2. Protecting children from exposure to tobacco Dr Jude Robinson Deputy Director of HaCCRU Senior Lecturer in Health Sciences

3. A Smoke Free Future? A future free from tobacco use will mean our children will not die early and unnecessarily from smoking-related illnesses A Smoke Free Future, Department of Health, 1 st February 2010

4. The role of research evidence Different forms of research evidence: Statistical Medical and population health Behavioural

5. Statistical Evidence How many adults smoke nationally? Regionally? Locally? How many smoke between 18 – 45 years? How many children are exposed by parent/ carer smoking? Two parent smokers, or only one of two parent smokers?

6. Tobacco and inequalities Differences between the number of adults smoke:  Occupation  Educational attainment  Housing quality Where do they live?  Areas where smoking is high What does this mean for their children:  More likely to take up smoking  More likely to smoke during pregnancy/ when their children are growing up  More likely to die early

7. Health, smoking and children Exposure to tobacco for babies and young children is linked to:  Risk of pre-term birth  Sudden Infant Death syndrome  Respiratory illness  Glue ear and hearing problems  Poor educational attainment  Poor health over their life-time

8. Smoking and children Girls are more likely to take up smoking during their teens than boys Rates of smoking vary by region We know that rates of teenage pregnancy are linked to living in disadvantaged areas and low educational attainment

9. But what does this tell us? It tells us why reducing children’s exposure to tobacco should be a government priority But What it doesn’t tell us, is why children are exposed to tobacco?

10. Behavioural, social and cultural data Why people do the things that they do Such research tends to be (by its nature) qualitative, small scale, regional/ local and involve relatively low numbers. Doesn’t claim to be representative and likely to be missed out in a Cochrane review etc. BUT is a vital part of the evidence base

11. So why are children exposed to tobacco? Currently 18.2% of women in the North West smoke during pregnancy Why?  Able to dismiss/ ignore advice from health care professionals  Contrary health beliefs in their community/ family  Physical and psychological addiction to cigarettes  Belief that the ‘harm is done’  Poor body image and weight management

12. Anything else?  Other social/ health problems  Lack of support from partners/ friends/ family members  Belief that small babies are easier to deliver  Poor understanding of the major risks to health  Lack of agency to change their immediate environment

13. What about when they are born? Babies and young children are:  More vulnerable to the effects of secondhand smoke  Spend more time in the home and are less likely to move away from the sources of smoke  At risk of serious illness and Sudden Infant Death Syndrome Good news – newborn babies are likely to be protected during the first weeks/ months/ years of their lives Bad news is, for some children that protection is fleeting and may only last a few weeks as parents start to perceive that they can ‘tolerate’ smoke

14. As they get older… Contact with health care professionals is less and less, children appear to thrive compared to other children living in the same area Mothers who quit during pregnancy may start to smoke again - Poor body image and weight loss Not breastfeeding and can leave their child Feeling that smoking is ‘something for them’ Stress and a coping mechanism Lack of support from partners/ friends and carers Poor understanding about risks to their child’s health

15. Other issues Prevalence of smoking means more likely to have smoking friends and family More likely to leave child with an informal carer (i.e. non-regulated environment) Mothers in hardship more likely to rely on informal sources of social, emotional and financial support

16. Poverty, neighbourhood and disadvantage Coping with ‘being poor’ and looking after a baby and young children Trusted sources of information tend to be friends and family Overcrowding and living in small houses Dangerous places to leave children Nowhere to go

17. Children starting smoking themselves Young children are influenced by the media, parents and schools and do not want to smoke, and wished adults would quit Critical time around leaving primary school and starting secondary school leads some young children to try smoking Some children start smoking in their teens and continue into adulthood Why? Peer pressure or a desire to experiment, boredom, compressed childhood, desirable alternative to drugs and drink and criminal activity Like it and like the taste Can afford it Easy supply from family, friends, other children and shops (sale and proxy purchase)

18. Gender and smoking  Transmission of smoking norms between family members, lead by women  Using position of influence to positively alter their own and other household’s behaviour Girls and Smoking  Girls engaged in multiple, risk taking behaviours engaged in multiple, risk taking behaviours  Socialisation of girls leading to wider social worlds  ‘Nothing’ will stop them smoking

19. So what about the good news? People more aware of the risks and harms of smoking and increasingly unacceptable to smoke near children. Media campaigns are working to highlight the issues and making people think and even talk about their behaviour Some evidence for a reduction in health inequalities, as parents seem to be taking measures to protect their children at home, even in areas where smoking rates are high and two parents smoke

20. So what is the future for children and tobacco?  Understand the issues to develop targeted interventions that use a range of strategies from the national campaigns, to regional and local initiatives directed at specific populations  Need high quality, publishable research that is widely disseminated to everyone who needs to know – i.e. effective knowledge transfer  Need a range of evidence, from Randomised Controlled Trials (RCTs) to small scale local studies  Need to make connections between all the evidence we have to understand the issues

21. A Smoke Free Future A future free from tobacco use will mean our children will not die early and unnecessarily from smoking-related illnesses A Smoke Free Future, Department of Health, 1 st February 2010