Involuntary Exposure Protecting Children from Secondhand Smoke

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Involuntary ExposureProtecting Children from
Secondhand Smoke

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Opener

• What do you hope to learn from this session?
• What is the primary focus of your current program
  (cessation, youth access, ETS)?

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What We Hope to Accomplish

• Acquaint you with EPAs program and how it came
  about.
• Equip you with some of the facts about the impact
  and health effects from ETS.
• Acquaint you with our specific strategies and
  tools.
• Encourage you to incorporate an ETS initiative
  into your existing program

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What are we talking about?

• Environmental Tobacco Smoke
• Passive Smoking
• Involuntary Smoking
• Side-Stream Smoke (subset)
• Secondhand Smoke (ShS?)
• Experience has shown that Secondhand Smoke has
  the greatest public recognition

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Why Focus on Children?

• It is where the need is the greatest
• Children are particularly susceptible to health
  risks from secondhand smoke
• Children's exposure is involuntary
• Most children of smokers are exposed in the home

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Whats the Problem

• 27 of homes with children age 6 under
  regularly allow smoking
• 9-12 million children under 5 are exposed in the
  home
• 38 of children 2 mos. - 5 yrs are exposed in the
  home

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Whats the Problem

• Up to 1 million children have their asthma
  worsened (costing 200 million annually)
• Estimated 700,000 - 1.6 million doctor visits for
  ear infections
• Estimated 1,900 - 2,700 SIDS deaths
• 150,000 - 300,000 cases of bronchitis and
  pneumonia annually in toddlers

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Involuntary ExposureProtecting Children from
Secondhand Smoke

• Health Effects

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Children Are Especially Susceptible to Toxic
Effects From ETS

• Childrens respiratory, immune, and nervous
  systems are still developing
• Children absorb greater doses than adults from
  the same exposure levels
• If mother smokes, infants and young children
  typically receive very high exposures from
  proximity to mother

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Conclusions of theNational Research Council
(1986)

• Children whose parents smoke have an increased
  frequency of pulmonary symptoms and respiratory
  infections
• Children whose parents smoke have a small
  decrease in the growth rate of lung function

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Conclusions of the 1986 Surgeon Generals Report
on Involuntary Smoking

• Young children whose parents smoke have an
  increased frequency of lower respiratory tract
  infections
• Children of smokers have an increased frequency
  of chronic respiratory symptoms
• Children of smokers have a small decrement in
  lung function
• Maternal smoking may influence the severity of
  asthma

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U.S. EPAs 1992 Risk Assessment on the
Respiratory Health Effects of ETS

• ETS is a human lung carcinogen (Group A)
• ETS causes an estimated 3,000 lung cancer deaths
  annually in U.S. nonsmokers
• ETS has subtle but significant effects on adult
  respiratory health, including coughing, phlegm
  production, chest discomfort, and reduced lung
  function

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U.S. EPA 1992 Conclusions
In children

• ETS exposure is causally associated with an
  increased risk of lower respiratory tract
  infections such as bronchitis and pneumonia

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U.S. EPA 1992 Conclusions (In children, cont.)
ETS exposure is causally associated with

• increased prevalence of fluid in the middle ear,
• symptoms of upper respiratory tract irritation,
  and
• a small but significant reduction in lung
  function

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U.S. EPA 1992 Conclusions (In children, cont.)

• ETS exposure is causally associated with
  additional episodes and increased severity of
  symptoms in children with asthma
• ETS is a risk factor for new cases of asthma in
  previously asymptomatic children

http//www.epa.gov/ncea/smoking.htm
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CalEPAs 1997 Conclusions on Childrens Health
Effects
Effects causally associated w/ ETS exposure

• reduced fetal growth
• sudden infant death syndrome
• acute lower respiratory infections
• asthma induction and exacerbation
• chronic respiratory symptoms
• middle ear infections

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CalEPAs 1997 Conclusions (cont.)
Effects with suggestive evidence

• adverse impact on cognition and behavior
• decreased pulmonary function
• exacerbation of cystic fibrosis

http//www.oehha.org/air/environmental_tobacco/ind
ex.html
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Australias National Health and Medical Research
Councils 1997 Conclusions

• Passive smoking causes lower respiratory tract
  illness and contributes to the symptoms of asthma
  in children
• There is also good evidence linking ETS exposure
  to SIDS and fluid in the middle ear
• Maternal exposure to ETS during pregnancy is
  associated with a small reduction in birthweight

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1997 Conclusions of the French National Academy
of Medicine

• ETS exposure is associated with an increased risk
  of lower and upper respiratory tract infections
  and irritation of the upper respiratory tract
• ETS exposure can induce asthma and, in children
  with asthma, it increases the number of asthmatic
  attacks and the severity of symptoms

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UKs Report of the Scientific Committee on
Tobacco and Health (1998)

• Smoking in the presence of infants and children
  is a cause of serious respiratory illness and
  asthmatic attacks.
• Sudden infant death syndrome is associated with
  exposure to ETS the association is judged to be
  causal.
• Middle ear disease in children is linked with
  parental smoking and this association is likely
  to be causal.

http//www.doh.gov.uk/public/scoth.htm
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WHO Consultation on ETS and Child Health (1999)

• ETS exposure is causally associated with
  increased risks of lower respiratory tract
  illnesses, including bronchitis and pneumonia, in
  the first years of life
• ETS exposure is a cause of chronic respiratory
  symptoms in school-aged children
• ETS exposure increases the severity and frequency
  of symptoms in children with asthma

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WHO Consultation (cont.)

