living smokefree - government of jersey and...of secondhand vapour exposure from e-cigarettes, for...

A handbook for healthcare professionals

Living Smokefree

TABLE OF CONTENTS

Who and Why?

Definition of secondhand smoke

What do we know?

Harmful effects of secondhand smoke on children

What about Jersey? Local picture

Ask, Advise, Act

Hints for families on managing secondhand smoke

Addressing parental and practitioner barriers to raising the issue

Additional information

Help2Quit Pharmacy Services in Jersey

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WHO AND WHY?Who should use this guide?This guide is for practitioners who work with families and children including professional and voluntary workers in health care, early years and family support services.

Why use this guide?1.To encourage people to smoke outside to protect babies, children

and other non-smokers from exposure to secondhand smoke.

2.To help the government achieve the Tobacco Strategy’s (2017-2022) goal of protecting families and communities from tobacco related harm.

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DEFINITION OF SECONDHAND SMOKESecondhand smoke is a mixture of two forms of smoke that come from burning tobacco.

It consists of:

Mainstreamsmoke: The smoke exhaled by a smoker and;

Sidestreamsmoke: Smoke from the lit end of a cigarette, pipe, cigar, or any other form of tobacco burning. Sidestream smoke has smaller particles than mainstream smoke that can make their way into the lungs and the body’s cells.

As exposure to secondhand smoke is involuntary, it is also sometimes called ‘passive smoking’.

Sidestream smoke has higher concentrations of cancer-causing agents (carcinogens) and is more toxic than mainstream smoke.

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WHAT DO WE KNOW

Secondhand smoke has 4000 chemicals of which at least 70 are known to cause cancer.

C

ANCE

R CA

USING CHEMICALS

TOXIC METALS

POISONOUS GASES

FORMALDEHYDEUsed to embalm

dead bodiesCHROMIUM

Used to make steel

ARSENICUsed in pesticides

LEADOnce used

in paint

CADMIUMUsed in making

batteries

BENZENEFound in gasoline

POLONIUM-210Radioactive and

very toxic

VINYL CHLORIDEUsed to make pipes

CARBON MONOXIDEFound in car exhausts

TOLUENE Found in paint thinners

HYDROGEN CYANIDEUsed in chemical weapons

BUTANEUsed in lighter fluid

AMMONIAUsed in household cleaners

FORMALDEHYDEUsed to embalm dead bodies

CHROMIUMUsed to make steel

ARSENICUsed in pestisides

LEADOnce used in paint

CADMIUMUsed in making batteries


POLONIUM-210Radioactive andvery toxic







TOXIC METALS

Can cause cancer, death and can damage

the brain and kidneys

CANCER CAUSING

CHEMICALSAll are

extremely toxic

POISON GASES

Can cause death, affect heart and respiratory functions. Can burn your throat, lungs, and eyes and cause

unconsciousness

CANCER CAUSING CHEMICALS

All are extremely toxic

TOXIC METALSCan cause cancer, death and

damage the brain and kidneys

POISON GASESCan cause death, affect heart and

respiratory functions. Can burn your throat, lungs, and eyes and

cause unconsciousness

CANC

ER C

AUSI

NG CHEMICALS

TOXIC METALS

POISON GASES



























TOXIC METALS

CANCER CAUSING

CHEMICALS

POISONOUSGASES








CANC

ER C

AUSI

NG CHEMICALS

TOXIC METALS

POISON GASES



























TOXIC METALS

CANCER CAUSING

CHEMICALS

POISONOUSGASES








CANC

ER C

AUSI

NG CHEMICALS

TOXIC METALS

POISON GASES



























TOXIC METALS

CANCER CAUSING

CHEMICALS

POISONOUSGASES








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Levelsofsmokemeasuredinsidethelivingroomintwosituations

Secondhand smoke exposure levels in homes

The WHO recommends that levels of indoor airborne fine particulate matter should be below 25 micrograms per cubic metre of air over 24 hours.The average fine particulate matter level in a house where people smoke inside is four times higher than this, and three times higher in cars where people smoke inside.

200

180

160

140

120

100

9.00

10.00

11.00

12.00 1.0

02.0

03.0

04.0

05.0

06.0

07.0

08.0

09.0

0

80

60

40

20

0Smok

e le

vels

as m

easu

red

by P

M2.

5 (µg

/m3 )

Time of day

Key Smoking at the backdoor Smoking outside WHO level (25)

Source: REFRESH Project

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Harmfuleffectsofsecondhandsmokeonchildren

The effects of secondhand smoke on children are more pronounced as their airways are still developing and they take more breaths. They are also less able to avoid exposure.

Babies exposed to secondhand smoke are at higher risk of sudden infant death syndrome (SIDS) also known as cot death.

