passive smoking and children’s health: new evidence and call for action

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

Author: lewis-cole

Post on 24-Dec-2015




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  • Passive smoking and childrens health: New evidence and call for action
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  • Royal College of Physicians Founded 1518 - London 25 000 Fellows & Members in 80 countries Set medical standards through training, exams, and advice to government Strong interest in public health
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  • 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)
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  • 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
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  • 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
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  • Childrens exposure to passive smoke
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  • Trend in passive exposure of children over time
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  • Effect of parent and carer smoking
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  • Children living in smoke-free homes in England
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  • 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 dont smoke 2 million children live in homes that allow smoking Exposure highest in the young and socio-economically disadvantaged
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  • Maternal active and passive smoking: Effects on fetal health
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  • 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)
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  • 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)
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  • Passive smoking and childrens health
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  • 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
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  • 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 3s if mother smokes in pregnancy Meningitis Twice as likely if one or more parents smoke
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  • Parental and sibling smoking and smoking uptake in children
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  • 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%
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  • 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
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  • Economic impact
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  • Excess disease in children UK general practice activity Excess UK cases Excess UK consultations Lower respiratory tract infections < 2 years20,50026,000 Middle ear infections 0-16 years121,400160,200 Wheeze < 2 years7,20010,300 Asthma 3-4 years1,7007,600 Asthma 5-16 years13,70099,000 Meningitis 0-16 years600800 Total165,100303,900
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  • Excess Disease Hospital Admissions in England Excess admissions Lower respiratory tract infections < 2 years3,361 Middle ear infections 0-16 years2,517 Wheeze < 2 years938 Asthma 3-4 years236 Asthma 5-16 years1,211 Meningitis 0-16 years231 Total8,494
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  • 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
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  • Primary care costs (UK) Additional 300,000 consultations 9 million 10.5m Asthma/wheeze treatments0.7 million 0.84m Hospital Costs (UK) Additional admissions million 13.6 million 16.5m
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  • 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.)
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  • 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
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  • 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 imager y 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
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  • Legislation at work: Growing support
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  • Increasingly, smokers support smokefree
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  • Smoke-free homes
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  • Better understanding of the risks
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  • Support for stronger action: Cars
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  • Support for stronger action: Outdoors
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  • 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
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  • 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
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  • More Information: [email protected]