1. Establishing Smoke Free Environments for Children
Robert McMillen, PhD
The AAP Julius B. Richmond Center of Excellence

2. Learning Objectives
Ability to describe the health effects of secondhand smoke on children
Awareness of smoke free policies and community interventions
Understand the benefits of smoke free laws
Knowledge of smoke free strategies

3. Secondhand Smoke is a Harmful Toxic Air Contaminant
There is no safe level of exposure to secondhand smoke (SHS)
U.S. Surgeon General
There is also indisputable evidence that implementing 100% smoke- free environments is the only effective way to protect the population from the harmful effects of exposure to SHS
World Health Organization 3 3

4. Harms of SHS on Children’s Health
Increases risk of SIDS
Low birth weight
Ear infections
Harms lung development in children
Causes bronchitis and pneumonia in young children
More severe asthma
Impacts cardiovascular system
Source: California EPA. (2005); Surgeon General Report. (2006); UICC. (2008).

5. Children’s Exposure to Secondhand Smoke
40% (~15 million) of U.S. children live with one or more smokers
Almost one half of the world’s children breathe air polluted by tobacco smoke
Image source: Adapted by CTLT from Pirkle, et al. (1996); The Tobacco Atlas. (2006).

6. Adolescents Exposed to SHS in their Homes, 2002-2005
Image source: Adapted by CTLT from European Environment and Health Information System,

7. Policies Recommended by the World Health Organization
100% smoke-free environment, not ventilation
Universal protection law
Proper implementation and adequate enforcement of the law
Public education to reduce secondhand smoke exposure in the home
Source: World Health Organization. (2007).

8. Global Smokefree Laws Nationwide Ireland Scotland Wales
Northern Ireland
England
New Zealand
Uruguay
Bermuda
State or local
U.S. states and cities
Canada provinces and territories
Australia states
Argentina provinces and cities
Source: Global Smokefree Partnership. (2008).

9. Smoke-Free Laws Improve Health
Pueblo, Colorado: 27% drop in heart attacks
Helena, Montana: 40% drop in heart attacks
Italy: fewer heart attacks
Norway: decline in the prevalence of respiratory symptoms
Sources: Pueblo Heart Study Fact Sheet (2005); Barone-Adesi, et al. (2007); Fagan, et al. (2006).

10. Youth Who Start Smoking, Continue Smoking
2004: Ireland is the first country to implement 100% smoke-free legislation that included all enclosed workplaces, including restaurants and bars
Additional countries have now passed 100% smoke-free laws, including the UK, New Zealand, Uruguay, Bermuda, Bhutan, Iran, and Turkey
Region
Support for a ban on smoking in public places (%)
Eastern Mediterranean
82.8
Eastern Europe
82.1
Americas
80.4
Southeast Asia
75.3
Western Pacific
72.9
Africa
60.2
Total
76.1
Source: Monitoring the future project, U.S., senior classes.

11. Smokefree Campaigns USA:
The EPA’s national smoke-free homes and cars program
American Legacy Foundation’s 2005 “Don’t Pass Gas” media campaign
Source: UICC and americanlegacy.org. (2008).

12. International Campaigns
Ontario, Canada, 2000: Breathing space: Community partners for smoke-free homes
Norwegian Cancer Society, 1995
Salford, UK, 2007: Smoke-free homes promise campaign

13. Effects on Youth Smoking
Lower rates of smoking initiation
Lower prevalence of smoking
More quit attempts
Higher rates of successful quit attempts
Lower consumption rates among continuing smokers

14. Environments for Exposure
Home—no government restrictions
Vehicle—some policies developing
Childcare—many existing regulations
Schools—many existing regulations
Restaurants—many existing regulations

15. Smoke-Free Homes
The prevalence of smoke-free homes in the U.S. has increased substantially in the past decade
The International Tobacco Control Four Country Survey
Country
Reported home smoking ban among homes of smokers
Wave 1
Wave 2
Canada
27.3%
31.5%
U.S.
26.4%
27.9% UK
15.3%
19.0%
Australia
34.1%
43.1%
Source: UICC. (2008).

16. Smoking Ban in Vehicles with Children
Jurisdiction
Applicable age
Date
Arkansas
Under 6 or 60 pounds
Enacted April 2006
California
Under 17
In effect January 2008
Louisiana
In effect August 2006
Puerto Rico
Under 13
In effect March 2007
Bangor, Maine
Under 18
In effect January 2007
Keyport, New Jersey
Enacted April 2007
Rockland County, New York
Enacted June 2007
West Long Branch, New Jersey
Cyprus
Under 16
Enacted 2002
Nova Scotia, Canada
Under age 19
South Australia
Enacted May 2007
Tasmania, Australia
Under age 18
In effect January 1, 2008
Source: UICC. (2008).

17. Childcare and Schools Pro Children Act of 1994
European Public Health Alliance
Austria, Denmark, the Czech Republic, Estonia, Finland, Hungary, Iceland, Latvia, Portugal, and Slovenia
Source: UICC. (2008).

18. Community Strategies Educate Build coalitions
Identify a local champion

19. Community Strategies Educate Build coalitions
Identify a local champion

20. Mass Media Campaigns Media Local newspaper Radio Television reporters
Free media
Op-ed pieces and letters to the editor
Image source: (Top) Jane M. Sawyer, (Bottom) npclark2k,

21. Examples Texas Letter writing campaign Earned media Washington
Mass media
Radio, television, newspaper
Evaluate your budget
Image source: Tobacco Control Branch, Government of Western Australia, Department of Health. (2008).

22. Grassroots-Community Coalitions, Community Leaders
Broad and inclusive
Meaningful representation
Hospitality workers and other employees
Community advocates
Medical professionals
Teachers
Youth groups
Supportive business owners
Health educators and others

23. Summary
The health effects of secondhand smoke on children have been well-documented
Many nations and states have enacted smoke free policies
These smoke free policies have had immediate and long-term health benefits
There are several strategies to achieve successful smoke free policies