Karen Wilson, MD, MPH, discusses the impact that tobacco and marijuana smoke exposure will have on children. While researchers have studied the effects of tobacco smoke exposure on children for years, marijuana smoke exposure has received comparatively little study. Dr. Wilson and other researchers at Mount Sinai have explored how these two substances can affect children’s health, individually, and together.
Referring a patient is easy. Just click the “Refer a Patient Online” button. My name is Karen Wilson and I am a Deborah and Leon Black, chief of the division of General pediatrics at the Icahn School of Medicine at Mount Sinai and Mount Sinai Kravis Children's Hospital and I'm also the vice chair for clinical and translational research for the Jack and lucy Clark department of Pediatrics at the Icahn School of Medicine at Mount Sinai. So unfortunately we actually don't know a lot about the impact of marijuana and Children's health and we're just starting to understand particularly the impact of secondhand marijuana smoke. We do know that if Children are exposed to marijuana in utero before they're born, so if their mothers are smoking marijuana um they do have problems with their neuro development like an increased A. D. H. D. As they get older and other neurodevelopmental issues and they also are lower birth weight. So we know that it has an impact of the mother smokes it during pregnancy. What we don't really understand is what the impact is if they are exposed to secondhand marijuana smoke after they are born, We do know from a couple of small studies that we've done that a significant proportion of Children and even young Children are exposed to marijuana smoke even after they are born. So we did one study here at Mount Sinai that found that 21 of Children in one of our practices between the ages of one and two had evidence that in their in their urine that they were exposed to marijuana smoke. So in general, for any type of smoke exposure, the highest risk that we see is for very young Children. Um, an older child's child who's going out to school during the day, of course. Now during Covid, that's not happening quite as much, but, you know, if the child can leave the, their apartment or their home, if they're being exposed to smoke, their exposure is a little bit lower. Um In addition, so the youngest Children, so infants and small Children are at the highest risk for being exposed by either somebody who is smoking in their apartment or in their home, or even somebody who is smoking in an apartment adjacent to the apartment. And that smoke is drifting in. And that is exposure that we are also concerned about. The other thing is that very young Children, infants and toddlers breathe a lot faster than b per their body size than older older Children too. And so they're actually inhaling more of these particles and more of the toxins that are found in both marijuana and tobacco smoke smoke. Um So we have done a couple of studies recently just looking at the prevalence of marijuana smoke exposure. The one I talked to you about before, um which found that 21% of Children had a metabolite of THC, so that's the psychoactive component of marijuana. Um And this is C. O. H. THC, which is metabolized in the body. And so um so that's a pretty high percentage of Children who are being exposed to a potentially neurotoxic chemical. The other thing that we found was a study that we did looking at reports of incursions into other apartments. And so what percentage of New York City parents are reporting that they are exposed to marijuana smoke from an apartment next door. And what we found was that about 27 report that they are exposed from an apartment next door and that's about the same percentage as we find. Um report that they're exposed from tobacco next door. And so that's been a concern I think for for public health professionals for a long time that the tobacco smoke incursions and multi unit housing. But now we're starting to understand that even in a place where marijuana smoking is technically illegal, there's still a significant amount of incursions that are happening even to families who don't use marijuana at all. Um, so I think the thing that I'd like to talk about with that is, um, I've mentioned a couple of the studies that we've done already. One of the things that we did, this was almost 10 years ago now was looking at tobacco smoke incursions in multi unit housing. And we were able to demonstrate that Children who lived in multi unit housing, so apartment buildings and other places where they could be exposed to another to the smoke coming from another apartment were significantly more likely to have elevated cotinine levels, which is a marker of tobacco smoke exposure than Children who live in detached homes. And this went on to be a part of obviously a lot of other information and studies that have come out um That that documented the impact of incursions and multi unit housing. But this all together was able to convince the Department of Housing and Urban Development to make it um to restrict smoking of any type in public multi unit housing and so really happy that we were able to make such a public health impact with a study that we did, you know, from a large data set. This was from enhanced data which is a very valuable set of data that comes out of the C. D. C. Um I think people think that tobacco and marijuana smoke exposure just doesn't happen that much anymore. And what we're really demonstrating is that this is really a persistent problem, particularly here in new york city where there are a lot of people who live in multi unit housing. Um and so I think that that's a big concern. I think people are also not really convinced that particularly for marijuana smoke, that it's really dangerous, and I think that