Smoking around pregnant women has been shown to lead to low birth weight in babies, preterm babies and still births.

Middle ear infection (glue ear) in a child is 50% more likely to occur if one parent smokes.

Exposure to secondhand smoke increases the risk of developing asthma in children. Children with asthma are twice as likely to be hospitalised due to asthma flare up if exposed to secondhand smoke.

Exposure to secondhand smoke is associated with increased risk of respiratory tract issues like bronchiolitis, coughing and wheezing.

Smoking households are 40% more likely to have house fires.

Uptake of smoking in children is more likely if either of their parents smoke.

Whataboute-cigarettes?

Moreresearchisneededtofullyunderstandhealthconsequencesofsecondhandvapourexposurefrome-cigarettes,forvulnerablegroups.Becauseofthis,itisnotrecommendedthate-cigarettesareusedinsidehomeswherechildrenlive.

Whilst evidence continues to accumulate, consensus has been growing that using e-cigarettes/vaping is less harmful to smokers than continuing to smoke cigarettes. However, the safest approach is to regard them as a route to stopping smoking completely.

The States of Jersey Strategic Public Health Unit issued a consensus statement recently that makes it clear that e-cigarettes are not suitable for use by non-smokers and children. (To view the consensus visit www.gov.je and search ‘e-cigarettes consensus’).

There is no direct research on impact of using e-cigarettes and risk of SIDS. So the recommendation is not to share beds with babies if e-cigarettes are being used.

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Thereisnohidingfromsecondhandsmokeathomeorincars.Here’swhy: Smoking in one room, or in a hall or stairwell does not protect children

because it pollutes all the air in a house. Secondhand smoke goes under doors, windows and through cracks.

Opening windows, or using extractor fans, air purifiers and air fresheners does not get rid of tobacco smoke.

Smoking less or smoking when children are not there doesn’t help, as smoke stays in a room for hours.

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Allowing people to smoke in only one room does not protect

children.

SECONDHAND

SMOKE

WHAT ABOUT JERSEY? LOCAL PICTURE

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Smokinginhomes

babies born in Jersey are at risk of passive smoking at 6-8 weeks of age (Jersey Smoking Profile 2017).

have atleastoneperson smoking regularly with children living within the homes (Jersey opinion and lifestyle survey 2016).

10%

1in6Smokingincars

Restriction on Smoking in Motor Vehicles (Smokefree Car Jersey) Law has been in place from September 2015. Thislawhasmadeitillegaltosmokeinamotorvehiclecarryingyoungpeople under the age of 18 years with associated fines payable up to £2500.

To view the law online visit www.gov.je/smokefree

ofhomesinJersey

In 2018 around 8accidental fires in houses were due to smoking in Jersey.

Housefires

ASKEstablish who smokes in the home, where smoking happens and if these rules ever change.

ADVISEExplain the benefits of reducing children’s exposure to secondhand smoke and that there is help available to achieve this.

ACTOffer practical support and help around creating and maintaining smokefree homes.

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ASK, ADVISE, ACT

The three key stages to help guide conversations with greater confidence are the 3 A’s:

Practicaltipsonraisingtheissue

Consideration should be given to whether the parent or carer is likely to be receptive talking about secondhand smoke taking into account the time, place and circumstances.

Build rapport with active listening and a non-judgemental attitude.

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Additional Information

For more advice on raising the issue, see pages 13-16.

There is also additional information about stop smoking services on pages 17-18.

Keyquestionstoaskparentstohelpguidebriefinterventions:

Q. How do you feel about secondhand smoke?

Q. What do you know about it?

Q. What have you heard about secondhand smoke and its health effects on children?

Q. How do you feel about people smoking around your children?

Q. Can I offer you some information if it’s a good time?

Q. Would you like to talk about it?

Q. What could you do to keep children and tobacco smoke separate?

Q. What can you change about where you smoke to keep children safe?

Q. What about family and friends?

Q. Can I tell you what’s worked for other people?

Q. Would you like to make a plan?

HINTS FOR FAMILIES ON MANAGING SECONDHAND SMOKE

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1. Decide to have a smoke free home and car and work towards a set target date to go smokefree

2. Seek support from family and friends

3. Request visitors to smoke outside and ask passengers in your car not to smoke inside the car

4. Remove ashtrays from your home

5. Create a space outside of the home for smoking

6. Keep coats and umbrellas separate for use only when smoking outside

7. Wash hands after smoking

8. Seek advice from Help2Quit Stop Smoking Services if you feel you would like to stop smoking altogether

9. Put a non-smoking sign in the car.

Ifchildrenarecaredforbychildminders/nannies,requestthemtosmokeoutside.

