Reducing Childrens Exposure to Second Hand Smoke SHS

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Reducing Childrens Exposure to Second Hand Smoke
(SHS)
Add facilitators name and title organisation
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Aims

• To present the evidence for the intervention
• Examine the risks of SHS
• What do people know?
• The 5 step plan
• Delivering the intervention
• Motivational Interviewing
• Key Questions

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The Netherlands Study
Smoking?Not in presence of the little ones
National campaign launched in the Netherlands 1996
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Parental education on SHS does work

• The main message in the study is to refrain from
  smoking in the
• presence of the child
• Training was developed for health professionals
  working with young children.
• A five-step plan was used to inform parents about
  the dangers of secondhand smoke and how it could
  be reduced.
• The campaign was very effective in reducing
  childrens exposure to SHS.
• The findings indicate a reduction in exposure in
  the home from 41 to 18.1

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The Five Step Plan

• 1 Assessing the occurrence of smoking at home and
  in the presence of a child.
• 2 Raising the issue and discussing the
  consequences of exposure to secondhand smoke.
• 3 Assessing the readiness of parents to prevent
  exposure and discussing possible house rules.
• 4 Discussing and tackling barriers to the house
  rules.
• 5 Follow-up the implementation and maintenance of
  house rules.

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Second Hand Smoke Kills
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Research Findings 2,18What the parents say
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Parents Knowledge

• Nearly 90 of parents correctly defined
  secondhand smoking without prompting.
• The majority of parents agree that secondhand
  smoke is bad for children.
• Parents understand about short-term illnesses
  associated with secondhand smoke, but have less
  understanding of the longer term health risks to
  children.
• The majority of parents understood the link to
  cot death, however this was seen as important for
  very young babies larger babies being seen as
  more robust.

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Parents Attitudes

• A quarter stated secondhand smoking did not worry
  them.
• A third of parents in smoking households smoked
  in front of pre-school age children.
• Less than half actively avoided taking their
  children to smoky places.
• Many felt their child was protected from
  secondhand smoke if the smoker moved away from
  the child.
• Wide variance in taking care to reduce exposure -
  some protect children to school age and some only
  to when a child crawls or walks.

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Parents skills

• There were many different attempts made to reduce
  childrens exposure to smoke in the home. For
  example some parents would smoke in one room,
  opened a back door or smoked outside.
• Some parents only smoked when children were in
  bed, opening the windows in the morning.
• Some parents failed to implement smoking house
  rules and therefore visitors and partners often
  smoked in the home.

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Parents and Health Professionals

• A number of parents stated that advice from
  health professionals helped them understand.
• A number stated that they felt pressurised into
  stopping smoking by health professionals.
• A small number felt that they were being judged.

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Assessing the Occurrenceof Secondhand Smoking
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Parents/ClientsReadiness to Change
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Stages of Change
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Stages of Change
Where is the client? Whats your job? Not
interested in Raise doubt changing
behaviour Thinking about change Tip the
balance Preparing to change Help client to
determine best course of action.
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Stages of Change

• Where is the client? Whats your job?
• Making change Help the client to take steps
  towards change
• Maintenance Help client identify
  strategies to prevent relapse
• Relapse Help client to renew the
  process without becoming stuck
  because of relapse

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Actions

• Not Ready Provide a leaflet
• Dont be judgmental
• Keep the door open
• Thinking/Relapse Provide a leaflet
• Dont be judgmental
• Keep the door open
• Follow up
• Ready Provide a leaflet
• Discuss the issue
• What are the barriers?
• How can they be overcome?
• Client sets action plan
• Follow-up

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Motivational Interviewing
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Definition

• A directive client centred counselling style to
  assist clients in exploring and resolving
  ambivalence to increase motivation to change. 20
• A non-judgmental approach to help people think
  about changing their behaviour.

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The Approach

• Motivation to change is from the client, not
  imposed from outside
• It is the clients task to identify and resolve
  ambivalence
• Direct persuasion is not effective
• Listen to how it seems to the client
• Respect their view and priorities

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Behavior characteristics

• Using reflective listening to understand a
  persons frame of reference.
• Expressing acceptance and affirmation.
• Reinforcing the patient's self-motivational
  statements of problem recognition, concern,
  desire, intention to change, and ability to
  change.
• Monitoring the patients degree of readiness to
  change, and not jumping ahead of the patient
• Affirming the patients freedom of choice and
  self-direction.

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Four General Principles

• Express Empathy accept without judging
• e.g. that must be difficult for you.
• Develop discrepancy between present behaviour and
  broader goals e.g. you say you cant imagine not
  smoking in the house, but you say your concerned
  about the children

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Four General Principles

• Support self efficacy reinforce clients belief
  in their own ability to succeed.
• Roll with resistance reluctance or ambivalence
  are accepted to be normal e.g. Client I cant
  imagine making that change. Advisor It sounds
  like this isnt an option right now.

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Recap on the 5-Point Plan

• Assess exposure
• Raise the issue
• Assess readiness to change
• Take action
• Follow up

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Websites
www.freshne.com www.who.int.toh/TFI/consult.htm ww
w.ash.org.uk www.doh.gov.uk/tobacco www.nwph.net/s
mokefree www.cleanairaward.org.uk www.tobaccofreek
ids.org www.smokefreeliverpool.com www.smokefreeac
tion.org.uk www.asthma.org.uk www.givingupsmoking.
co.uk www.d-myst.info
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• Future training needs?
• Resources?
• Local contact details

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• End of Session Evaluation
• Post Training Evaluation
• Thank you for attending