that's really problematic. Marijuana smoke contains many of the same toxic chemicals as tobacco smoke does. It also contains particulates in the same way that tobacco or even wood stove smoke would. Um and those are things that we know can increase the risk of pulmonary pulmonary diseases, particularly asthma in Children. And so we don't expect that there will be a lower risk of things like asthma with marijuana smoke exposure than there is with tobacco smoke exposure. And then of course, you have the very unique chemical THC that's found in marijuana smoke that we've demonstrated gets into the bodies of these very young Children, and we just don't understand what the impact on the neuro development of these Children will be. Um, from those low levels of exposure, we do know that for tobacco smoke exposure, even very low levels of exposure can can actually decrease scores on cognitive testing in Children. And so we worry that very low marijuana smoke exposures may have the same impact. Um, so we very quickly realized that COVID-19 could have a big impact on the experience of people with incursions, both tobacco and marijuana smoke because people were indoors more often they weren't able to get out and go to school or go to other places. We felt like maybe people were more likely to be exposed and because people were indoors more often, they might be more likely to be smoking indoors even if it's not allowed in their building. And so we um in addition to that particular area of research, we also realized that The the stay at home orders and and the COVID-19 itself could have a very, very significant impact in our patient populations in what we call the social determinants of health, things like food insecurity and housing and job loss. Um these are all things that we suspected would be impacted by COVID. And so we went into the field very quickly with a with the study that we did by phone so that we didn't have to go in person. Um We have had a bunch of medical students who were able to go to the floors and and actually be seeing patients in person. And so we were able to have them help us do these these surveys with families. Um, We're in the process of analyzing this data and we um hope to be releasing some of that soon. But you know, we definitely did see some increases in incursions. Um, and certainly in food insecurity. I'd really like my colleagues particularly to be addressing smoking both marijuana and tobacco smoke smoking with their families. You know, this is something that we need to be talking to families about in a nonjudgmental way. Um, these are difficult, particularly cigarette smoking is incredibly addictive and it can be very, very difficult to stop. And I think that providers need to have very honest conversations and be supportive of the efforts that their parents are making to both quit themselves and also reduce their Children's exposure. Um, I also think that policymakers really need to be thinking carefully about about the legislation that is happening, particularly with marijuana. One of the things that we found in colorado when I was there was when they legalized marijuana, they legalized it only in, in not public spaces. And so if you don't have your own backyard, the only place that you can legally smoke marijuana, which is a legal product in Colorado is inside your apartment. And so there weren't really options given for people who wanted to use marijuana, um, but didn't want to use it in the same place as their Children. And I'm really concerned about that, you know, and what that kind of exposure does to Children. And so when people are thinking about legalizing marijuana, you need to take into consideration that balancing measure of how our Children going to be exposed to this and do what you can to limit that, such as, you know, making it making it illegal to smoke in the presence of a child. Um, and that might make things or make it illegal to smoke anything. You know, either tobacco or marijuana in multi unit housing where you might be exposing somebody next door. That is a very interesting question. And you know, I think every time we, we think we have this figured out, you know, there's always, there always seems to be a new way of inhaling toxic things into your lungs. You know, um, we we were starting to get a handle on tobacco smoking in combusted tobacco smoking and then, you know, jewel and electronic cigarettes came on the market. And now we have an entire new generation of Children who are being addicted to nicotine, um, with the use of these products. And so, um, I think that what I've seen the future is continued efforts by the tobacco companies and, um, and the like to create new products because they want new markets that are going to be able to, to replace the tobacco smoking, since that is fortunately decreasing to some extent. Um, and so I think that we will be continuing to do what we can to be heads up and figuring out what the new things are, um, and continuing to address the old ones and making sure that we're not keeping, not taking your eye off that ball as well. Um, what I would really love to see are some really well done prospective studies of the impact of marijuana smoke exposure on young Children. And we certainly are working with our colleagues to create the evidence base that would support the preliminary data that would support those grants, um, and to think about how we could put those into the field because we really need to have what we've had in tobacco for quite a long time, which is good evidence based that shows that secondhand tobacco smoke exposure is dangerous for Children, um, and to be able to go to the regulators and say you need to prevent Children from being exposed to marijuana smoke. We need to have that same evidence for marijuana smoke exposure.