Transcript
Page 1: Passive smoking and children’s health: New evidence and call for action

Passive smoking and children’s health:

New evidence and call for action

Page 2: Passive smoking and children’s health: New evidence and call for action

Royal College of Physicians

• Founded 1518 - London

• 25 000 Fellows & Members in80 countries

• Set medical standards through training, exams, and advice to government

• Strong interest in public health

Page 3: Passive smoking and children’s health: New evidence and call for action

Tobacco & Royal College of Physicians

• Long history of involvement in tobacco control• 1962 report “Tobacco or Health”

• Smoking and the young (1992)• Nicotine addiction in Britain (2000)• Forty Fatal Years (2002)• Going smoke-free (2005)• Harm reduction in nicotine addition (2007)

Page 4: Passive smoking and children’s health: New evidence and call for action
Page 5: Passive smoking and children’s health: New evidence and call for action

Smoke-free legislation in the UK:

• In place since 2006 (Scotland), 2007 (England, NI, Wales)

• Amongst the most comprehensive in Europe

• All enclosed workplaces including all bars and restaurants

• No smoking rooms allowed

• Includes residential mental health settings

• Includes work vehicles

• Young Offender institutions

• Partial exemptions for adult prisons and some residential facilities

Page 6: Passive smoking and children’s health: New evidence and call for action

The impact of UK smoke-free legislation:

• Highly effective and popular

• Has generated marked improvements in health, particularly heart disease

• Legislation does not extend into the home

• This is where the majority of exposure, and particularly of children, occurs

• This report explores the extent of and possible policy responses to the problem of passive smoking in children

Page 7: Passive smoking and children’s health: New evidence and call for action

Children’s exposure to passive smoke

Page 8: Passive smoking and children’s health: New evidence and call for action

Trend in passive exposure of children over time

Page 9: Passive smoking and children’s health: New evidence and call for action

Effect of parent and carer smoking

Page 10: Passive smoking and children’s health: New evidence and call for action

Children living in smoke-free homes in England

Page 11: Passive smoking and children’s health: New evidence and call for action

Key Points:

• Main determinants of exposure are:– Whether parents and carers smoke– Whether smoking is allowed in the home

• Homes usually smoke-free if parents don’t smoke

• 2 million children live in homes that allow smoking

• Exposure highest in the young and socio-economically disadvantaged

Page 12: Passive smoking and children’s health: New evidence and call for action

Maternal active and passive smoking:Effects on fetal health

Page 13: Passive smoking and children’s health: New evidence and call for action

Effect of active smoking during pregnancy

• Each year in the UK, smoking during pregnancy causes around:• 5000 miscarriages• 300 perinatal deaths• 2200 premature births• 19,000 low birth weight

• Smoking in pregnancy also increases risk of birth defects:• Heart (15-50% increase in risk)• Missing/deformed limbs or digits (30-50% increase in risk)• Face: cleft lip/palate (35% increase in risk)

Page 14: Passive smoking and children’s health: New evidence and call for action

Effect of passive smoking in pregnancy

• General consistency with active smoking studies

• Clear evidence on low birth weight and premature births

• Some direct evidence on birth defects (e.g. of the face, cleft lip/palate)

Page 15: Passive smoking and children’s health: New evidence and call for action

Passive smoking and children’s health

Page 16: Passive smoking and children’s health: New evidence and call for action

• Sudden infant death syndrome• 3-fold increase with mother smoking• More than doubling with father or other household

member smoking

• Lower respiratory infection• 54% increase in risk from household smoking• Mostly bronchiolitis (2.5-fold increase in risk from mother

smoking)

• Middle ear infection• 35% increase in risk from household smoking• Stronger effects on disease requiring surgery

Page 17: Passive smoking and children’s health: New evidence and call for action

Wheeze • 65% or more increase with mother smoking• Up to 37% increase with household smoking

Asthma• 50% increase in asthma at school age by household

smoking• Approx 2 fold increase in asthma in under 3’s if mother

smokes in pregnancy

Meningitis• Twice as likely if one or more parents smoke

Page 18: Passive smoking and children’s health: New evidence and call for action

Parental and sibling smoking and smoking uptake in children

Page 19: Passive smoking and children’s health: New evidence and call for action

Smoking uptake

• 62% increase if one parent smoked

– Stronger for mother than father

• Nearly 3 fold increase if both parents smoked

• More than doubling in risk if sibling smoked

• Any household smoking increased risk by 92%

Page 20: Passive smoking and children’s health: New evidence and call for action

Key points:

• Smoking in pregnancy causes significant harm to the unborn child

• Passive smoking in pregnancy is common and has similar, though less strong effects, particularly on birth weight and facial defects

• Passive smoking significantly increases risk of sudden infant death, lung infections, asthma, wheeze, meningitis and ear disease in children

