Involuntary Exposure Protecting Children from Secondhand Smoke

Opener What do you hope to learn from this session? What is the primary focus of your current program (cessation, youth access, ETS)? 9-12 Million figure is from a study conducted by the AAP in the late ’80s

What We Hope to Accomplish Acquaint you with EPA’s program and how it came about. Equip you with some of the facts about the impact and health effects from ETS. Acquaint you with our specific strategies and tools. Encourage you to incorporate an ETS initiative into your existing program 9-12 Million figure is from a study conducted by the AAP in the late ’80s

What are we talking about? Environmental Tobacco Smoke Passive Smoking Involuntary Smoking Side-Stream Smoke (subset) Secondhand Smoke (ShS?) Experience has shown that Secondhand Smoke has the greatest public recognition 9-12 Million figure is from a study conducted by the AAP in the late ’80s

Why Focus on Children? It is where the need is the greatest Children are particularly susceptible to health risks from secondhand smoke Children's exposure is involuntary Most children of smokers are exposed in the home 9-12 Million figure is from a study conducted by the AAP in the late ’80s

What’s the Problem 27% of homes with children age 6 & under regularly allow smoking 9-12 million children under 5 are exposed in the home 38% of children 2 mos. - 5 yrs are exposed in the home 9-12 Million figure is from a study conducted by the AAP in the late ’80s

What’s the Problem Up to 1 million children have their asthma worsened (costing $200 million annually) Estimated 700,000 - 1.6 million doctor visits for ear infections Estimated 1,900 - 2,700 SIDS deaths 150,000 - 300,000 cases of bronchitis and pneumonia annually in toddlers 9-12 Million figure is from a study conducted by the AAP in the late ’80s

Involuntary Exposure Protecting Children from Secondhand Smoke Health Effects

Children Are Especially Susceptible to Toxic Effects From ETS Children’s respiratory, immune, and nervous systems are still developing Children absorb greater doses than adults from the same exposure levels If mother smokes, infants and young children typically receive very high exposures from proximity to mother

Conclusions of the National Research Council (1986) Children whose parents smoke have an increased frequency of pulmonary symptoms and respiratory infections Children whose parents smoke have a small decrease in the growth rate of lung function

Conclusions of the 1986 Surgeon General’s Report on Involuntary Smoking Young children whose parents smoke have an increased frequency of lower respiratory tract infections Children of smokers have an increased frequency of chronic respiratory symptoms Children of smokers have a small decrement in lung function Maternal smoking may influence the severity of asthma

U.S. EPA’s 1992 Risk Assessment on the Respiratory Health Effects of ETS ETS is a human lung carcinogen (Group A) ETS causes an estimated 3,000 lung cancer deaths annually in U.S. nonsmokers ETS has subtle but significant effects on adult respiratory health, including coughing, phlegm production, chest discomfort, and reduced lung function

U.S. EPA 1992 Conclusions In children: ETS exposure is causally associated with an increased risk of lower respiratory tract infections such as bronchitis and pneumonia

U.S. EPA 1992 Conclusions (In children, cont.) ETS exposure is causally associated with: increased prevalence of fluid in the middle ear, symptoms of upper respiratory tract irritation, and a small but significant reduction in lung function

U.S. EPA 1992 Conclusions (In children, cont.) ETS exposure is causally associated with additional episodes and increased severity of symptoms in children with asthma ETS is a risk factor for new cases of asthma in previously asymptomatic children http://www.epa.gov/ncea/smoking.htm

CalEPA’s 1997 Conclusions on Children’s Health Effects Effects causally associated w/ ETS exposure: reduced fetal growth sudden infant death syndrome acute lower respiratory infections asthma induction and exacerbation chronic respiratory symptoms middle ear infections

CalEPA’s 1997 Conclusions (cont.) Effects with suggestive evidence: adverse impact on cognition and behavior decreased pulmonary function exacerbation of cystic fibrosis http://www.oehha.org/air/environmental_tobacco/index.html

Australia’s National Health and Medical Research Council’s 1997 Conclusions Passive smoking causes lower respiratory tract illness and contributes to the symptoms of asthma in children There is also good evidence linking ETS exposure to SIDS and fluid in the middle ear Maternal exposure to ETS during pregnancy is associated with a small reduction in birthweight

1997 Conclusions of the French National Academy of Medicine ETS exposure is associated with an increased risk of lower and upper respiratory tract infections and irritation of the upper respiratory tract ETS exposure can induce asthma and, in children with asthma, it increases the number of asthmatic attacks and the severity of symptoms

UK’s Report of the Scientific Committee on Tobacco and Health (1998) Smoking in the presence of infants and children is a cause of serious respiratory illness and asthmatic attacks. Sudden infant death syndrome is associated with exposure to ETS; the association is judged to be causal. Middle ear disease in children is linked with parental smoking and this association is likely to be causal. http://www.doh.gov.uk/public/scoth.htm

WHO Consultation on ETS and Child Health (1999) ETS exposure is causally associated with increased risks of lower respiratory tract illnesses, including bronchitis and pneumonia, in the first years of life ETS exposure is a cause of chronic respiratory symptoms in school-aged children ETS exposure increases the severity and frequency of symptoms in children with asthma

