International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571

Review Article

Reducing Harm of Passive Exposure among Children

Rishad Choudhury Robin1, Narongsak Noosorn2

1Doctoral Candidate, 2Associate Professor, Faculty of , Naresuan University, Phitsanulok, Thailand

Corresponding Author: Rishad Choudhury Robin

ABSTRACT

Passive smoking is a curse for the children. Every year almost 600,000 premature deaths occur due to passive smoking. Almost 63% of ischemic heart disease is a consequence of passive smoking. There are different initiatives have been taken across the world to reduce the harm of this exposure. The objective of this review article is to present different approaches of reducing the harmful effect of passive smoking exposure focused on children. Most of the initiatives are almost same in nature and work well in the developed countries. Counseling is the key component of reducing exposures. A Different form of counseling such as personal counseling, motivational interview or group session counseling can help to reduce the exposure. Along with counseling regulations, technologies, health education and the use of pharmacotherapy, different forms of methods have been taken by different countries. The clinic-based setting is another important method to reduce this exposure across the world. Mutual understanding among the parents to avoid smoking in front of their children can help to lessen the burden, as child’s health is always the primary concern of the parents. Particularly, mother's awareness is necessary to reduce the exposure as well.

Key words: Passive Smoking, Exposure, Reducing Harm, Children

INTRODUCTION two, and in case of low income countries, it is a devastating word which is ranked as number seven. [3] is related to millions of every year. In Tobacco has been used in different fact, it is the highest cause of preventable forms. It can be inhaled as smoke or can be death. At present, more than 1.1 billion taken in other forms like chewing or sniff. people smoke different forms of tobacco. Everyone knows that active or direct 80% of them are from low and middle- smoking of tobacco is dangerous, but the income countries. Each year tobacco-related indirect smoking or passive smoking is also diseases cause 6 million deaths and if this a health concern. Passive smoke or second pattern persists, it will reach up to 8 million hand smoke is formed by burning of by 2030. Currently, half of the tobacco- different tobacco products such as related deaths take place within the age of , cigars or pipes. It is the smoke 35 to 69 years. [1,2] In every socio- which has been breathed out and exhaled by economical context, smoking is a burden for the smokers. [4] Worldwide every year all the countries around the world. For the 600,000 premature deaths are caused by high-income countries, smoking is the passive smoking. Almost half of the total number one cause of death; while for children around the world are exposed to middle income countries, it follows number in open or public places. [5]

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Almost 63% of ischemic heart disease is a wants to get rid of tobacco. World Health consequence of passive smoking followed Organization has a framework to control by the lower respiratory infection which is tobacco and almost all the countries’ law 27%. [6] and regulation of follow this Children are at the greatest risk of guideline. In the of America, passive smoking. Honestly, they are the and Australia, the rules worst sufferer of passive smoking. In every and regulations are almost same. In these corner of the globe, there are passive countries, smoking is not allowed in public smoking affected children. Turkey is the top places, no retailer can sell cigarettes to in the world of overall exposure of passive minors, tobacco companies do not have smoking scenario among the children. permission to sponsor any programs, no Almost 89% children of the country are visual advertisement is allowed, a warning exposed to passive smoking. 49.2% children sign with the picture should be clearly of United Kingdom are exposed to passive mentioned over every package and smoking; whereas, in Australia, it is 43%, implementation of tobacco tax are common 35% in the United States of America and the laws. [8-10] In India, along with the regular lowest is in Canada which is 33%. [7] In laws guided by WHO framework; there is a Indonesia, almost 80% children who are significant regulation for the ban of smoking younger than 15 years are affected by within the 100 yards of any kind of passive smoking at home. In Vietnam, it is educational institutions. Also, in Nigeria, almost 75% which is second in the row and smoking is restricted within five meters of in China, it is around 67%. In the case of the doorways and windows of any public places , almost 90% of the Chinese and also within five meters of queues of any below 15 years of age are exposed to public transport. [11,12] passive smoking. In Vietnam and Indonesia, There were different types of the percentage is almost 85%. China is also initiatives that have been taken across the leading in workplace smoking where 65% world to reduce the burden of passive of 15 children are exposed to it. Bangladesh smoking exposure. The aim of this article is comes after China where 62% exposure is to present different methods of reducing the visible and the third in the row is Egypt harmful effect of passive smoking exposure where 60% of 15 children are exposed to that will be focused on children. Though the passive smoking. [5] nature of approaches will be almost the In developed countries, 90% of lung same and most of the interventions are in men and up to 86% of cases in taking place in the developed country, the women are caused by smoking. [1,2] But the public health consequence of passive scenario of passive smoking is also not smoking exposure is huge and this burden is minor. The harmful health effect of passive affecting the developed, developing and smoking is enormous as more than 7000 underdeveloped countries. The diverse different chemicals are found in tobacco methods used to reduce the harmful effect smoke; out of which many of them are of passive smoking among the healthy child responsible for . Passive smoke as well as the sick child will be reflected in causes ear infections, attack, this article. coughing, sneezing, shortness of breath, Counseling the finest way to reduce and pneumonia and the risk for passive smoking harm: sudden infant death syndrome among Almost all around the globe, children. For adults, it causes different kinds counseling is used as an effective way to of cancer and cardiovascular diseases reduce the harm of passive smoking mainly (CVD) such as heart attack and stroke. [4] among children. Effective and proper Tobacco is a curse for everyone. counseling is proved to reduce the burden Although it seems tough, every country throughout the world from east to the west.

