

Similar to tobacco, primary marijuana use in adults has been associated with a number of negative health outcomes, including wheeze, cough, and shortness of breath. Primary marijuana use in adolescents has been associated with increased ED visits, with a large number related to psychiatric complaints. While adolescent marijuana use/exposure has been studied, marijuana’s impact on younger children has not been fully elucidated. A previous study investigating young children hospitalised with bronchiolitis found almost 50% of children exposed to tobacco also had detectable levels of secondhand marijuana, yet just how marijuana smoke affects children has not been studied in depth.

With the rise in marijuana use by adults, the known concerning effects from primary exposure to marijuana, and the similarities of marijuana and tobacco smoke, the examination of secondhand marijuana smoke exposure, and its potential effects on child health is of substantial public health importance.

The objective of this study was to estimate the self-reported prevalence of marijuana use among caregivers in a state which has legalised marijuana for both medical and recreational use. Our secondary objectives were to determine the frequency of ED or urgent care (UC) visits and frequency of several tobacco smoke exposure-related illnesses (asthma attacks, ear infections, and viral respiratory infections (VRIs)) in the prior year among children with secondhand marijuana smoke exposure as compared to children with secondhand tobacco smoke exposure and children with neither marijuana nor tobacco smoke exposure.

We aimed to find an association between secondhand marijuana smoke exposure and ED/UC visits as well as the tobacco smoke exposure-related illnesses.

Study details

Association between secondhand marijuana smoke and respiratory infections in children

Adam B. Johnson, George S. Wang, Karen Wilson, David M. Cline, Timothy E. Craven, Sarah Slaven, Vidya Raghavan & Rakesh D. Mistry

Published in Nature Pediatric Research 29 July 2021

Abstract

Background
Little is known about the effects of secondhand marijuana smoke on children. We aimed to determine caregiver marijuana use prevalence and evaluate any association between secondhand marijuana smoke, childhood emergency department (ED) or urgent care (UC) visitation, and several tobacco-related illnesses: otitis media, viral respiratory infections (VRIs), and asthma exacerbations.

Methods
This study was a cross-sectional, convenience sample survey of 1500 subjects presenting to a pediatric ED. The inclusion criteria were as follows: caregivers aged 21–85 years, English- or Spanish-speaking. The exclusion criteria were as follows: children who were critically ill, medically complex, over 11 years old, or using medical marijuana.

Results
Of 1500 caregivers, 158 (10.5%) reported smoking marijuana and 294 (19.6%) reported smoking tobacco. Using negative-binomial regression, we estimated rates of reported ED/UC visits and specific illnesses among children with marijuana exposure and those with tobacco exposure, compared to unexposed children. Caregivers who used marijuana reported an increased rate of VRIs in their children (1.31 episodes/year) compared to caregivers with no marijuana use (1.04 episodes/year) (p = 0.02).

Conclusions
Our cohort did not report any difference with ED/UC visits, otitis media episodes, or asthma exacerbations, regardless of smoke exposure. However, caregivers of children with secondhand marijuana smoke exposure reported increased VRIs compared to children with no smoke exposure.

Impact
• Approximately 10% of caregivers in our study were regular users of marijuana.
• Prior studies have shown that secondhand tobacco smoke exposure is associated with negative health outcomes in children, including increased ED utilization and respiratory illnesses.
• Prior studies have shown primary marijuana use is linked to negative health outcomes in adults and adolescents, including increased ED utilization and respiratory illnesses.
• Our study reveals an association between secondhand marijuana smoke exposure and increased VRIs in children.
• Our study did not find an association between secondhand marijuana smoke exposure and increased ED or UC visitation in children.

 

Association between secondhand marijuana smoke and respiratory infections in children (Open access)

 

See more from MedicalBrief archives:

 

Secondhand smoke heightens risk of child hospitalisation – Cincinnati study

 

Early smoke exposure link to later anti-social behaviour

 

Smoke exposure in womb increases AF risk

 

Child passive smoking 'increases chronic lung risk'

 

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