WHO Consultation (cont.) ETS exposure is causally associated with increased risk of acute and chronic middle ear disease ETS exposure of nonsmoking women during pregnancy is a cause of small reductions in average birth weight

WHO Consultation (cont.) Maternal smoking is a cause of small reductions in lung function. The predominant effect may be from smoking during pregnancy. Maternal smoking is a major cause of SIDS. The predominant effect is believed to be from in utero exposure. There is also some evidence that postnatal ETS exposure contributes to the risk of SIDS. http://www.who.int/toh/TFI/consult.htm

U.S. Institute of Medicine (2000) Causal relationship between ETS exposure and exacerbations of asthma in preschool-aged children sufficient evidence of an association between ETS and development of asthma in preschool-aged children

Lower Respiratory Tract Infections e.g., pneumonia, bronchitis, bronchiolitis very strong, consistent evidence for infants and young children (up to about 3 years) strongest effect from maternal smoking, but also evidence from paternal smoking increased risks of about 50 to 100% for young children; higher for young infants

Respiratory Symptoms Chronic cough, phlegm, and wheezing strong consistent evidence, especially for preschool children increased risks of about 20 to 40%

Asthma asthma is the most common chronic condition of childhood strong evidence for increased number of asthmatic episodes and increased severity of symptoms (affecting at least 20% of asthmatic children) increasing evidence of asthma induction?

Middle Ear Disease strong evidence for acute and chronic middle ear disease fluid in the middle ear is the most common reason for operations in young children in the U.S. increased risks of up to about 20 to 40%

Other Health Effects Decreased lung function small (<10%), but significant reduction in lung growth/function Sudden Infant Death Syndrome (SIDS) some evidence for effect independent of maternal smoking during pregnancy Decreased Fetal Growth consistent evidence of small effect for nonsmoking mothers during pregnancy

Emerging Science Cognitive and Behavioral Effects Poor performance in school and standardized and behavioral tests Cardiovascular Effects Adults and Children (stronger for adults) Childhood Cancer Suggestive evidence of leukemia & brain tumors

Population Impacts (U.S. children) Lower respiratory tract infections in children under 18 months: - 150,000 to 300,000 cases/year - 900 to 1800 hospitalizations/year Asthma exacerbation: 400,000 to 1 million children Asthma induction: 18,000 to 36,000 new cases/year U.S. EPA, 1992

Population Impacts (U.S. children, cont.) Middle ear infections: 0.7 to 1.6 million physician visits/year Low birthweight: 9,700 to 18,600 cases/year Sudden Infant Death Syndrome: 1,900 to 2,700 deaths/year CalEPA, 1997

Conclusions Strong international scientific consensus that ETS exposure causes increased risk of a variety of health effects in children Increased risks of common ailments, coupled with widespread exposure, result in large public health impacts and financial costs ETS exposure and resultant health effects in childhood may also increase the risk of further adverse effects in adulthood

Involuntary Exposure Protecting Children from Secondhand Smoke EPA’s Goal, Message & Strategy

The Federal Effort: How EPA Fits In Federal Agencies (HHS/CDC/NCI) work on a variety of tobacco issues, including; Cessation Youth access Prevention Public smoking bans/secondhand smoke EPA’s outreach efforts focus exclusively on reducing children’s exposure to secondhand smoke at home We’ll talk more about EPA’s specific goal later this afternoon. EPA’s 1992 Risk Assessment found: causal relationship between exposure to ShS and lung cancer in adults Causal relationship between exposure to ShS and the following in children: lower respiratory tract infections (bronchitis and pneumonia), build-up of fluid in the middle ear, upper respiratory tract irritation, a reduction in lung function, and more frequent and severe asthma attacks in children

Crafting EPA’s ETS Role EPA consulted with members of tobacco control community to identify work already being done Progress being made in public places Gap in progress in homes EPA science highlighted children’s particular vulnerability to ETS

How Do We Fit In? EPA’s focus is consistent with & benefits traditional tobacco control programs Restrictions result in greater quit rates Ads that stress ShS are most effective at reducing smoking Smokers who believe ShS is harmful & take action make more progress towards quitting ShS work encouraged in CDC’s best practices

A Clear Goal To reduce the proportion of households where children 6 and younger are regularly exposed to secondhand smoke from 29% in 1994 to 15% by 2005

Tracking Progress

Protecting Children in the Home Key Messages for our target audience Choose not to smoke in your home or permit others to do so Choose not to smoke if children are present, particularly infants & toddlers If you must smoke, choose to smoke outside

How We Plan to Reach That Goal EPA teams with trusted partners to: Get our health messages out to constituencies beyond our own Create products, tools, and messages appropriate for specific audiences Keep in touch with public need and progress on IAQ Partners = non-profit organizations, states, coalitions, etc. Constituencies There is a certain segment of the American population that is used to working with, hearing from, and listening to EPA, but their numbers are limited By partnering with other organizations that are trusted by different groups than EPA’s traditional constituents, EPA can get its IAQ messages out to a broader, more diverse audience We tap into the knowledge and the trusted name established by reputable partners such as yourselves, the ALA, the AAP, CFAF, etc. We also work together with our partners to create tools and resources that will meet the needs of very specific groups, such as daycare providers, schools, and pediatricians to name a few