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In-person counseling can help to make the 1983 which was mainly used for addiction parents or caregivers understand the risk of treatment, but nowadays it is widely used to passive smoking exposure. Long-term change human behavior. The main goal of counseling can be more effective other than MI is to help the participants to recognize as short-term counseling. Counseling mainly well as change their behaviors and to focuses on practicing outdoor smoking prevent them from developing risky health habits, reducing indoor smoking, fixing problems. The important principles of MI some rooms of the house as a non-smoking are empathy, roll with resistance and the area, stopping smoking while accompanied development of discrepancy. In empathy, by children in any vehicle and requesting the researcher should see the problem or grandparents not to smoke at home when scenario through the participant's point of children are visiting. [13] In-person view or perspective. It is very important that counseling also focuses on the importance the researcher must comprehend the of healthy environment at home, the danger participant's inner thoughts. In the second of health related to active and passive principle- roll with resistance- the smoking exposure, the positive effect of researcher should understand the common quitting smoking and the process of making characteristics of resistance of the the house air smoke-free. [14] Though participants and he or she should not impose counseling helps mostly short-term smoking anything on the participants. In developing a cessation, it may be considered as the discrepancy, the researcher should influence foundation for quitting smoking. [15] the participants to change their unhealthy Group support session is a relatively behaviors indirectly. [20] In the view of these new way of counseling where the smoker principles, intervention can be designed to parent/caregiver can discuss together with support the caregivers/parents by preparing the help of a counselor and can make plans them to take initiatives to reduce the passive on how effectively they can make their smoking exposure effect, building home tobacco smoke-free. [16] Like group confidence and motivating them when they support session, collaborative learning is feel hesitant about the change or quit another way where a group of people with smoking and also to give brief personalized common aim adapt an intervention, spread counseling if the their knowledge in a common platform for a caregiver is ready to quit. The intervention long time with a certain interval which may can be carried out by personal and reduce the harmful health behavior such as telephonic interviews. [21] smoking. [17] In-person counseling at For successful completion of MI, participants’ houses can allow the adequate training can help the researchers to researcher to support the home environment explain the behavioral change among the and to make it passive smoking exposure parents and can also help to reduce free. Counseling has not only significantly exposure. Smoking in Children's worked for the healthy child, but it works Environment Test (SiCET) is a process perfectly well with the parents who have a which helps to get motivational interview sick child who might be suffering from implantation successfully. SiCET is cancer. [18] Smoking hygiene intervention basically a self-reported questionnaire (SHI) is another counseling method which is which is supposed to be answered by the delivered through in-person and telephonic caregivers/parents and then, the outcome counseling as well as self-help education will be useful in the research to further material. [19] initiate a dialog with the participating Motivational Interview (MI) is an members. The combination of MI and effective way: SiCET can help the participants to improve Motivation Interview was first their self-efficacy which will allow them to described by William Miller in the year of

