Reducing children’s exposure to environmental tobacco smoke in homes: issues and strategies - air purifier for smoke
Exposure of children to environmental tobacco smoke (ETS)
Has a significant impact on public health and the economy.
Children are more susceptible to the health effects of ETS exposure than adults, and families are the most important places for such exposure.
Although the responsibility and authority of community and health professionals to protect children from harm is deeply rooted in North American society, social, economic, legal, compared to workplaces and public places, political factors have led to lower support for ETS controls in families.
It is now clear that ETS control in the home environment must be a priority on the public health agenda.
The programme and policy options and strategies for ETS control in the home environment are outlined.
We conclude that the current research base is not sufficient to fully support programme and policy development in this area and to identify priorities for the study.
Reasons for handling ETS in a home environment Environmental Protection Agency's 1993 reports (EPA)
The United States recorded the causal relationship between ETS and the important health effects of children.
Dozens of studies published since then support their conclusions.
Recently, the California Environmental Protection Agency's comprehensive report further confirmed, improved and expanded these proposals.
4 It is now clear that ETS exposure is the cause of lower respiratory infections in children, such as bronchitis and pneumonia, as well as fluid in the middle ear, symptoms of upper respiratory tract stimulation, and slight but significant reduction in lung function.
In addition, ETS is responsible for new cases of asthma, additional episodes of asthma, and increased severity of asthma symptoms.
As recorded in the EPA and California reports, and a recent comprehensive meta-
Analysis, the impact of 5 children's exposure to ETS on public health is substantial.
Moreover, it is clear that the economic impact is far from negligible.
67. children are particularly exposed to ETS.
They had a higher relative ventilation rate compared to adults, which resulted in higher internal exposure of ETS, measured at the same level of external exposure, by urinary cotinine.
Babies and young children cannot complain;
Older children troubled by ETS may not complain, or may be ignored or reprimanded when they complain.
In addition, children are often unable to get out of contact and therefore rely on other protective measures.
Communities, professionals and state responsibility and authority to protect children from harm are deeply rooted in North American society.
The attitude of the community supports the cultivation and protection of children, and various laws have been enacted for this purpose.
Although the lack of regulation of access to ETS for children in the family is inconsistent with the efforts of other communities to protect children, there is a reason for this inconsistency.
It has not been until the last decade that people know that ETS is more than just a stimulus.
Even today, many people do not know the harm it does to health.
Others may think that effective protection can be achieved by taking simple measures, such as opening windows, smoking in another room, or using an air purifier. Although none of these measures significantly reduced exposure.
1112 of children, especially preschool children, are likely to stay at home most of the time.
According to the national survey, 37% to 39% of Canadians live in families that smoke frequently, 13 (
Health Canada, unpublished form)
Of American children aged 2 months to 11 years, 43% were also exposed to this environment, and serum cotinine levels were generally higher than adults.
Mother smoking is a particularly important determinant of infant and child contact
Children aged 17 and single
Parents and families may face higher risks than two children. Parents and families.
For infants and children, families are often the most important places for ETS exposure.
Therefore, programmes and policies for ETS in the family are the next logical step in a comprehensive strategy to reduce child morbidity and mortality caused by ETS.
Findings from Ontario, Canada indicate strong support for voluntary restrictions on children's access to ETS at home. 19-
In 1996, almost 40% people (39. 4%)
In the population, some people are in favor of legal restrictions. 21 A majority (54. 6%)
Expressing support for a law prohibiting children from accessing ETS in cars, 21 this can be seen as an extension of the family.
However, the potential for change lies not only in the attitude of 2223, but also in the reality of housing, income and childcare.
24 social, economic, legal and political issues compared to the workplace and many public settings, several factors have led to a lower level of support for ETS control measures in families.
Some argue that governments or other external agencies should not interfere with the behavior in a private environment.
23 for many, "My home is my castle," and "the divine of home" is a deeply rooted creed.
This universal belief contrasts sharply with laws and regulations that protect children from physical abuse and sexual abuse, as well as those that need to go to school, immunization, baby restraint and seat belts for use on vehicles.
Social pressure is also included.
Even parents who want their family to smoke
Freedom may not be willing to offend family, relatives and friends.
A number of health and social welfare professionals raised additional concerns.
Representative of Low
Income and single
At the recent Health Canada women's and tobacco conference, parent women's groups expressed strong opposition to even exploring the possibility of restricting smoking in their homes.
The harassment they envisioned was low.
Earning a mother, worried that the child may be taken away from a family that does not smokefree.