• Effects typically stronger for mother smoking after birth

• Significant impact on risk of smoking uptake in children

Page 21: Passive smoking and children’s health: New evidence and call for action

Economic impact

Page 22: Passive smoking and children’s health: New evidence and call for action

Excess disease in children – UK general practice activity

Excess UK cases Excess UK consultations

Lower respiratory tract infections < 2 years 20,500 26,000

Middle ear infections 0-16 years 121,400 160,200

Wheeze < 2 years 7,200 10,300

Asthma 3-4 years 1,700 7,600

Asthma 5-16 years 13,700 99,000

Meningitis 0-16 years 600 800

Total 165,100 303,900

Page 23: Passive smoking and children’s health: New evidence and call for action

Excess Disease – Hospital Admissions in England

Excess admissions

Lower respiratory tract infections < 2 years 3,361

Middle ear infections 0-16 years 2,517

Wheeze < 2 years 938

Asthma 3-4 years 236

Asthma 5-16 years 1,211

Meningitis 0-16 years 231

Total 8,494

Page 24: Passive smoking and children’s health: New evidence and call for action

Other excess disease

• Approximately 40 UK cases of sudden infant death

• Approximately 25,000 UK children start smoking before age 16

– 50% chance of death caused by smoking

– Average loss of 10 years life expectancy

Page 25: Passive smoking and children’s health: New evidence and call for action

Primary care costs (UK)• Additional 300,000 consultations £9 million

€10.5m

• Asthma/wheeze treatments £0.7 million€0.84m

Hospital Costs (UK)• Additional admissions million £13.6 million

€16.5m

Page 26: Passive smoking and children’s health: New evidence and call for action

Long term costs from uptake of smoking

• Total excess health care cost of – £48 million over 60 years*

€58m*(discounted at 3.5% p.a.)

• Productivity losses due to absenteeism and ill health estimated at:– £63 to £72 million over lifetime**

€79 to €87m**(discounted at 3.5% p.a.)

Page 27: Passive smoking and children’s health: New evidence and call for action

Key points:• Each year in children in the UK, passive smoking causes approximately

– 165,000 new cases of disease– 300,000 GP consultations– 9500 hospital admissions– 40 sudden infant deaths – 25,000 new smokers by age 16

– National Health Service costs of £23.3 million (€27m) per annum• Lifetime discounted health care costs £48 million (€58m)• Wider economic costs of up to £72 million (€87m) due to future

lost productivity

• All of this disease and cost is avoidable

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Ethical issues

Page 29: Passive smoking and children’s health: New evidence and call for action

A general duty on adults to protect children from smoke• Preventing direct harm

– Not exposing children to smoke– Not giving children tobacco products

• Preventing or limiting “role modelling”– Not smoking around children in “safe” (i.e. open)

environments– Limiting media exposures to (positive) smoking messages

• Making tobacco sales less visible, and making packaging less attractive

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Key points:

• General duty of parents and all adults to protect children from

• Tobacco smoke

• Tobacco smoking

• Tobacco products and imagery

• Restrictions appropriate where they can work• Smoking in cars

• Tobacco promotion, sale and imagery in media

• Looked-after children

• Rights of the child should be paramount• UN Convention on the Rights of the Child

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Public opinion on smoke-free policy

Page 32: Passive smoking and children’s health: New evidence and call for action

Legislation at work: Growing support

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Increasingly, smokers support smokefree

Support for smokefree law (by smoking status)

929294

78 79 80

4541

34

0

10

20

30

40

50

60

70

80

90

100

2007(b) 2009 2010

Never Smoked All Smoke Daily

Page 34: Passive smoking and children’s health: New evidence and call for action

Smoke-free homes

6167 69

78

2621 20

14

13 12 10 8

0

10

20

30

40

50

60

70

80

90

100

ONS 2006 ONS 2007 ONS 2008 YouGov 2009

Smoking permittedthroughout

Partial restrictions

Smokingprohibitedthroughout

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Better understanding of the risksP erc ived impact of s econdhand s moke on ris k of s udden infant death

17 1926

26 25

30

0

10

20

30

40

50

60

2007 (b) 2008 2009

Hass omeimpact

Has a bigimpact

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Support for stronger action: Cars

"B an s moking in all cars "

4537 35

179

11

10 10

8

3

21

2118

18

13

1619

19

28

24

713 18

28

50

0

10

20

30

40

50

60

70

80

90

100

Nevers moker

ex-s mokers All adults Non-dailys mokers

D ailyS moker

S tronglydis agree

D is agree

Neither/ D K

Agree

S tronglyagree

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Support for stronger action: Outdoors

"S moking should be allowed in all outdoor areas regardless of children"

5 7 7 10178

12 1420

29

1616 17

21

22

2727 26

31

214539 35

1810

0

10

20

30

40

50

60

70

80

90

100

Never s moker P arent of achild under 18

All adults Non dailys moker

D aily S moker

S trong lydis agree

D is agree

Neither/D on't know

Agree

S trong lyagree

Page 38: Passive smoking and children’s health: New evidence and call for action

Key points:

• Support is high and rising, particularly among smokers

• Attitudes are underpinned by growing belief that passive smoking is harmful and that smoke-free rules improve health

• There is a substantial support for measures to include private and to protect children

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Recommendations for action

Page 40: Passive smoking and children’s health: New evidence and call for action

1. Reduce the number of parents and younger adult smokers

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Measures to reduce smoking in young adults

• Cost: increase real cost, reduce illicit supply

• Retail availability: licensing, location, opening hours

• Promotion: Point of Sale display, smoking in media, generic packs

• Health promotion: Media campaigns and health warnings

• Cessation: improve coverage and design of services

• Harm reduction: promote alternative nicotine sources

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2. Prevent exposure to smoke

• Smoke-free homes:

– mass media campaigns

– health warnings

– behavioural interventions

– nicotine substitution

• Smoke-free cars:

– Prohibit smoking in vehicles

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3. Prevent exposure to smoking

• Change social acceptability of smoking in public, particularly around children

• Mass media campaigns to explain policy

• Prevent exposure to tobacco products and brands in shops, films, TV, other media

• Extend smoke-free regulations to include places frequented by children

Page 44: Passive smoking and children’s health: New evidence and call for action

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