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You could also enlist the benefits of having smokefree cars and homes.The key is to identify, with input from families, what is important to them and their personal situation. Things that are likely to be important include:

Removing the health risks associated with secondhand smoke for the parents/carers and their family

Children are less likely to develop asthma and those who do have asthma are able to control their symptoms better

Children who live in a smokefree home are less likely to die from Sudden Infant Death Syndrome (SIDS)

Children are less likely to be absent from school with colds, coughs, respiratory infections and middle ear disease

Children are less likely to become smokers when they get older

Parents/carers who make their homes smokefree, smoke less and are more likely to make a quit attempt and go on to quit

The house and car will be fresher, cleaner and smell better

The risk of accidental house fires will be reduced

Save time, money and energy by not having to clean curtains, walls, windows and mirrors or redecorate as often

Resale value of the home and car may be higher

Less distractions whilst driving, lowering the chances of traffic offences and accidents.

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ADDRESSING PARENTAL AND PRACTITIONER BARRIERS TO RAISING THE ISSUE

Below are some examples of scenarios faced when delivering brief advice:

Q. Whatifaparentorcarerdoesn’twanttochangetheirhomeandcarsmokingbehaviours?

A. If a parent or carer does not want to change what they are doing, then you can tell them that this is OK. Our experience has been that there is no need to worry that this might have a negative influence on your relationship with the family.

Q. Whatifaparentorcarerstatesthattheywanttostopsmokingalltogether?

A. If you raise the issue of smoking and a parent/carer states that they would like to quit, then you can simply refer them to your local stop smoking service. (Refer to page 17 for more information).

Q. Won’tmyfamiliesresentbeingtoldtochangetheirhomeandcarsmokingbehaviours?

A. No. Carers recognise that it is a valid topic of conversation to be having with health and social care professionals and many will be surprised if you are not advising them about the best way of protecting their children. In fact, not discussing smoking with your families could lead them to think that this is not something you are concerned about and therefore neither should they be.

Q. Whydon’tIaskmyfamilieshowmuchtheysmokeinthehomeandcar?A. There is no safe level of smoking in the home and car. Partial restrictions,

such as smoking in only one room do not protect children from the harms of secondhand smoke exposure. For those parents or carers who cannot or will not quit, you can still support them to make their homes and cars completely smokefree.

Q. Howtohandleasituationwherethepartnersmokesandthereisfearofcausingupsettotherelationships?

A. This situation can be dealt with by reinforcing the message of the hazardous effects of secondhand smoke on children’s health - reminding them that they are not being asked to stop smoking but just to smoke outside.

Q. Whatifthehomeisinaflatinatallbuildingwithnoaccesstoabalcony?A. As children cannot be left alone, the first advice is that parents/carers

identify a responsible adult for care giving whilst they go outside the building to smoke. Alternatively, parents/carers can go to a nearby park where children can play safely while they smoke. Another option is smoking when they are doing errands outside (eg: on the way to shops, school runs). Thought could also be given for use of nicotine replacement therapy products, following advice from pharmacists, or the smoking cessation team.

Q. Howtohandlecravings?A. Cravings subside in a few minutes and distraction techniques work best to

deal with them. Suggestion of some relaxation techniques like deep breathing, using worry beads, Yoga and going on a walk have been known to help.

Q. Myfamiliesareindenialoftheharmfuleffectsofsecondhandsmoke.A. Talk to parents/carers about the impacts of secondhand smoke on health,

with evidence as outlined previously in the resource.

Q. Tacklingviewsthatsmokinginoneroomorwithwindowsorbackdoorsopenissafe.

A. Reiterate the key message that smoking in a room with an extractor fan or window open, or by the back door, does not get rid of pollutants and the harmful chemicals linger in the air for many hours after smoking. Smoking outside is the only way to protect non-smokers from the harmful effects of secondhand smoke. Suggest creating a space outside the home or in a communal area fit for smoking.

Q. Beliefslikequittingsmokingcanleadtoweightgain.A. Give reassurance that parents/carers are not being asked to quit completely,

unless they want to. It is not very often that people gain weight upon quitting smoking. They can seek help from their GPs for advice and undertake moderate physical exercise. Remaining positive and motivated is the key to achieving good health for the whole family.

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Q. WhyHealthCareProfessionals?A. HCPs have direct access to families who smoke. They are role models in the

society and are perceived as people with reliable knowledge about health. Families are more receptive to advice from them and open to accept change.

Q. I’mconcernedthatIwon’tbeabletoanswersomeofthequestionsthatmyfamiliesmighthave.HowdoIincreasemyconfidencetoraisetheissueofsecondhandsmoke?

