Second hand smoke/vapor and kids

1
Second hand smoke/vapor and kids
J. Gary Wheeler, MD, MPS Chief Medical
Officer Arkansas Dept. of Health
May 2015
2
dedicated to eliminating childrens exposure to
tobacco and secondhand smoke
3
Learning Objectives

• To understand
• The harms of second/third hand smoke (SHS)
  exposure to kids
• The influential role YOU have when delivering the
  You should quit message
• The importance of a smoke free home
• How to refer clients and their families to
  1-800-QUIT-NOW

4
Local Tobacco Use

• One in four adults smoke in Arkansas
• One in five high school kids smoke in Arkansas
• gt 5000 deaths every year

5
Many Children Are Exposed

• More than 30 of children live with at least one
  smoker
• Younger children spend most of their time with a
  parent if that parent smokes, SHS exposure can
  be highly significant
• Exposures occur in the home, child care, car

6
Tobacco-Free Homesare Protective

• Children and adolescents who live in tobacco-free
  homes are less likely to use tobacco
• Strict smoke free home rules encourage cessation
  among smoking members of household
• Home smoking bans reduce smoking rates and
  cigarette consumption among youth

7
The Health Effects of Tobacco Use
Asthma Otitis Media Fire-related Injuries
Influences to Start Smoking
SIDs Bronchiolitis Meningitis
Childhood
Infancy
Adolescence
Nicotine Addiction
In utero
Adulthood
Low Birth Weight Stillbirth Neurologic Problems
Cancer Cardiovascular Disease COPD
8
SHS Exposure Causes Deathand Disease in Children

• 6,200 children die each year in the U.S. as a
  result of SHS exposure
• 5.4 million childhood illnesses are attributed
  to SHS exposure
• Annual costs attributable to SHS exposure 4.6
  billion

9
Childrens health and tobacco disease

• Infectious Diseases
• Meningitis (3-4 fold rate)
• Sepsis (3-4 fold rate)
• OM (3.4 million cases) OME (110,000 PE tubes)
• Pneumonia (gt 2 fold risk)
• RSV (22,000 hospitalizations 1,100 deaths)
• Respiratory Diseases
• Asthma (1.8 million outpatient visits, 28,000
  hospitalizations, 14 deaths)
• CF

10
Childrens health and tobacco disease

• Miscarriage (80,000 spontaneous abortions/yr
  nationally)
• Low birth weight (46,000 cases)
• Pregnancy complications and SIDS (2,800 cases )
• Burns (10,000 visits 590 hospitalizations 250
  deaths)
• SIDS (OR2)

Aligne CA. Arch Pediatr Adolesc Med. In press
11
Pediatric ER admissions

• FY2003
• Top 50 diagnoses 21,084 visits
• Diagnoses assd with higher incidence in homes
  with second hand smoke 10,706 or 51
• Otitis media, asthma, pneumonia, URI, etc.

Dave English, ACH-ER
12
Tobacco Use As an Infectious Disease

• Is tobacco use a disease transmitted by exposure?
• Increased access to tobacco products for
  experimentation
• Modeling of tobacco use behaviors?
• Normalization of tobacco use?

13
Tobacco UseDuring Pregnancy

• Stillbirth, SIDS
• Premature delivery, low birth weight
• Placental abruption the placenta tears away
  from the uterus
• Cancers
• Neurological, psychological, developmental
  effects
• Anesthesia issues

14
Immediate Effects of SHS Exposure

• Decreased lung function
• Respiratory infections
• Asthma
• Ear infections
• Meningitis, pneumonia
• Household fires

15
SHS Health Effects in Adults

• Cancers
• Respiratory
• Heart disease
• Increased infection
• Decreased fertility

16
Long Term Effects ofSHS Exposure

• Increased risk of cancers
• Adult leukemia and lymphoma associated with
  exposure to maternal smoking before age 10
• Increased risk of lipid and cholesterol
  disorders?
• Metabolic syndrome? (a newly recognized syndrome
  associated with diabetes and cardiovascular
  disease)

17
SHS Exposure and Asthma

• SHS exposure increases frequency of episodes and
  severity of symptoms
• SHS exposure causes asthma symptoms in 200,000- 1
  million kids

18
Third hand smoke

• Increased risk to children
• Particulate-
• Deposited chemical compounds or physical
  particles which are deposited on fabrics and
  surfaces
• Off-gassing
• Volatile organic compounds in cigarette smoke
  partition in materials and then are released at a
  later time
• Nicotine
• Combines with nitrous acid from indoor air to
  form carcinogens

19
(No Transcript)
20
E-cigarettes/ENDS/vapes

• What we know about disease
• Some reactive airway responses
• Some anecdotal responses
• No long term data
• What we know about the products
• Particulate including new nanoparticles
• Some carcinogens
• Heavy metals
• Nicotine

21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
E-cigarettes/ENDS/vapes

• What we know about second hand vapor
• Absorption of nicotine
• Precipitation of vapor on to floors, carpets and
  accumulation
• Anecdotes of airway irritation

25
Principles of Tobacco Dependence Treatment

• Nicotine is addictive
• Tobacco dependence is a chronic condition
• Effective treatments exist
• Every person who uses tobacco should be offered
  treatment

26
(No Transcript)
27
Smokers Want to Quit

• 70 of tobacco users report wanting to quit
• Most have made at least one quit attempt
• Cite health expert advice as important
• Regardless of type! THIS MEANS YOU!