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believe that they can modify their harmful of passive smoking exposure can encourage health behaviors. [17] the parents to take steps for reducing Communication can play a vital role: exposure. [28] Smart devices such as smart- Communication is another effective phones or Tabs are widely used devices process to reduce passive smoking exposure nowadays. Mobile app focusing on real-time burden. Several telephonic interviews with self-monitoring smoking, trigger factors, psychologists regarding the consequences of tracing of health progress as well as the exposure and the possible health risk can information on tobacco session and passive help to reduce the passive smoking smoking exposure protection, is potentially exposure. [22] Telephonic calls can also help an effective way to reduce exposure. Mobile to evaluate the development of the goal, app can also integrate to a web link different counseling barriers and also to help counselor portal where a counselor can see the participants to set new goals to reduce the progress of proper use of an app which exposure. [14] Along with telephonic calls, allows the counselor to give supportive postal mail and email can help to convey the feedback to the participants. It is knowledge. [23] Telephonic counseling with comparatively a new approach. [29] pediatricians can also significantly change Real time audio-visual feedback by the parents’ mind and can help to take monitoring the air particle level is an necessary steps to reduce the risk of the exclusive technology to reduce exposure. exposure for the children. [24] An airborne particle monitor and a feedback Technology and Media also can act as a device with visual graphical display play the part: role to reduce exposure. The air particle Different technologies and media monitor may be kept at different places of products can help to reduce passive smoking the house where the possibility of children’s exposure. Website can be used where the smoke exposure is higher. A visual graphics smoker parents or caregivers can share their monitor with an audio system needs to be ideas and can also participate in the placed in a common area. While smoking, discussion sessions to exchange their views. the air particle monitor will get the signal [16] Also, governmental websites on smoking and will also show the real-time rate of air control can be a good source to increase pollution on the visual monitor along with knowledge about the harmful effect of activating the alarm system. It will warn the passive smoking. [17] Video games aiming at parents about the home environment and dissemination of knowledge can reduce will give immediate mitigation of air passive smoking at home and in the car. It pollution by opening the windows, smoking can be used as a process to develop near windows or outdoor. [30] Electronic awareness about the harmful effect of health records are also used in clinic-based passive smoking. [16] Clinical counseling intervention where a physician can record video can help pediatrician to address a and follow-up the data of child smoking patient within their limited counseling time. exposure and can take necessary steps to [25,26] Motivational video helps the parents to protect them. [31] understand the risk and encourage them to Postcard, [32] booklets, [17] brochures, reduce exposure. [27] Smart-phone is the posters, [28,31] leaflets [25,33], pamphlets, [29] most useable gadget nowadays. Mobile- table tents, manuals, [28] signs, stickers, [34] phone-based smoking session intervention refrigerator magnets, mug [26] act as or mHealth based intervention can also reminder of the exposure. Quit cards which involve parents to reduce smoking and can are business cards that also include quitting make an exposure free environment for the information and press release to inform the children. Different text massages focusing parents or caregivers to join a community on the health effects of smoking, the intervention program, are another approach motivation of quitting and the consequence to reduce exposure effect. [25]

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Total in the home can as camel , taboka work effectively to reduce exposure: reduce the smoker’s craving for smoking. Most of the children experience [36] Smoking cessation is certainly a difficult passive smoking exposure in their own task especially when there is no scope to house. Smoking banning in the house is a avoid children while smoking; NRT is positive way to reduce exposure. As there is helpful to stop smoking. [13,15] It also no safe limit for the exposure; that is why, encourages a smoker to quit smoking. [33] the implementation of a total smoking ban NRT acts as a temporary absence from can bring significant outcomes. Although smoking, but in long run, it helps in the nonsmoker families are more concerned complete smoke cessation. [37] During about smoking ban in their house, the counseling, if the participants get logistic knowledge and benefits of the complete support for replacement therapy smoking ban can be successfully transferred and medication for cessation that can truly to the smoker parents with telephonic reduce the smoking rate which can further coaching calls and different informative reduce the passive smoking exposure. [31] materials that facilitate the smoker family to Those who are less interested in quitting introduce the smoking ban. [34] Child health smoking, can get benefit from PREPs to is a significant motivational factor for ban help reduce their child’s exposure to it while because every parent wants to see their child smoking. This method is not an optimal as a healthy kid and no one wants to be the choice, but it helps to get substantial health cause of their child’s illness. benefits. [38] Thus, there are different barriers to Awareness among mother is more make the home smoke free such as living effective: with extended family especially There is no doubt that children are grandparents, lack of social support to make closer to their mother than anybody else. the home smoke free, weather such as That is why, parental smoking; mainly, winter which is a barrier to let the smoke go mother’s smoking directly makes a child a outside or to open the window, safety of the passive smoker. Dropping in the rate of neighborhood and also some of the mother’s smoking per day significantly embarrassing situations of requesting others reduces the effect of passive smoking on to avoid smoking at home. [35,43] children. [39] Whatever the home condition Occasionally, the child himself acts as a is; the willingness of the mother can save barrier because the parents do not want to her child’s health. Mother’s views to save leave their child alone in a room and cannot her child’s health are incremental in nature go outside for smoking. But, it was also true and these can overcome the barriers of that some of these barriers also act as behavioral change. [40] By taking the child positive factors for the total home ban on away from the smoker, and placing no smoking such as living with extended smoking sign also increase the intensity of family and social network. Grandparents are requesting father/partner to stop smoking to often the most concern persons for their reduce the exposure. [42] A nonsmoker grandchildren’s exposure to smoke and also mother can also play a vital role to reduce some of the societies take initiatives to exposure to smoking. They can help to implement the ban on smoking. [35] motivate their smoker spouses to quit Exposure can be reduced by smoking. Mutual support of both parents Pharmacotherapy: always plays a significant role in reducing Noncombustible products with smoking exposure. [23,33] nicotine contain Nicotine Replacement Clinic-based intervention is a noble Therapy (NRT) like nicotine inhaler, approach: lozenge, gum and also Potentially Reduced To reduce the harm of passive Exposure Tobacco Products (PREPs) such smoking exposure, clinic-based intervention