The time of smoking is considered to be one of the few breaks these women allow themselves to rest, and cigarettes are thought to provide some comfort in life that was originally tense and not rewarding.
This question is considered to be between feminism and "classic"Class and upper
Professionals impose their health values on lowincome women.
This could be an extension of the view against interfering with the use of tobacco, alcohol and illicit drugs by pregnant women. 26Low-
Income families may encounter more practical difficulties in providing cigarettes.
Free environment. Low-
Parents with income are more likely to smoke and friends who smoke. 27-
30 they are more likely to live in small housing units, usually apartments, with limited access to the outdoors, few rooms and few ventilation systems.
They usually do not have a balcony or garage when smoking outdoors.
Many single parents have to leave their children alone or take them with them every time they go out to smoke.
Even if there is no clear regulation of the family environment, court cases bring the ETS problem in the family into the legal field.
In the United States and Canada, children with asthma have been the focus of cases involving the exposure of smoking parents to children and custody. 233132 (
April 30, 1996, Rob Cuningham, Cancer Society of Canada. )
Parents who refuse to smoke
Free environment for children with asthma is denied access or custody.
Sweda33 reviewed 33 cases of child custody in the United States between 1989 and 1996.
Most decisions tend to protect children from ETS (24 vs 9]
The presence of respiratory diseases in children does not seem to be a factor.
In some cases involving the protection of ETSsmoking parent;
In other cases, both parents are prohibited from smoking in the presence of their children.
Some people are allowed to smoke elsewhere in the home, but most people are completely prohibited from smoking, including smoking in vehicles.
In some cases, the court ruled that failure to stop smoking around the child was evidence of a lack of attention to the child's health. In one case (
ND vs Reed, ND 1995)
The court overturned the sentence of custody to Africa.
The father who smoked because the father committed domestic violence ruled that "we do not believe that the legislature, the presumed perpetrator who granted custody of the child must use the victim of domestic violence-parent smokes.
The second opinion states: "I also disagree with the fact that most people despise the harm of cigarette smoke to children with asthma. . . . Under N. D. C. C. secs. 14–07.
1-01, domestic violence includes "physical injury ".
Smoking in the presence of children with asthma, whose health is therefore threatened, is likely to constitute this physical injury.
"Health care professionals are involved in identifying ETS exposure, particularly for children with respiratory diseases, raising the issue of interference on the one hand and, on the other, failure to act.
Evidence from family doctors is a key factor in some custody cases.
For example, in Wilk vs Wilk (Mo. App. 1989), a non-
A doctor advised the smoking mother not to go to the father's house where she was smoking and she was granted primary custody of the child.
In other cases, the "medical advice" is used as a supporting argument for the decision.
Other regulatory issues involve non-
Smoking tenants of ETS due to shared ventilation system.
In Fort Pierce, Florida, the local housing authority has asked new tenants to sign an agreement not to smoke in an apartment under their jurisdiction.
This is believed to be the first time residents have been banned from smoking at home by public institutions.
34. Although the law provides for the tradition of protecting children, a major political issue, if not always in practice, is that it is inappropriate to invade the private environment.
Therefore, the protection of children's access to ETS from their parents by law is not as good as that of strangers smoking in public places.
This difference may be based in part on the notion that parents have a greater vested interest in the well-being of their children and can count on protecting them from harm.
However, child abuse legislation demonstrates the political will to intervene in the family.
Programme and policy options for reducing access to family ETS and strategic intervention options include public education, community programmes, clinical interventions, policy and advocacy statements, legal and regulatory measures, and monitoring and evaluation mechanisms.
Educating the public about the adverse effects of ETS on health and effective ways to control exposure can take multiple forms, including information disseminated through electronic and print media, billboards, even warnings on cigarette packaging.
Not only adults, adolescents and children, but also depending on the attitude towards smoking and ETS and the level of acceptance of information and impact, the information may need to be addressed separately.
A major Canadian study commissioned by Health Canada shows that about 30% of the parent population is responsive or likely to respond to information, but has not yet been translated into counter-
The number of smokers is 35, while the other 11% are considered unlikely to respond to information, but there is a possibility of a change.
Sources of information are suspected and are considered a difficult target and 7% are considered to have strong resistance to change.
Behavior changes in the latter group may require more intensive intervention.
36 in this unpublished study, the survey found that 61% of parents reported that there were some smoking restrictions in the family, while only 43% of households with smoking had such restrictions
At this time, the lack of data among peers
Literature was reviewed on the extent and manner of smoking restriction in Canadian households.
However, in a study on informal control of Canadian Winnipeg families, Goldstein37 concluded that the gap between harmful effects knowledge (90%)
Actual Control (24%)
At home, this suggests the need to study situational factors that interfere with the adoption of family rules.
