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文/青少年親善團隊 孫麗娟醫師
在兒科門急診，常常遇見爸爸媽媽慌慌張張的帶著寶寶來看診，因得到急性細支氣管炎(如:呼吸融合病毒、人類間質病毒感染) 而喘、呼吸急促，甚至嚴重到需要住院接受治療。通常我會問家庭史，問到家裡有人抽菸嗎?常常得到的回答是〝阿公或爸爸有抽，但不會在孩子面前吸菸〞，認為不在孩子面前吸菸，就沒有傷害。根據文獻資料顯示，家中有吸菸者時，孩子即使未主動吸菸，仍可能暴露在二手菸與三手菸中，導致多種呼吸道疾病與腦部的發育受到影響1。
多達四千多種化學物質可在二手菸中偵測得到，其中有250多種已知會致癌或有毒性2。在二手菸與三手菸環境下，寶寶們也會暴露下列有毒物質中:〝 氫氰酸（Hydrogen Cyanide）、一氧化碳（Carbon Monoxide, CO）、丁烷(Butane)、氨(Ammonia)、甲苯(Toluene)、砷(arsenic)、鉛(Lead)、鉻(Chromium)、鎘(Cadmium)〞3 及〝多環芳香族碳氫化合物(polycyclic aromatic hydrocarbons)、亞硝酸(N-nitrosamines)及烴( hydrocarbons)、醛(aldehydes)、很多有機化合物(organic compounds)、金屬(metals)〞4-5。
2011年研究已確實證實，即使經過2個月的清潔與空置，三手菸(third-hand smoke)仍在住家存在並透過表面與塵埃持續暴露新住者6。因此沒有在孩子面前吸菸，仍有很大的機會讓心愛的孩子們暴露於有毒的環境。為了守護孩子的健康，我們應該建立100%無菸家庭與車內環境。
孩子們在產前(孕期)及產後持續暴露在二手菸的環境中，會有下列不良影響及風險:
一. 嬰兒猝死症(SIDS)7-8 風險增加
孕期媽媽吸菸，嬰兒猝死症的風險提高達2.25倍7。
出生後媽媽吸菸，嬰兒猝死症的風險提高達1.97倍7。
孕期媽媽戒菸，可降低嬰兒猝死症的風險8。
二. 呼吸系統疾病增加3,9-12
引起中耳炎、中耳積水風險增加3,9-10，須接受手術治療12及聽力受損11機率也增加。
家中有吸菸者的嬰幼兒得到急性細支氣管炎風險是無暴露在二手菸的環境知嬰幼兒的1.54 倍13。
兒童之氣喘發生率和嚴重度都因孩童暴露在二手菸的環境而增加14 , 因氣喘急性發作須掛急診次數15、住院次數和接受插管機率都會增加16。
三. 智力與認知功能受損、學習表現與注意力問題
菸中含有多種對〝神經系統有毒性（神經毒性）〞的成分，如:尼古丁（Nicotine）最主要的神經毒素，會刺激中樞神經系統，造成依賴與成癮，長期影響大腦發育（特別是青少年與胎兒）;一氧化碳（Carbon Monoxide）會干擾血紅素運氧能力，間接導致腦部缺氧而影響認知功能與記憶力。
在學齡前時期，曾經在產前或產後暴露在二手菸的環境中的兒童，表現出比未暴露在二手菸中的兒童更多的行為問題17-18。一些較常見的問題包括：過度要求關注、情緒波動、情緒不穩定、具有攻擊性以及破壞性行為18-19。在兒童早期所出現的不良影響往往會持續到青少年時期20-25。曾在產前暴露於二手菸的兒童，更可能表現出攻擊行為、違反規則以及其他行為問題26。
早在1975年的一項研究中，就有報告指出注意力不足過動症（ADHD）與二手菸暴露之間的關聯。該研究發現，吸菸的母親其子女出現過動行為的可能性是其他母親的三倍27。回顧近40年的研究文獻顯示，孕期暴露於二手菸是ADHD及類似行為障礙的風險因子28。研究也指出，暴露於二手菸的兒童罹患ADHD的風險比未暴露的兒童高出2.4至3.4倍29-30。
四. 提高未來吸菸風險
孩子長大後抽菸的風險明顯受父母是否抽菸影響，根據2023年「Growing Up in Ireland」研究顯示：父母任何一方抽菸，孩子有過吸菸行為的調整後風險比為約2.10倍（aOR 2.10）31。
大量研究記錄了兒童在產前或產後暴露於二手菸所帶來的眾多健康危害，暴露於二手菸不只影響到童年時期的不良結果，這些影響甚至會持續到成年，並貫穿整個人生，二手菸及三手菸對兒童之危害不容忽視。
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