28
Counseling 101

• Patients and families expect you to discuss
  tobacco use
• If counseling is delivered in a non-judgmental
  manner, it is usually well-received
• Even small doses are effective - and cumulative!

29
The Theory
Assessing Stage of Readiness
Precontemplation
Contemplation
Ready for Action
Relapse
Action
Maintenance
Behavior change occurs in stages not all at once
30
Your Goal Help the Tobacco User Take the Next
Step

• First, establish a system for asking
• Help a precontemplator become a contemplator
• a contemplator start to make plans
• someone who relapsed become ready for action
• And so on.

31
Brief Intervention

• Minimal interventions lasting less than 3 minutes
  increase overall tobacco use abstinence rates.
• Every tobacco user should be offered at least a
  minimal intervention, whether or not he or she is
  referred to an intensive intervention.

32
The 5 As
2As and an R
Ask
Advise
Refer
33
2 As and an R ASK

• Ask about tobacco use and SHS exposure at every
  visit
• Make asking routine, consistent, and systematic
• Use standardized documentation
• Document as a vital sign
• Just asking can double quit attempts

34
How Do You Ask?

• Dont lead You dont smoke, do you?
• Depersonalize the question Does anyone living
  in your home use tobacco in any way? Who is
  it? Where do they smoke? Is that inside the
  house?
• Explore You say no one smokes around your son.
  What does that mean?
• Dont judge check your body language, tone of
  voice, the phrasing of the question

35
2 As and an R ADVISE

• Strongly advise every tobacco user to quit
• Provide information about cessation to all
  tobacco users
• Strongly urge smoke free homes and cars
• Look for teachable moments
• Personalize health risks
• Document your advice

36
What Do You Say?

• Clear I advise you to quit smoking.
• Strong Eliminating smoke exposure of your son
  is the most important thing you can do to protect
  the health of your child.
• Personalized Emphasize the impact on health,
  finances, the child, family, or patient.
• Smoking is bad for you (and your child/family).
  I can help you quit.
• Tobacco smoke is bad for you and your family.
  You should make your home and car smoke free.

37
Child labor
Kristin Palitza theguardian.com, Wednesday 14
September 2011
38
Be Specific

• Having a smoke free home means no smoking
  ANYWHERE inside the home or car!
• It DOES NOT mean smoking
• Near a window or exhaust fan
• In the car with the windows open
• In the basement
• Inside only when the weathers bad
• Cigars, pipes, or hookahs
• On the other side of the room

39
2 As and an R REFER

• To quit line, 1-800-QUIT-NOW
• To community and Internet resources
• Give every tobacco user something that contains
  information about quitting, the harms of tobacco
  use, etc.

40
What Do You Say?

• You should call this number. Its a free service
  and the person on the other end of the
  telephone line can help you get ready to quit.
• You should learn as much as you can about
  quitting the more you know, the more successful
  youll be.

41
Quitlines

• It takes only 30 seconds to refer a patient to a
  toll-free tobacco use cessation quitline
• Quitlines are staffed by trained cessation
  experts who tailor a plan and advice for each
  caller
• 1-800-QUIT-NOW callers are routed to state-run
  quitlines or the National Cancer Institute
  quitline

42
Advantage of Quitlines

• Accessibility
• Appeal to those who are uncomfortable in a group
  setting
• Tobacco users more likely to use a quitline than
  face-to-face program
• No cost to patient
• Easy intervention for healthcare professionals
  -Fax-back referral services

43
Medications Work!

• Bupropion SR (Zyban ) Varenicline (Chantix )
• Start BEFORE the quit date
• Prescription needed
• Nicotine replacement products
• Gum, patch, lozenge
• Others need prescription
• Under 18 years need prescription
• FOLLOW THE DIRECTIONS!!!

44
Follow Up

• Ask clients how theyre doing
• Ask them if their home and car are smoke free
• Ask them if they called 1-800-QUIT-NOW

45
For theUnwilling/Not Ready

• The 5 Rs
• Relevance
• Risks
• Rewards
• Roadblocks
• Repetition

46
Community Advocacy

• Community and school education programs
• Be politically active
• Advocate for (and support!) smoke free
  environments
• Participate in media presentations
• DONT USE TOBACCO IN ANY FORM!

47
Current law in Arkansas

• No sales to minors of any tobacco product
  enforcement of illegal sales by Tobacco Control
  Board
• No use of combustible or vaping/e-cig products on
  school or college campuses
• No use of combustibles in public places (does not
  include vaping/e-cig products).

48
Volunteer regulations

• Smoke free bars
• Smoke free employees
• Baptist Hospital
• Arkansas Childrens Hospital
• Heart Hospital
• Health care savings
• 3rd hand smoke

49
Summary

• You should now understand
• The harms of secondhand smoke (SHS) exposure
• The influential role YOU have when delivering the
  message You should quit
• The importance of a smoke free home
• How to refer clients and their families to
  1-800-QUIT-NOW

50
Need more information?The AAP Richmond Center
www.aap.org/richmondcenter
Audience-Specific Resources State-Specific
Resources Cessation Information Funding
Opportunities Reimbursement Information Tobacco
Control E-mail List Pediatric Tobacco Control
Guide
51
Questions?
Skull of a Skeleton with Burning
Cigarette Antwerp 1885-1886 Van Gogh
Museum Amsterdam