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or intervention in a pediatric setting is effectively deliver the knowledge to the helpful. The Clinical Effort against community members. [19,32] Sending several Secondhand Smoke Exposure (CEASE) is a educational mails to the smoker parents is process addressing through pediatric office also helpful to reduce exposure. [32] Also, intervention. This intervention is flexible in the presence of an expert in tobacco field design and adaptable with pediatrics office acts as a motivating factor in the smoking individual resources. [25] cessation related health program. [17] General Hospital has developed the Incentive is always fruitful: program. The three main elements of the Incentive in the form of money or program are Ask, Assist and Referred any other gifts also acts as an effective way (AAR). AAR reflects asking about child to reduce the harm. It motivates the parents exposer of passive smoking, assisting about to participate in different intervention the harmful effect of the exposure and sessions such as counseling or interviews. referring to smoking cessation. [41] The [13] Monetary incentive can attract the focus of CEASE is the regular screening of participants to maintain their goal. [27,33] tobacco use for parents by CEASE action Incentive like gift cards attracts the sheet to help the clinic staff identify the participants to get involved with the smoker family and record the information. It research. [21,34] Even providing lunch also includes individual inspirational improves the number of attendants in a message emphasizing on child’s illness and session. [25] possible recommendation for and gum by the pediatricians. [25] CONCLUSION The Kids Safe and Smoke Free There is no doubt that the risk (KiSS) is a program that focuses on burden of passive smoking exposure is intensive individual-level counseling as well tremendous. To mitigate this huge public as community-based service in a clinic- health burden, different incentives have based setting. KiSS adapts the guideline been taken across the world. Though the principle of CEASE. But KiSS includes approaches are more or less same in nature, behavior intervention by counselor instead but unfortunately, there were very few of the clinician that includes intensive initiatives for a low socio-economic family-centered counseling along with condition in the underdeveloped country. personalizing counseling and smoking For smoking cessation and reduce exposer, quitting coping skill training. Like the counseling acted as the key factors through CEASE program, KiSS also provides motivation, knowledge sharing and group community and social support by using activities. Changing behavior is a very nicotine replacement therapy and cessation complex task, but one can get success by medication. The goals of KiSS are to influencing one’s inner desire that can be identify smoker parents with a child, activated by proper motivational counseling. tobacco use counseling, no smoking policy As 21stcentury is the era of technology, the establishment, different smoking effective use of these technologies can also interventions, medication to quit smoking help to reduce the burden. Due to the busy and the use of health record of the clinic for life schedule, in-person meeting seems to be follow-up. [31] a difficult job, but this can be dealt with by Health Education can develop using telephonic counseling, sending text knowledge: messages or email. A cellular phone is Passive smoking exposure can be available almost everywhere; even low- reduced through health education. income population uses cellular phone Community worker can play a vital role in regularly. Utilizing these phone features this as they are considered as a trusted such as SMS or Short Message Service can mouthpiece of the neighborhoods and can be an efficient way to deliver knowledge. A

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How to cite this article: Robin RC, Noosorn N. Reducing harm of passive smoking exposure among children. Int J Health Sci Res. 2018; 8(2):288-296.

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