Thursday, April 17, 2014
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Home: Last bastion for secondhand smoke

Should you make your home smoke-free? The whole house? How?

Home: Last bastion for secondhand smoke

Nan Feyler is chief of staff for the Philadelphia Department of Public Health.

By Nan Feyler

Exposure to secondhand smoke is dangerous, especially to infants and children. Secondhand smoke can impact children’s lung growth and pulmonary functions. It can cause sudden infant death syndrome (SIDS), respiratory illnesses, ear infections and more frequent and severe asthma attacks.

Smoke-free laws have significantly reduced exposure to secondhand smoke. Philadelphia’s Clean Indoor Air Worker Protection Law banned smoking in Philadelphia’s restaurants, bars and workplaces in 2007. Last year, Philadelphia implemented a 100 percent smoke-free policy for all city recreation centers, pools and playgrounds. A handful of other places have followed suit, including Cherry Hill this week.
 
But what about homes? The home is now becoming the predominant location in the United States where children as well as adults are exposed to secondhand smoke. A recent survey conducted by the Annenberg Public Policy Center (not yet published) found that slightly more than half of Philadelphia households with a smoker and a child under 13 allowed smoking in the home. Another study, of low income children with asthma in Baltimore, found evidence of significant exposure to secondhand smoke in younger children, children with a higher number of household smokers, and homes without complete smoking bans (as well as homes where a caregiver reported symptoms of depression and there were more than moderate levels of daily stress).
 
Families face practical barriers to enforcing a smoke-free household rule. Tobacco is an addiction, and smokers struggle with limiting or curtailing their habit; when the weather makes smoking outdoors uncomfortable, or if there are no good or safe places to smoke outside, they will do it in the house. A caretaker who smokes may be deterred from going outside where he or she cannot supervise the children, or would need to bundle them up to leave the house together. People report reluctance to engage in conflict with smokers who live in the house or visit. Living in a home owned by a relative who smokes can make a smoke-free rule impossible to enforce.
 
It may come as no surprise that heads of households who overcome these barriers credit their own motivation and commitment. In one study, participants who were able to establish smoke-free homes said they were motivated foremost by concern for the health of their children. Quitting smoking, contemplating quitting, and smoking less often went along with their decision to prohibit indoor smoking for others. Some changed their habits to increase the amount of smoking they did outdoors, ended a relationship with a smoker, or moved out in order to establish a smoke-free household.
 
Determining the best strategy to reduce the health risks associated with secondhand smoke at home raises complex issues. What should be the government’s role in reducing smoking in private homes or cars, especially when children’s health is at stake? Increasingly, evidence shows a health threat from smoking in an adjacent housing unit, like an apartment, where toxins from secondhand smoke seep through walls, ductwork, windows, and ventilation systems. Should smoke-free laws be extended to include multiunit private housing? Should smoking in a car be banned when children are present?
 
Alternatively, what kind of encouragement would help people voluntarily ban smoking on their own? Given the challenges of adopting a smoke-free home, is there value in supporting families who take a gradual, more incremental approach – starting small, say, by not smoking in front of children or establishing a single smoke-free room – as worthwhile steps on the path to going entirely smoke-free? Or does this confuse the message because only a total ban on secondhand smoke will protect children’s health?
 
For specific suggestions, download the New York City Department of Health pamphlet, "How to Make Your Home Smoke-Free.
 
Public education is critical. In the U.S. and elsewhere, media campaigns focused on secondhand smoke have successfully reduced exposure to secondhand smoke and promoting quitting among adult smokers. Pediatricians can also play an important role in helping parents understand the risks – to their children’s health – of their own habit.
 
It’s worth taking a moment to applaud the recent news that smoking among adults in Philadelphia decreased from 27.3 percent in 2008 to 23.5 percent in 2012,a drop that works out to 15 percent – and 40,000 fewer smokers. While the rate of smoking in in the city is still well above the19.3 percent national average, this is real progress and everyone who has successfully quit smoking should be congratulated. (Rates vary significantly from neighborhood to neighborhood, as shown in this interactive map of smoking rates in the city and Pennsylvania suburbs.) As every former smoker knows, quitting is not easy – but success is possible.
 
If you are a smoker, the single best way to protect your family from secondhand smoke is to quit. For help, call the Pennsylvania Free Quit Line at 1-800-QUIT-NOW, or go to SmokeFreePhilly.org,where there are a range of services to help smokers stop once and for all. In the meantime, enforcing smoke-free policies at home will protect the health of other adults and children living there. And smokers who have instituted smoke-free home rules are significantly more likely to quit or to smoke fewer cigarettes per day. Restricting smoking also sends an important antismoking message to your children.
 
So, while policymakers grapple with the public health goal of reducing secondhand smoke exposure, there is a clear role for the smokers, too: Keep trying to quit! You can do it. And while you’re thinking about it, do what you can to avoid exposing others – especially children – to your cigarette smoke. For inspiration, check out this video.
 

Read more about The Public's Health.

About this blog

What is public health — and why does it matter?

Through prevention, education, and intervention, public health practitioners - epidemiologists, health policy experts, municipal workers, environmental health scientists - work to keep us healthy.

It’s not always easy. Michael Yudell, Jonathan Purtle, and other contributors tell you why.

Michael Yudell, PhD, MPH Associate Professor, Drexel University School of Public Health
Jonathan Purtle, MPH Doctoral candidate and Research Associate, Center for Nonviolence and Social Justice, Drexel University
Janet Golden, PhD Professor of history, Rutgers University-Camden
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