A. Simply by participating in the online training module ‘Secondhand Smoke: promoting smokefree homes and cars’ you’ll have increased your knowledge and hopefully your confidence too! The more times that you raise the issue the easier that it will become. If there is a question that you can’t answer, then simply tell the parent/carer that you don’t know, but you’ll find out the answer and then you can discuss it again the next time you see the family.

Q. I’masmoker,sowhoamItotellsomebodyelsetochangetheirsmokingbehaviours?

A. We know that some health care professionals who are smokers are less likely to raise the smoking related issues of cessation with their clients, but the important thing to remember is that you’re not asking parents/carers to stop smoking, you’re asking them to make their homes and cars completely smokefree. So it doesn’t matter whether you’re a smoker or not. As long as you’re committed to raising the issue of secondhand smoke and to helping families to make changes to protect their children, you’ll have no problems.

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Q. Mostofmyfamilieshaveotherprioritiesthataremoreimportanttothemthanchangingtheirsmokingbehaviours:howdoIraisetheimportanceofsmokingbehaviourintheirprioritylist?

A. Don’t assume that your families are not interested in changing their home and car smoking behaviours. After raising the issue, they may feel that this is one of things that they can do compared to some of the other things that they are currently dealing with.

The thing to remember is that you’ll find plenty of carers who are worried that their smoking is affecting their children and who wished that they had never started smoking in the first place. You’ll also struggle to find a parent/carer who, after making their home or car smokefree, wants to go back to smoking inside.

By using the online training module ‘Secondhand Smoke: promoting smokefree homes and cars’, you will increase their knowledge and allow them to make an informed choice about whether they want to make changes. In addition, you’re offering practical help and support to do this, rather than simply telling them the facts and then leaving them to it.

Q. Fearofbeingjudgementalandhamperingthesensitiveclientrelationship.A. Adoption of a non-judgemental and empathetic approach can help, respecting

the other person’s point of view without bringing in personal prejudices.

Q. HowdoIfindthetimetoraisetheissueofsecondhandsmoke? A. It really doesn’t take more than a couple of minutes to raise the issue of smoking

in the home and car. The more that you do it the easier it will become!

Maintenance:Providing support at all client appointments is essential for achieving success. Positive words and praise can help families continue with maintaining smokefree homes and reduce the chances of relapse.

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ADDITIONAL INFORMATION:MakingareferraltoHelp2Quitstopsmokingservices:There are a number of ways of making a referral to Help2Quit, stop smoking services:

1. Email the team at [email protected]. Call 445022 or 445021

Alternatively families can self-refer by

1. Calling Help2Quit 08007351155 and leaving a message.

WhatdoestheHelp2Quitstopsmokingserviceprovide?

The Jersey Help2Quit service helps hundreds of Islanders to quit every year. Smokers are four times more likely to stop smoking for good using the Help2Quit services than if they do it alone.

Help2QuitSpecialistServices:

Most patients in hospitals who are interested in quitting are usually referred to the FREE Specialist Services where they will see a Specialist Stop Smoking Nurse.

The Specialist Service also supports patients in the community who may need more intensive support including:

Pregnant women People with long term conditions Young people under 16 years of age People with mobility problems who may need home visits People with mental health issues.

Help2QuitPharmacyService:

Is a FREE confidential and friendly service Offers an initial 30 minute appointment Will see patients for 8 weekly support sessions lasting 10 minutes Offers up to 12 weeks of FREE supply of nicotine replacement therapy

for clients who attend support sessions Is provided by local pharmacies across the island.

Pharmacy Address Telephonenumber

Boots 23-29 Queens Street 730432

Boots Rue des Pres 625810

Boots Centenary House St Peter 482164

Boots Quennevais Parade 735536

IslandPharmacy 14 Gloucester Street 516171

PharmacyLocale New Era St Clement 720642

PharmacyLocale La Rue de L'Eglise St Peter 481512

PharmacyLocale Grande Marche St Helier 615994

PharmacyLocale Bath Street 724701

QueensRoad Queens Road Health Centre 762983

LloydsPharmacy 2-8 Oxford Road St Helier 721223

LloydsPharmacy Millenium Arcade St Brelade 743301

LloydsPharmacy Red Houses 741313

LloydsPharmacy Quennevais Parade 743600

LloydsPharmacy Gorey Village 854340

LloydsPharmacy 10 David Place 871098

LloydsPharmacy 7/8 The Parade St Helier 722862

ReidsPharmacy Charing Cross 732242

ReidsPharmacy The Lido Medical Centre 728883

LeQuesne 25 Don Street 722571

CastleQuay Le Capelain House, Rue de L'Etau 833855

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Patients can drop into one of the pharmacies to arrange an appointment with a trained Stop Smoking Advisor at a time suitable to them.

Help2QuitPharmacyServicesinJersey

living smokefree - government of jersey and...of secondhand vapour exposure from e-cigarettes, for...

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