establishing smoke free environments for children

2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence

Robert McMillen, PhDThe AAP Julius B. Richmond Center of Excellencehttp://www.aap.org/richmondcenter/

Establishing Smoke Free Environments for ChildrenEstablishing Smoke Free Environments for Children


Learning Objectives

Ability to describe the health effects of secondhand smoke on children

Awareness of smoke free policies and community interventions

Understand the benefits of smoke free laws

Knowledge of smoke free strategies

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Secondhand Smoke is a Harmful Toxic Air Contaminant

There is no safe level of exposure to secondhand smoke (SHS) U.S. Surgeon General

There is also indisputable evidence that implementing 100% smoke-free environments is the only effective way to protect the population from the harmful effects of exposure to SHS World Health Organization

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Harms of SHS on Children’s Health

Increases risk of SIDS

Low birth weight

Ear infections

Harms lung development in children

Causes bronchitis and pneumonia in young children

More severe asthma

Impacts cardiovascular system

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Source: California EPA. (2005); Surgeon General Report. (2006); UICC. (2008).


Children’s Exposure to Secondhand Smoke

40% (~15 million) of U.S. children live with one or more smokers

Almost one half of the world’s children breathe air polluted by tobacco smoke

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Image source: Adapted by CTLT from Pirkle, et al. (1996); The Tobacco Atlas. (2006).


Adolescents Exposed to SHS in their Homes, 2002-2005

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Image source: Adapted by CTLT from European Environment and Health Information System, http://www.enhis.org/object_document/o4744n27382.html


Policies Recommended by the World Health Organization

1. 100% smoke-free environment, not ventilation

2. Universal protection law

3. Proper implementation and adequate enforcement of the law

4. Public education to reduce secondhand smoke exposure in the home

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Source: World Health Organization. (2007).


Global Smokefree Laws

Nationwide Ireland Scotland Wales Northern Ireland England New Zealand Uruguay Bermuda

State or local U.S. states and cities Canada provinces and

territories Australia states Argentina provinces

and cities

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Source: Global Smokefree Partnership. (2008).


Smoke-Free Laws Improve Health

Pueblo, Colorado: 27% drop in heart attacks

Helena, Montana: 40% drop in heart attacks

Italy: fewer heart attacks

Norway: decline in the prevalence of respiratory symptoms

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Sources: Sources: Pueblo Heart Study Fact Sheet (2005); Barone-Adesi, et al. (2007); Fagan, et al. (2006).


Source: Monitoring the future project, U.S., 1976-1986 senior classes.

Youth Who Start Smoking, Continue Smoking

2004: Ireland is the first country to implement 100% smoke-free legislation that included all enclosed workplaces, including restaurants and bars

Additional countries have now passed 100% smoke-free laws, including the UK, New Zealand, Uruguay, Bermuda, Bhutan, Iran, and Turkey

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RegionSupport for a ban on smoking in public places (%)

Eastern Mediterranean

82.8

Eastern Europe 82.1

Americas 80.4

Southeast Asia 75.3

Western Pacific 72.9

Africa 60.2

Total 76.1


Smokefree Campaigns

USA: The EPA’s national

smoke-free homes and cars program

American Legacy Foundation’s 2005 “Don’t Pass Gas” media campaign

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Source: UICC and americanlegacy.org. (2008).


International Campaigns

Ontario, Canada, 2000: Breathing space: Community partners for smoke-free homes www.toronto.ca/health/smokefree

Norwegian Cancer Society, 1995

Salford, UK, 2007: Smoke-free homes promise campaign

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Effects on Youth Smoking

Lower rates of smoking initiation

Lower prevalence of smoking

More quit attempts

Higher rates of successful quit attempts

Lower consumption rates among continuing smokers

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Environments for Exposure

Home—no government restrictions

Vehicle—some policies developing

Childcare—many existing regulations

Schools—many existing regulations

Restaurants—many existing regulations

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Smoke-Free Homes

The prevalence of smoke-free homes in the U.S. has increased substantially in the past decade

The International Tobacco Control Four Country Survey

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Source: UICC. (2008).

Country

Reported home smoking ban among homes of smokers

Wave 1 Wave 2

Canada 27.3% 31.5%

U.S. 26.4% 27.9%

UK 15.3% 19.0%

Australia 34.1% 43.1%


Smoking Ban in Vehicles with Children

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Jurisdiction Applicable age Date

Arkansas Under 6 or 60 pounds Enacted April 2006

California Under 17 In effect January 2008

Louisiana Under 17 In effect August 2006

Puerto Rico Under 13 In effect March 2007

Bangor, Maine Under 18 In effect January 2007

Keyport, New Jersey Under 18 Enacted April 2007

Rockland County, New York Under 18 Enacted June 2007

West Long Branch, New Jersey Under 18 Enacted June 2007

Cyprus Under 16 Enacted 2002

Nova Scotia, Canada Under age 19 In effect January 2008

South Australia Under 16 Enacted May 2007

Tasmania, Australia Under age 18 In effect January 1, 2008


Childcare and Schools

Pro Children Act of 1994

European Public Health Alliance Austria, Denmark, the

Czech Republic, Estonia, Finland, Hungary, Iceland, Latvia, Portugal, and Slovenia

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Community Strategies

1. Educate

2. Build coalitions

3. Identify a local champion

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Community Strategies

1. Educate

2. Build coalitions

3. Identify a local champion

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Mass Media Campaigns

Media Local newspaper Radio Television reporters

Free media Op-ed pieces and letters to

the editor

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Image source: (Top) Jane M. Sawyer, www.morguefile.com, (Bottom) npclark2k, www.morguefile.com


Examples

Texas Letter writing campaign Earned media

Washington Mass media Radio, television, newspaper

Evaluate your budget

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Image source: Tobacco Control Branch, Government of Western Australia, Department of Health. (2008).


Grassroots-Community Coalitions, Community Leaders

Broad and inclusive

Meaningful representation

Hospitality workers and other employees

Community advocates

Medical professionals

Teachers

Youth groups

Supportive business owners

Health educators and others

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Summary

The health effects of secondhand smoke on children have been well-documented

Many nations and states have enacted smoke free policies

These smoke free policies have had immediate and long-term health benefits

There are several strategies to achieve successful smoke free policies

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establishing smoke free environments for children

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