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 SmokePassive SmokingInvoluntary SmokingSide-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 greatestChildren are particularly susceptible to health risks from secondhand smokeChildren's exposure is involuntaryMost 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 home38% of children 2 mos. - 5 yrs are exposed in the home

7

What’s the ProblemUp to 1 million children have their asthma worsened (costing $200 million annually)Estimated 700,000 - 1.6 million doctor visits for ear infectionsEstimated 1,900 - 2,700 SIDS deaths150,000 - 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 developingChildren absorb greater doses than adults from the same exposure levelsIf 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 infectionsChildren 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

SmokingYoung children whose parents smoke have an increased frequency of lower respiratory tract infectionsChildren of smokers have an increased frequency of chronic respiratory symptomsChildren of smokers have a small decrement in lung functionMaternal 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. nonsmokersETS 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 asthmaETS is a risk factor for new cases of asthma in previously asymptomatic children

http://www.epa.gov/ncea/smoking.htmhttp://www.epa.gov/ncea/smoking.htm

16

CalEPA’s 1997 Conclusions on Children’s Health

Effects

reduced fetal growthsudden infant death syndromeacute lower respiratory infectionsasthma induction and exacerbationchronic respiratory symptomsmiddle ear infections

Effects causally associated w/ ETS exposure:

17

CalEPA’s 1997 Conclusions (cont.)

adverse impact on cognition and behaviordecreased pulmonary functionexacerbation of cystic fibrosis

Effects with suggestive evidence:

http://www.oehha.org/air/environmental_tobacco/index.htmlhttp://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 childrenThere is also good evidence linking ETS exposure to SIDS and fluid in the middle earMaternal 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 tractETS 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.htmhttp://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 lifeETS exposure is a cause of chronic respiratory symptoms in school-aged childrenETS 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 diseaseETS 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.htmhttp://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 childrensufficient evidence of an association between ETS and development of asthma in preschool-aged children

25

Lower Respiratory Tract Infections

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

26

Respiratory Symptoms

Chronic cough, phlegm, and wheezingstrong consistent evidence, especially for preschool childrenincreased risks of about 20 to 40%

27

Asthma

asthma is the most common chronic condition of childhoodstrong 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 Diseasestrong evidence for acute and chronic middle ear diseasefluid 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 Growthconsistent evidence of small effect for nonsmoking mothers during pregnancy

30

Emerging Science

Cognitive and Behavioral EffectsPoor performance in school and standardized and behavioral tests

Cardiovascular EffectsAdults and Children (stronger for adults)

Childhood CancerSuggestive 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/yearAsthma exacerbation: 400,000 to 1 million childrenAsthma induction: 18,000 to 36,000 new cases/year

U.S. EPA, 1992U.S. EPA, 1992

32

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

Middle ear infections: 0.7 to 1.6 million physician

visits/yearLow birthweight: 9,700 to 18,600 cases/yearSudden Infant Death Syndrome: 1,900 to 2,700 deaths/yearCalEPA, 1997CalEPA, 1997

33

ConclusionsStrong international scientific consensus that ETS exposure causes increased risk of a variety of health effects in childrenIncreased risks of common ailments, coupled with widespread exposure, result in large public health impacts and financial costsETS 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;

CessationYouth accessPreventionPublic 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 RoleEPA consulted with members of tobacco control community to identify work already being done

Progress being made in public placesGap 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 ratesAds that stress ShS are most effective at reducing smokingSmokers who believe ShS is harmful & take action make more progress towards quittingShS work encouraged in CDC’s best practices

38

A Clear GoalTo 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

0

5

10

15

20

25

30

35

40

1986 1990 1992 1994 1996

% of smokinghouseholds

40

Protecting Children in the Home

Key Messages for our target audience

Choose not to smoke in your home or permit others to do soChoose not to smoke if children are present, particularly infants & toddlersIf 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 ownCreate products, tools, and messages appropriate for specific audiencesKeep 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 carcinogenFederal District Court Judge ruled in favor of industry (summer 1998)

Vacated lung cancer chapters of the risk assessmentDecision addresses only carcinogen classification, not children's healthDecision procedural in nature

43

EPA Risk Assessment Lawsuit

EPA's response:Justice Department is appealing decision on behalf of EPAEPA stands behind its scienceDespite tobacco industry lawsuit, total body of SHS science is stronger than everFindings regarding children’s health effects remain unchallenged

44

Involuntary ExposureProtecting Children from Secondhand

Smoke

Tools and Resources

45

EPA’s Tools and Resources: Designed for

You

Media campaignDaycare ModulePediatrician’s Speakers KitCommunity Action KitSmoke-Free Home Pledge Campaign

Outreach program guidePoisoning Our Children WebsitePrinted information (Risk Assessment, brochures, posters)CDC State ShS/Asthma Grants

46

CDC-EPA ShS/Asthma Grants

Competitive grants to tobacco control community targeted to ShS/Asthma workSupplement to CDC’s comprehensive state tobacco program grants11 states have been selected and have received fundingAnticipate continuing this programNM, TN, MN, VT, CO, AL, NC, WI, OH, NE, WV

47

Media CampaignCreated by CFAF, AMA & EPA; Released wave 1 spring 1999; wave 2 planned summer 2000Script, tone,message reflect researchAvailable for TV, radio, and printWhat can you do?

Coordinate with EPA regional office or state tobacco control contact to market PSA at local radio and TV stationsSecure 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” messageKid's health is #1 motivational messageLogic and facts are not enoughProvide options and choiceAcknowledge the difficulty of quittingSoft Sell works best – avoid hard-hitting lectures

49

Community Action KitOne-stop shopping for community leaders working on ShSFocuses on health effects and actionsIncludes these and more:

“Poisoning our Children” videoSample letters to press, health officials, etc.Complete “turn-key” ShS presentationContact listsInformation 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 programsContains broad spectrum of ShS activities and info on how to customize and implementIncludes info on funding opportunities and replicable programs

51

Daycare Module

Not designed to make daycare centers smoke-freeDesigned to teach daycare providers how to communicate to parents about the risks of secondhand smoke to young childrenIdeal if incorporated into a state’s continuing education credit system

52

AAP Pediatrician’s Speakers Kit

American Academy of Pediatrics productDesigned as an aid to pediatricians who agree to communicate to parents about ShS health risksIncludes slides and speaker notesHas been frequently used and praised by real pediatricians

53

“Poisoning Our Children” Video

“Poisoning our Children: The Perils of Secondhand Smoke”Product of American Academy of Otolaryngology – Head and Neck Surgery Foundation12 minutes longPerfect for hospital maternity wards

54

Smoke Free Home PledgeNational pledge campaign designed to motivate parents to make their homes smoke-freeIncludes 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

55

Printed ResourcesSecondhand 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 Assessmenthttp://www.epa.gov/iaq/pubs/etsfs.html

Setting the Record Straighthttp://www.epa.gov/iaq/pubs/strsfs.html

56

EPA’s General Web & Phone Info

EPA's ETS Web Site: http://www.epa.gov/iaq/ets.htmlNational Service Center for Environmental Publications (NSCEP)

1-800-490-9198http://www.epa.gov/nscephom

IAQINFO: 1-800-438-4318ETS Team main number: 202-564-9370

57

What’s Next?Smoke-Free Home Pledge Campaign Launch & 2nd round of Media CampaignUSDA’s ShS Week Oct 1-7National ShS Meeting

Organized by CALate May in San Diego

World No Tobacco Day May 31, 2000ShS Theme