This gap is worth addressing, and the recently released data from the Massachusetts survey show that in households with smoking restrictions, ETS exposure levels for adolescents living with adult smokers are much lower.
38 evaluation of the community
Ontario39 and elsewhere reported programmes based on reducing exposure to ETS in the home, 4041 indicating varying levels of success.
These programs can provide support and guidance to those who have difficulty implementing their preferences.
Ways of trying to expand current behaviour in the workplace and in public places may be more effective than those that require new responses.
For example, smokers can be reminded that since they do not expose colleagues or the public in many places, they should provide the same benefits to their children and partners.
ETS awareness and control strategies for families can also be incorporated into compulsory tobacco education programmes in schools.
Demonstration projects with full evaluation content and national communication and implementation potential are needed.
Efforts to improve the knowledge and skills of health professionals on smoking every 42 years should be reviewed to ensure effective interventions with parents, other caregivers, in addition, children themselves related to ETS exposure and their control were also discussed.
Many health professionals are in a favourable position to intervene in these groups, and some evidence has been found in clinical studies involving children with asthma and newborn parents that ETS exposure is reduced in family settings. 43-
47 successful interventions were reported to be aimed at improving the effectiveness of family physicians and pediatricians in reducing ETS exposure.
In addition, there is evidence that parents would like such advice.
5051 the policy and advocacy statements raise awareness of the issue and contribute to the development of an action agenda.
Recently, a number of voluntary health associations, expert groups, professional associations and government agencies have announced public positions advocating strategies to protect children from ETS. 52-
60. in Canada, a recent National Workshop on ETS was characterized by the fact that exposure in the home was equal to exposure in public places and workplaces.
61 there may still be considerable resistance to exploring the applicability and feasibility of legal and regulatory interventions.
While child protection legislation can be expanded or interpreted to include ETS exposure, it is not clear to what extent existing regulations and regulations can be used to address ETS control issues in the home, especially for babies and children with impaired respiratory systems.
As noted above, in recent court decisions in the United States and Canada on custody and access in divorce proceedings, this risk is taken into account in determining the best interests of the child. 2331-33 (
April 30, 1996, Rob Cuningham, Cancer Society of Canada. )
Monitoring and evaluation is a key component of any strategy to reduce ETS exposure at home, especially since there are difficulties in measuring compliance.
Attitudes and behaviors of the general population should be systematically monitored in the survey. Self-
The data reported need to be supplemented by an objective monitoring system.
If we are to understand which programs and policies are effective in reducing ETS exposure, it is critical to evaluate components.
While it is clear that protecting children in a family environment from ETS should be a priority in programming and policy development, it is also clear that the issues are diverse and complex, the current research foundation is not sufficient to fully support this development.
The priority areas of the study include: attitudes and intentions of health professionals and decision makers regarding family ETS control;
Evaluation of existing effective interventions;
Assess public support for regulatory changes;
Evaluation of control options in accordance with current legislation and regulations;
And the potential applicability of harm reduction strategies.
We need to assess smokers knowledge of the scope and importance of ETS exposure health effects and their belief in the effectiveness of various ETS reduction measures --
Open windows, fans, air purifiers, and filters, for example.
Specific exposure data is also required in environments with different levels of ventilation, such as apartments, small families, large houses and vehicles.
Continuing the study, monitoring the extent of informal control of smoking in the family, and the form of these controls, should be a priority for the study.
In addition, we need to identify factors that are most likely to change behaviour and promote effective interventions, including those in the social and policy environment.
Given our limited knowledge in some of these areas, it is appropriate to explore these research priorities using a combination of quantitative and qualitative approaches.
Finally, although current knowledge of the health impact of ETS exposure on children is sufficient to warrant action now, there is much to be learned about the scope and severity of the health impact of ETS exposure.
Clearly, a solid Research Foundation is an important foundation for programmes and policy initiatives to reduce the risk of children's exposure to ETS.
Since the paper was accepted for publication, the new country
The US Behavioral Risk Factor monitoring system released estimated information on children's exposure to ETS at home in 1996.
62. Three to half of American adults who smoke live at home, and most of these families (From 70.
Washington State 6% to 95.
6% in the District of Colombia)
, Smoking is allowed in some or all areas of the home.
Based on these findings, 21.
Of the children under the age of 18, 9% had access to ETS at home.
This estimate does not include
Parents smoke or are exposed at home.
However, since the collection of restricted smoking information from 1992-93, the proportion of households restricting smoking may increase.
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