Table 2.1aConclusions from previous Surgeon General’s reports on the adverse effects of tobacco use and exposure to secondhand smoke in children and young adults

Preventing Tobacco Use Among Young People: A Report of the Surgeon General (1994, p. 9)
  1. Cigarette smoking during childhood and adolescence produces significant health problems among young people, including cough and phlegm production, an increased number and severity of respiratory illnesses, decreased physical fitness, an unfavorable lipid profile, and potential retardation in the rate of lung growth and the level of maximum lung function.
  2. Among addictive behaviors, cigarette smoking is the one most likely to become established during adolescence. People who begin to smoke at an early age are more likely to develop severe levels of nicotine addiction than are those who start at a later age.
  3. Tobacco use is associated with alcohol and illicit drug use and is generally the first drug used by young people who enter sequence of drug use that can include tobacco, alcohol, marijuana, and harder drugs.
  4. Smokeless tobacco use by adolescents is associated with early indicators of periodontal degeneration and with lesions in the oral soft tissue. Adolescent smokeless tobacco users are more likely than nonusers to become cigarette smokers.
The Health Consequences of Smoking: A Report of the Surgeon General (2004, pp. 27–8)
Chronic Respiratory Diseases
  1. The evidence is sufficient to infer a causal relationship between maternal smoking during pregnancy and a reduction of lung function in infants.
  2. The evidence is suggestive but not sufficient to infer a causal relationship between maternal smoking during pregnancy and an increase in the frequency of lower respiratory tract illnesses during infancy.
  3. The evidence is suggestive but not sufficient to infer a causal relationship between maternal smoking during pregnancy and an increased risk for impaired lung function in childhood and adulthood.
  4. The evidence is sufficient to infer a causal relationship between active smoking and impaired lung growth during childhood and adolescence.
  5. The evidence is sufficient to infer a causal relationship between active smoking and the early onset of lung function decline during late adolescence and early adulthood.
  6. The evidence is sufficient to infer a causal relationship between active smoking and respiratory symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea.
  7. The evidence is sufficient to infer a causal relationship between active smoking and asthma-related symptoms (i.e., wheezing) in childhood and adolescence.
  8. The evidence is inadequate to infer the presence or absence of a causal relationship between active smoking and physician-diagnosed asthma in childhood and adolescence.
  9. The evidence is suggestive but not sufficient to infer a causal relationship between active smoking and a poorer prognosis for children and adolescents with asthma.
Fertility
10.

The evidence is inadequate to infer the presence or absence of a causal relationship between active smoking and sperm quality.

11.

The evidence is sufficient to infer a causal relationship between smoking and reduced fertility in women.

Pregnancy and Pregnancy Outcomes
12.

The evidence is suggestive but not sufficient to infer a causal relationship between maternal active smoking and ectopic pregnancy.

13.

The evidence is suggestive but not sufficient to infer a causal relationship between maternal active smoking and spontaneous abortion.

14.

The evidence is sufficient to infer a causal relationship between maternal active smoking and premature rupture of the membranes, placenta previa, and placental abruption.

15.

The evidence is sufficient to infer a causal relationship between maternal active smoking and a reduced risk for preeclampsia.

16.

The evidence is sufficient to infer a causal relationship between maternal active smoking and preterm delivery and shortened gestation.

17.

The evidence is sufficient to infer a causal relationship between maternal active smoking and fetal growth restriction and low birth weight.

Congenital Malformations, Infant Mortality, and Child Physical and Cognitive Development
18.

The evidence is inadequate to infer the presence or absence of a causal relationship between maternal smoking and congenital malformations in general.

19.

The evidence is suggestive but not sufficient to infer a causal relationship between maternal smoking and oral clefts.

20.

The evidence is sufficient to infer a causal relationship between sudden infant death syndrome and maternal smoking during and after pregnancy.

21.

The evidence is inadequate to infer the presence or absence of a causal relationship between maternal smoking and the physical growth and neurocognitive development of children.

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General (2006, pp. 13–4)
Fertility
1.

The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke and female fertility or fecundability. No data were found on paternal exposure to secondhand smoke and male fertility or fecundability.

Pregnancy (Spontaneous Abortion and Perinatal Death)
2.

The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke during pregnancy and spontaneous abortion.

Infant Deaths
3.

The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and neonatal mortality.

Sudden Infant Death Syndrome
4.

The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke and sudden infant death syndrome.

Preterm Delivery
5.

The evidence is suggestive but not sufficient to infer a causal relationship between maternal exposure to secondhand smoke during pregnancy and preterm delivery.

Low Birth Weight
6.

The evidence is sufficient to infer a causal relationship between maternal exposure to secondhand smoke during pregnancy and a small reduction in birth weight.

Congenital Malformations
7.

The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and congenital malformations.

Cognitive Development
8.

The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and cognitive functioning among children.

Behavioral Development
9.

The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and behavioral problems among children.

Height/Growth
10.

The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke and children’s height/growth.

Childhood Cancer
11.

The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood cancer.

12.

The evidence is inadequate to infer the presence or absence of a causal relationship between maternal exposure to secondhand smoke during pregnancy and childhood cancer.

13.

The evidence is inadequate to infer the presence or absence of a causal relationship between exposure to secondhand smoke during infancy and childhood cancer.

14.

The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood leukemias.

15.

The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood lymphomas.

16.

The evidence is suggestive but not sufficient to infer a causal relationship between prenatal and postnatal exposure to secondhand smoke and childhood brain tumors.

17.

The evidence is inadequate to infer the presence or absence of a causal relationship between prenatal and postnatal exposure to secondhand smoke and other childhood cancer types.

Lower Respiratory Illnesses in Infancy and Early Childhood
18.

The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke from parental smoking and lower respiratory illnesses in infants and children.

19.

The increased risk for lower respiratory illnesses is greater from smoking by the mother.

Middle Ear Disease and Adenotonsillectomy
20.

The evidence is sufficient to infer a causal relationship between parental smoking and middle ear disease in children, including acute and recurrent otitis media and chronic middle ear effusion.

21.

The evidence is suggestive but not sufficient to infer a causal relationship between parental smoking and the natural history of middle ear effusion.

22.

The evidence is inadequate to infer the presence or absence of a causal relationship between parental smoking and an increase in the risk of adenoidectomy or tonsillectomy among children.

Respiratory Symptoms and Prevalent Asthma in School-Age Children
23.

The evidence is sufficient to infer a causal relationship between parental smoking and cough, phlegm, wheeze, and breathlessness among children of school age.

24.

The evidence is sufficient to infer a causal relationship between parental smoking and ever having asthma among children of school age.

Childhood Asthma Onset
25.

The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke from parental smoking and the onset of wheeze illnesses in early childhood.

26.

The evidence is suggestive but not sufficient to infer a causal relationship between exposure to secondhand smoke from parental smoking and the onset of childhood asthma.

Atopy
27.

The evidence is inadequate to infer the presence or absence of a causal relationship between parental smoking and the risk of immunoglobulin E-mediated allergy in their children.

Lung Growth and Pulmonary Function
28.

The evidence is sufficient to infer a causal relationship between maternal smoking during pregnancy and persistent adverse effects on lung function across childhood.

29.

The evidence is sufficient to infer a causal relationship between exposure to secondhand smoke after birth and a lower level of lung function during childhood.

From: 2, The Health Consequences of Tobacco Use Among Young People

Cover of Preventing Tobacco Use Among Youth and Young Adults
Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.
National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health.

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