EPA Risk Assessment Lawsuit Tobacco industry challenged EPA’s classification of ETS as a carcinogen Federal District Court Judge ruled in favor of industry (summer 1998) Vacated lung cancer chapters of the risk assessment Decision addresses only carcinogen classification, not children's health Decision procedural in nature

EPA Risk Assessment Lawsuit EPA's response: Justice Department is appealing decision on behalf of EPA EPA stands behind its science Despite tobacco industry lawsuit, total body of SHS science is stronger than ever Findings regarding children’s health effects remain unchallenged

Involuntary Exposure Protecting Children from Secondhand Smoke Tools and Resources

EPA’s Tools and Resources: Designed for You Media campaign Daycare Module Pediatrician’s Speakers Kit Community Action Kit Smoke-Free Home Pledge Campaign Outreach program guide Poisoning Our Children Website Printed information (Risk Assessment, brochures, posters) CDC State ShS/Asthma Grants I’ll go into some detail on most of these and leave you with information on how to obtain the materials you need.

CDC-EPA ShS/Asthma Grants Competitive grants to tobacco control community targeted to ShS/Asthma work Supplement to CDC’s comprehensive state tobacco program grants 11 states have been selected and have received funding Anticipate continuing this program NM, TN, MN, VT, CO, AL, NC, WI, OH, NE, WV Remember, this is what works for this specific target audience: namely parents who smoke and have young children living at home. This may not work for you, it may not work for teens. It’s not supposed to.

Media Campaign Created by CFAF, AMA & EPA; Released wave 1 spring 1999; wave 2 planned summer 2000 Script, tone,message reflect research Available for TV, radio, and print What can you do? Coordinate with EPA regional office or state tobacco control contact to market PSA at local radio and TV stations Secure commitments from local papers, TV, and radio stations to air PSA

Delivering the Message: What Works Research conducted by EPA & CFAF found: 70% of those surveyed would be receptive to a “smoke outside” message Kid's health is #1 motivational message Logic and facts are not enough Provide options and choice Acknowledge the difficulty of quitting Soft Sell works best – avoid hard-hitting lectures Remember, this is what works for this specific target audience: namely parents who smoke and have young children living at home. This may not work for you, it may not work for teens. It’s not supposed to.

Community Action Kit One-stop shopping for community leaders working on ShS Focuses on health effects and actions Includes these and more: “Poisoning our Children” video Sample letters to press, health officials, etc. Complete “turn-key” ShS presentation Contact lists Information on how to obtain numerous other products

ALA’s Secondhand Smoke and Children: Conducting Public Outreach Programs Spiral-bound notebook full of useful guidance on conducting local ShS programs Contains broad spectrum of ShS activities and info on how to customize and implement Includes info on funding opportunities and replicable programs

Daycare Module Not designed to make daycare centers smoke-free Designed to teach daycare providers how to communicate to parents about the risks of secondhand smoke to young children Ideal if incorporated into a state’s continuing education credit system Available fall 2000

AAP Pediatrician’s Speakers Kit American Academy of Pediatrics product Designed as an aid to pediatricians who agree to communicate to parents about ShS health risks Includes slides and speaker notes Has been frequently used and praised by real pediatricians

“Poisoning Our Children” Video “Poisoning our Children: The Perils of Secondhand Smoke” Product of American Academy of Otolaryngology – Head and Neck Surgery Foundation 12 minutes long Perfect for hospital maternity wards

Smoke Free Home Pledge National pledge campaign designed to motivate parents to make their homes smoke-free Includes promotional brochure with published 1-800 “Smoke Free Homes Pledge Hotline” Parents who pledge receive follow-up “Smoke Free Home Kit” To be promoted and launched fall 2000

Printed Resources Secondhand smoke brochure (in English, Spanish and Chinese) http://www.epa.gov/iaq/pubs/etsbro.html (English version) http://www.epa.gov/iaq/pubs/humo.html (Spanish version) EPA Risk Assessment http://www.epa.gov/iaq/pubs/etsfs.html Setting the Record Straight http://www.epa.gov/iaq/pubs/strsfs.html

EPA’s General Web & Phone Info EPA's ETS Web Site: http://www.epa.gov/iaq/ets.html National Service Center for Environmental Publications (NSCEP) 1-800-490-9198 http://www.epa.gov/nscephom IAQINFO: 1-800-438-4318 ETS Team main number: 202-564-9370

What’s Next? Smoke-Free Home Pledge Campaign Launch & 2nd round of Media Campaign USDA’s ShS Week Oct 1-7 National ShS Meeting Organized by CA Late May in San Diego World No Tobacco Day May 31, 2000 ShS Theme These are just a few ideas of what you can do to promote smoke-free homes in your community