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
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)
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
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
Children’s exposure to passive smoke
Trend in passive exposure of children over time
Effect of parent and carer smoking
Children living in smoke-free homes in England
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
Maternal active and passive smoking:Effects on fetal health
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)
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)
Passive smoking and children’s health
• 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
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
Parental and sibling smoking and smoking uptake in children
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%
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
Economic impact
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
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
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
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
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.)
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
Ethical issues
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
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
Public opinion on smoke-free policy
Legislation at work: Growing support
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
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
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
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
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
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
Recommendations for action
1. Reduce the number of parents and younger adult smokers
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
2. Prevent exposure to smoke
• Smoke-free homes:
– mass media campaigns
– health warnings
– behavioural interventions
– nicotine substitution
• Smoke-free cars:
– Prohibit smoking in vehicles
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
More Information:[email protected]