Involuntary Exposure Protecting Children from Secondhand Smoke

1. Involuntary ExposureProtecting Children from Secondhand Smoke

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

3. What We Hope to Accomplish • Acquaint you with EPA’s 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

4. 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

5. 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

6. What’s 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

7. What’s 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

8. Involuntary ExposureProtecting Children from Secondhand Smoke Health Effects

9. Children Are Especially Susceptible to Toxic Effects From ETS • Children’s 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

10. 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

11. Conclusions of the 1986 Surgeon General’s 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

12. U.S. EPA’s 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

13. U.S. EPA 1992 Conclusions • ETS exposure is causally associated with an increased risk of lower respiratory tract infections such as bronchitis and pneumonia In children:

14. U.S. EPA 1992 Conclusions (In children, cont.) • increased prevalence of fluid in the middle ear, • symptoms of upper respiratory tract irritation, and • a small but significant reduction in lung function ETS exposure is causally associated with:

15. 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

16. CalEPA’s 1997 Conclusions on Children’s Health Effects • reduced fetal growth • sudden infant death syndrome • acute lower respiratory infections • asthma induction and exacerbation • chronic respiratory symptoms • middle ear infections Effects causally associated w/ ETS exposure:

17. CalEPA’s 1997 Conclusions (cont.) • adverse impact on cognition and behavior • decreased pulmonary function • exacerbation of cystic fibrosis Effects with suggestive evidence: http://www.oehha.org/air/environmental_tobacco/index.html

18. Australia’s National Health and Medical Research Council’s 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

19. 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

20. UK’s 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

21. 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

22. 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

23. 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

24. 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

25. 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

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

27. 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?

28. 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%

29. Other Health Effects • Decreased lung function • small (<10%), 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

30. 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

31. 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

32. 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

33. 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

34. Involuntary ExposureProtecting Children from Secondhand Smoke EPA’s Goal, Message & Strategy

35. 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 • EPA’s outreach efforts focus exclusively on reducing children’s exposure to secondhand smoke at home

36. Crafting EPA’s 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 children’s particular vulnerability to ETS

37. How Do We Fit In? • EPA’s 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 CDC’s best practices

38. 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

39. Tracking Progress

40. 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

41. 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.

42. EPA Risk Assessment Lawsuit • Tobacco industry challenged EPA’s 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

43. 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 children’s health effects remain unchallenged

44. Involuntary ExposureProtecting Children from Secondhand Smoke Tools and Resources

45. Media campaign Daycare Module Pediatrician’s 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 EPA’s Tools and Resources: Designed for You

46. CDC-EPA ShS/Asthma Grants • Competitive grants to tobacco control community targeted to ShS/Asthma work • Supplement to CDC’s 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

47. 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

48. 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

49. 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

50. ALA’s 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