The nature and extent of children’s in-home exposure to secondhand tobacco smoke Ioana-Andreea Rus, MA Center for Health Policy and Public Health, Babes- Bolyai University Cluj-Napoca PRELIMINARY FINDINGS FROM A PILOT STUDY IN CLUJ- NAPOCA, ROMANIA

Background  Tobacco-attributable deaths are estimated to rise at 6.4 million in 2015, and reach 8.4 million in the year 2030  Second Hand Tobacco Smoke (SHS) is classified as the second most prevalent human exposure to carcinogen, after sun exposure  Children’s exposure SHS has been associated with  respiratory infections,  middle ear diseases,  initiation as well as aggravation of asthma symptoms,  sudden infant death syndrome,  increased risk of lung cancer development in adulthood,  slight neuro-developmental problems,  acute gastroenteritis  and even infections

Determinants of children’s exposure  There still is contradicting evidence on children’s exposure, as it has a strong socio- cultural character  Main determinants:  Level of household education  Parental awareness of SHS health risks  Parental attitudes towards SHS  Family income  Migration status  Living arrangements (single parent families, family size)  Maternal smoking  Child’s age (under 7)

Smoking in Romania  In Romania almost one third of adults are daily smokers  5% of adults report themselves of being social smokers  Romanian standard death rates (SDRs) on selected smoking related causes are of per (EU average is )  No information on children’s SHS exposure extent or nature in Romania

Methodology  A cross-sectional survey, using a self- administered questionnaire  Total sample 1177 sixth grade children (ages 11-12), recruited from 39 schools in Cluj-Napoca, Romania.  Data collected between March and April 2011  Parental assent, school and county inspectorate approvals were obtained  Questionnaires were administered in class, by a trained operator

 SHS exposure in different settings,  smoking experimentation,  family smoking behaviors and rules,  family structure and education,  smoking education,  child’s attitudes towards smoking and smokers,  family affluence,  neighborhood information,  child’s self-reported health status  school performance. Data and measures

Results (1)  55% of the interviewed children reported to live with at least one smoker in the home.

Results (2)  Only 35% of the total number of children reported having a smoke-free rule in their home

Results (3)  34% of children reported no exposure (no person smoking for any amount of time in their home)  16% reported to have the equivalent of more than 2 daily smokers in a week living with them

Results (4)  SHS exposure was found to be significantly associated in our sample with:  Family affluence* (p=.000)  Neighborhood deprivation (p=.002)  Home crowdedness (p=.001)  Parental education* (p=.000)  Children’s self reported school performance* (p=.000)  Home smoking rules for guests * (p=.000)  Children’s knowledge on smoking and SHS * (p=.001)  Reporting health symptoms such as nausea (p=.004), coughs (p=.002), sore throat (p=.016), headaches (p=.000)  Smoking experimentation among children, in terms of having ever tried to smoke (p=.000) *Negative associations

Conclusions  The result suggest high exposure rates among Romanian children in our sample, urging immediate action in order to mitigate the harmful effects of SHS exposure on children.  We showed that this behavior is significantly associated with poor health outcomes on one hand, as well as smoking experimentation among youth on the other hand  Additional significant associations with family affluence, parental education and children’s health education on tobacco control, stress the need to understand this complex issue on multiple levels and further explore its determinants.

Acknowledgement The current research was funded through award number 5 D43 TW0D from the Fogarty International Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health.

References 1. Aligne, C. A., & Stoddard, J. J. (1997). Tobacco and children. An economic evaluation of the medical effects of parental smoking. Arch Pediatr Adolesc Med, 151, Blackburn, C., Bonas, S., Spencer, N., Coe, C., Dolan, A., & Moy, R. (2005). Parental smoking and passive smoking in infants: fathers matter too. Health Education Research, 20(2), Bolte, G., Fromme, H., & E., G. M. (2009). Socioeconomic determinants of children's environmental tobacco smoke exposure and family's home smoking policy. Eur J Public Health, 19, Brinzaniuc, A., Chereches, R. M., Rus, I. A., Duse, I. A., & Pop, O. M. (2011). Are tweens safe at home from second-hand tobacco smoke exposure? Supplement of the European Journal of Public Health, 21. Copenhagen, Denmark. 5. Celermajer, D. S. (2007). Protecting children from passive smoking. Circulation, 115, Center for Health Policy and Services Bucharest. (2004). Smoking and Public Health in Romania - document in Romanian. Bucharest: CHPS. Retrieved 08 20, 2011, from in/Romania/- /knowledge,/attitudes/and/practices/on/tobacco/consumption/among/general/Romanian/populati on,/Bucharest/2004.html 7. Chen, R. (2009). Mortality attributable to smoking in China. N Engl J Med, 360, 1911; author reply Cheraghi, M., & Salvi, S. (2009). Environmental tobacco smoke (ETS) and respiratory health in children. Eur J Pediatr, 168, Ciobanu, M., Bursuc, M., & Paunescu, B. (2009). Studiu de evaluare a cunoştinţelor, atitudinilor şi practicilor cu privire la fumatul activ şi pasivStudiu de evaluare a cunoştinţelor, atitudinilor şi practicilor cu privire la fumatul activ şi pasiv. Bucuresti: Ministrul Sanatatii, INSTITUTUL DE PNEUMOFTIZIOLOGIE „MARIUS NASTA” Cobanoglu, N., Kiper, N., Dilber, E., Gurcan, N., Gocmen, A., Ozcelik, U.,... Kose, M. (2007). Environmental tobacco smoke exposure and respiratory morbidity in children. Inhal Toxicol, 19,

Thank you! Ioana-Andreea Rus, Project Manager Questions