Establishing Smoke Free Environments for Children

1. Establishing Smoke Free Environments for Children Robert McMillen, PhD The AAP Julius B. Richmond Center of Excellence http://www.aap.org/richmondcenter/

2. 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

3. 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

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

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

6. Adolescents Exposed to SHS in their Homes, 2002-2005 Image source: Adapted by CTLT from European Environment and Health Information System, http://www.enhis.org/object_document/o4744n27382.html

7. Policies Recommended by the World Health Organization • 100% smoke-free environment, not ventilation • Universal protection law • Proper implementation and adequate enforcement of the law • Public education to reduce secondhand smoke exposure in the home Source: World Health Organization. (2007).

8. 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 Source: Global Smokefree Partnership. (2008).

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

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

11. Smokefree Campaigns • USA: • The EPA’s national smoke-free homes and cars program • American Legacy Foundation’s 2005 “Don’t Pass Gas” media campaign Source: UICC and americanlegacy.org. (2008).

12. 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

13. 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

14. Environments for Exposure • Home—no government restrictions • Vehicle—some policies developing • Childcare—many existing regulations • Schools—many existing regulations • Restaurants—many existing regulations

15. 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 Source: UICC. (2008).

16. Smoking Ban in Vehicles with Children Source: UICC. (2008).

17. 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 Source: UICC. (2008).

18. Community Strategies • Educate • Build coalitions • Identify a local champion

19. Community Strategies • Educate • Build coalitions • Identify a local champion

20. Mass Media Campaigns • Media • Local newspaper • Radio • Television reporters • Free media • Op-ed pieces and letters to the editor Image source: (Top) Jane M. Sawyer, www.morguefile.com, (Bottom) npclark2k, www.morguefile.com

21. Examples • Texas • Letter writing campaign • Earned media • Washington • Mass media • Radio, television, newspaper • Evaluate your budget Image source: Tobacco Control Branch, Government of Western Australia, Department of Health. (2008).

22. 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

23. 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