• ETS exposure is causally associated with
  increased risk of acute and chronic middle ear
  disease
• ETS exposure of nonsmoking women during pregnancy
  is a cause of small reductions in average birth
  weight

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WHO Consultation (cont.)

• Maternal smoking is a cause of small reductions
  in lung function. The predominant effect may be
  from smoking during pregnancy.
• Maternal smoking is a major cause of SIDS. The
  predominant effect is believed to be from in
  utero exposure. There is also some evidence that
  postnatal ETS exposure contributes to the risk of
  SIDS.

http//www.who.int/toh/TFI/consult.htm
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U.S. Institute of Medicine (2000)

• Causal relationship between ETS exposure and
  exacerbations of asthma in preschool-aged
  children
• sufficient evidence of an association between ETS
  and development of asthma in preschool-aged
  children

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Lower Respiratory Tract Infections

• e.g., pneumonia, bronchitis, bronchiolitis
• very strong, consistent evidence for infants and
  young children (up to about 3 years)
• strongest effect from maternal smoking, but also
  evidence from paternal smoking
• increased risks of about 50 to 100 for young
  children higher for young infants

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Respiratory Symptoms

• Chronic cough, phlegm, and wheezing
• strong consistent evidence, especially for
  preschool children
• increased risks of about 20 to 40

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Asthma

• asthma is the most common chronic condition of
  childhood
• strong evidence for increased number of asthmatic
  episodes and increased severity of symptoms
  (affecting at least 20 of asthmatic children)
• increasing evidence of asthma induction?

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Middle Ear Disease

• strong evidence for acute and chronic middle ear
  disease
• fluid in the middle ear is the most common reason
  for operations in young children in the U.S.
• increased risks of up to about 20 to 40

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Other Health Effects

• Decreased lung function
• small (lt10), but significant reduction in lung
  growth/function
• Sudden Infant Death Syndrome (SIDS)
• some evidence for effect independent of maternal
  smoking during pregnancy
• Decreased Fetal Growth
• consistent evidence of small effect for
  nonsmoking mothers during pregnancy

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Emerging Science

• Cognitive and Behavioral Effects
• Poor performance in school and standardized and
  behavioral tests
• Cardiovascular Effects
• Adults and Children (stronger for adults)
• Childhood Cancer
• Suggestive evidence of leukemia brain tumors

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Population Impacts (U.S. children)

• Lower respiratory tract infections in children
  under 18 months
• - 150,000 to 300,000 cases/year
• - 900 to 1800 hospitalizations/year
• Asthma exacerbation
• 400,000 to 1 million children
• Asthma induction
• 18,000 to 36,000 new cases/year

U.S. EPA, 1992
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Population Impacts (U.S. children, cont.)

• Middle ear infections
• 0.7 to 1.6 million physician visits/year
• Low birthweight
• 9,700 to 18,600 cases/year
• Sudden Infant Death Syndrome
• 1,900 to 2,700 deaths/year

CalEPA, 1997
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Conclusions

• Strong international scientific consensus that
  ETS exposure causes increased risk of a variety
  of health effects in children
• Increased risks of common ailments, coupled with
  widespread exposure, result in large public
  health impacts and financial costs
• ETS exposure and resultant health effects in
  childhood may also increase the risk of further
  adverse effects in adulthood

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Involuntary ExposureProtecting Children from
Secondhand Smoke

• EPAs Goal, Message Strategy

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The Federal Effort How EPA Fits In

• Federal Agencies (HHS/CDC/NCI) work on a variety
  of tobacco issues, including
• Cessation
• Youth access
• Prevention
• Public smoking bans/secondhand smoke
• EPAs outreach efforts focus exclusively on
  reducing childrens exposure to secondhand smoke
  at home

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Crafting EPAs ETS Role

• EPA consulted with members of tobacco control
  community to identify work already being done
• Progress being made in public places
• Gap in progress in homes
• EPA science highlighted childrens particular
  vulnerability to ETS

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How Do We Fit In?

• EPAs focus is consistent with benefits
  traditional tobacco control programs
• Restrictions result in greater quit rates
• Ads that stress ShS are most effective at
  reducing smoking
• Smokers who believe ShS is harmful take action
  make more progress towards quitting
• ShS work encouraged in CDCs best practices

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A Clear Goal

• To reduce the proportion of households where
  children 6 and younger are regularly exposed to
  secondhand smoke from 29 in 1994 to 15 by 2005

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Tracking Progress
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Protecting Children in the Home

• Key Messages for our target audience
• Choose not to smoke in your home or permit others
  to do so
• Choose not to smoke if children are present,
  particularly infants toddlers
• If you must smoke, choose to smoke outside

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How We Plan to Reach That Goal

• EPA teams with trusted partners to
• Get our health messages out to constituencies
  beyond our own
• Create products, tools, and messages appropriate
  for specific audiences
• Keep in touch with public need and progress on
  IAQ
• Partners non-profit organizations, states,
  coalitions, etc.

