1. Why SHS should be high on everyone’s agenda : What we can all do to help protect children Dr Jude Robinson Senior Lecturer Deputy Director of the Health and Community Care Research Unit,.

2. Why secondhand smoke is an issue 60% of children (ages 4-15 years old) had cotinine levels indicative of passive smoke exposure The Health Survey for England (2008) 165,000 new episodes of disease 300,000 primary care contacts 9500 hospital admissions RCP, Passive smoking and children. 2010, Royal College of Physicians: London.

3. Health risks to children Specific health risks for children include: Respiratory tract infections, asthma, and glue ear, Sudden Infant Death Syndrome (SIDS), bacterial meningitis An increased chance of developing health conditions such as heart disease and cancer in the future [32,33] Longer term exposure to ETS in childhood has been linked to poor school performance and absences [29,30,31] Children whose parents smoke are more likely to go on to smoke themselves [2,5]

4. What do we know about households where children live with adults who smoke? Over-representation of smoking in some of the poorest households in the UK, and the children who live here are more likely to go on to smoke when they are older [1,2,3,4,5] Children are more likely to be exposed in households where two parents/ carers smoke, or where they are cared for by a lone smoking parent [6,7,8] Poorest people live in the poorest housing (size, ventilation, occupancy, quality of, and access to, outdoor space) [3,9,10,11] People are changing their behaviours, and may have only one room where they smoke, or smoke outdoors [8,12,13 ] People’s behaviours are not static, and smoking and smoking behaviours are influenced by other events in people’s lives [1,14]

5. What about other people’s homes? Family and friends more likely to smoke [14, 17] Poorer parents are less likely to be able to access, or afford, statutory childcare if they work, and are more likely generally to reply on informal (unregulated) childcare [15,16] More likely that their friends live in smoking homes, as even the children of non-smoking parents can show levels of exposure to ETS [6,7,8] Some people may be empowered to ask people not to smoke in their own homes, but are reluctant to ask other people not to smoke in theirs [18] Some people are able to ask people not to smoke when they visit, and will remove their child, or refuse to visit if the house is not smoke-free when they come [19] There can be a ‘knock-on’ effect from one household to another, within families (vertically and laterally) and within wider social networks [19]

6. How can we change household behaviours? Recognise that houses represent a private space, and there are no foreseeable plans to introduce legislation to regulate home smoking [20,21] Some evidence that people have retreated to their homes to smoke and guard their freedom to smoke there [22] People do not like to be told what they have to do in their own homes, although they may be prepared to listen to good information conveyed in an appropriate manner [23] People are concerned with the health of children, particularly babies, and may be willing to moderate their behaviour to improve their child’s health [23,24] So… need to continue to campaign and to develop ways of communicating with parents, carers and family members

7. Issues around inequalities Some low income smokers may be experiencing feelings of stigma (not just about their smoking) and low self-esteem and disengagement from wider society [25] Tendency for some initiatives to target smokers in low income areas AND Issues around service delivery may mean that families from more affluent areas may not receive the same information and advice Need a whole family approach as households with children that include two or more smokers are more likely to smoke in their home [1,6,7,8]

8. What is a brief intervention? a single episode as brief as 30 seconds to a more detailed 30 minutes, a professional will raise and discuss an issue Also give advice and support as part of their routine activities Advantages over other interventions? does not require large amounts of time, is not resource intensive, can be easily tailored to individuals, can and should be delivered by any professional, at every opportunity, can deliver clear, consistent messages [26]

9. What are the barriers to delivering them? Health and social care professionals Time and competing agendas Screening Appropriateness to the individual Health and social care professionals feelings about the subject Reaction (real and anticipated) from the audience Setting

10. What are the barriers to delivering them? Parents, carers and other household members Concern that they are going to be lectured or made to feel bad about their smoking [27] Lack of control over their own time and other people’s behaviour, leading to a sense of fatalism [18] Not really seeing secondhand smoke as an issue, or as the most important issue [23, 28] Lack of rapport with the person delivering it [27]

11. How can these barriers be overcome? Developing an approach that is acceptable to the people delivering and receiving the intervention Clear, concise, acceptable messages that deal with the issue, not the person Brief intervention, followed up with supporting information for both parties, and delivered to everyone as often as needed Freedom for people delivering the intervention to adapt the wording, but keep the core messages Supportive environment for all

12. Developing a brief intervention First steps…. Raising the issue “I’m sure you are aware that being around any secondhand smoke is unhealthy for children.” Providing information and advice “Secondhand smoke is linked to a number of health problems in children, such as cot death, asthma, glue ear and general poor health” (or give other examples) Enhancing motivation “There is no safe level of exposure to secondhand smoke for children or adults, so if you do smoke you should always take it 7 steps outside and encourage others to do the same around your child”

13. Next steps… Moving towards changing behaviour “Can you think of any times when your child is exposed to smoke in your home or in other people’s houses?” If the answer is ‘no’, you can move on to another topic. However if the answer is ‘yes’, move on to discuss this in Question 5. Suggesting solutions and building confidence “Is there anything you can do to prevent your child’s exposure?” “What might help you achieve this?”

14. What now? Importance of (continuous) feedback to develop the intervention that people need to deliver information about secondhand smoke The need to dovetail with other resources available regionally, nationally and internationally (briefing papers, websites. E-resources, reports, academic articles) The need to make sure that the resources are the best and most up-to-date

15. Key messages Target everyone, irrespective of their smoking status Give clear, consistent and informative messages Incorporate the brief intervention into practice with everyone who you have contact with