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EPA Risk Assessment Lawsuit

• Tobacco industry challenged EPAs classification
  of ETS as a carcinogen
• Federal District Court Judge ruled in favor of
  industry (summer 1998)
• Vacated lung cancer chapters of the risk
  assessment
• Decision addresses only carcinogen
  classification, not children's health
• Decision procedural in nature

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EPA Risk Assessment Lawsuit

• EPA's response
• Justice Department is appealing decision on
  behalf of EPA
• EPA stands behind its science
• Despite tobacco industry lawsuit, total body of
  SHS science is stronger than ever
• Findings regarding childrens health effects
  remain unchallenged

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Involuntary ExposureProtecting Children from
Secondhand Smoke

• Tools and Resources

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EPAs Tools and Resources Designed for You

• Media campaign
• Daycare Module
• Pediatricians Speakers Kit
• Community Action Kit
• Smoke-Free Home Pledge Campaign

• Outreach program guide
• Poisoning Our Children
• Website
• Printed information (Risk Assessment, brochures,
  posters)
• CDC State ShS/Asthma Grants

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CDC-EPA ShS/Asthma Grants

• Competitive grants to tobacco control community
  targeted to ShS/Asthma work
• Supplement to CDCs comprehensive state tobacco
  program grants
• 11 states have been selected and have received
  funding
• Anticipate continuing this program
• NM, TN, MN, VT, CO, AL, NC, WI, OH, NE, WV

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Media Campaign

• Created by CFAF, AMA EPA Released wave 1
  spring 1999 wave 2 planned summer 2000
• Script, tone,message reflect research
• Available for TV, radio, and print
• What can you do?
• Coordinate with EPA regional office or state
  tobacco control contact to market PSA at local
  radio and TV stations
• Secure commitments from local papers, TV, and
  radio stations to air PSA

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Delivering the Message What Works

• Research conducted by EPA CFAF found
• 70 of those surveyed would be receptive to a
  smoke outside message
• Kid's health is 1 motivational message
• Logic and facts are not enough
• Provide options and choice
• Acknowledge the difficulty of quitting
• Soft Sell works best avoid hard-hitting lectures

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Community Action Kit

• One-stop shopping for community leaders working
  on ShS
• Focuses on health effects and actions
• Includes these and more
• Poisoning our Children video
• Sample letters to press, health officials, etc.
• Complete turn-key ShS presentation
• Contact lists
• Information on how to obtain numerous other
  products

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ALAs Secondhand Smoke and Children Conducting
Public Outreach Programs

• Spiral-bound notebook full of useful guidance on
  conducting local ShS programs
• Contains broad spectrum of ShS activities and
  info on how to customize and implement
• Includes info on funding opportunities and
  replicable programs

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Daycare Module

• Not designed to make daycare centers smoke-free
• Designed to teach daycare providers how to
  communicate to parents about the risks of
  secondhand smoke to young children
• Ideal if incorporated into a states continuing
  education credit system

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AAP Pediatricians Speakers Kit

• American Academy of Pediatrics product
• Designed as an aid to pediatricians who agree to
  communicate to parents about ShS health risks
• Includes slides and speaker notes
• Has been frequently used and praised by real
  pediatricians

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Poisoning Our Children Video

• Poisoning our Children The Perils of
  Secondhand Smoke
• Product of American Academy of Otolaryngology
  Head and Neck Surgery Foundation
• 12 minutes long
• Perfect for hospital maternity wards

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Smoke Free Home Pledge

• National pledge campaign designed to motivate
  parents to make their homes smoke-free
• Includes promotional brochure with published
  1-800 Smoke Free Homes Pledge Hotline
• Parents who pledge receive follow-up Smoke Free
  Home Kit
• To be promoted and launched fall 2000

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Printed Resources

• Secondhand smoke brochure (in English, Spanish
  and Chinese)
• http//www.epa.gov/iaq/pubs/etsbro.html (English
  version)
• http//www.epa.gov/iaq/pubs/humo.html (Spanish
  version)
• EPA Risk Assessment
• http//www.epa.gov/iaq/pubs/etsfs.html
• Setting the Record Straight
• http//www.epa.gov/iaq/pubs/strsfs.html

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EPAs General Web Phone Info

• EPA's ETS Web Site http//www.epa.gov/iaq/ets.ht
  ml
• National Service Center for Environmental
  Publications (NSCEP)
• 1-800-490-9198
• http//www.epa.gov/nscephom
• IAQINFO 1-800-438-4318
• ETS Team main number 202-564-9370

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Whats Next?

• Smoke-Free Home Pledge Campaign Launch 2nd
  round of Media Campaign
• USDAs ShS Week Oct 1-7
• National ShS Meeting
• Organized by CA
• Late May in San Diego
• World No Tobacco Day
• May 31, 2000
• ShS Theme