Creating a smoke-free home REFRESH How to Guide for Professionals Working with Families and Children SECTION 1 Introduction Page 3 SECTION 2 Who should use this guide? Page 4 SECTION 3 Why should you use this guide? Page 4 SECTION 4 How to use this guide Page 4 SECTION 5 What does the evidence say? Page 5 5.1 What is second-hand smoke? Page 5 5.2 Is smoking in the home and car common? Page 5 5.3 What do we know about exposure levels in the home and car? Page 5 5.4 Key facts on second-hand smoke and effects on children’s health Page 7 5.5 Tobacco smoke and house fires Page 7 SECTION 6 Common beliefs around second-hand smoke exposure Page 8 SECTION 7 The benefits of having a completely smoke-free home and car Page 10 SECTION 8 Hints and tips for parents on creating a smoke-free home and car Page 11 SECTION 9 Toxic breakdown of a cigarette Page 12 RAISING THE ISSUE - GUIDANCE FOR PROFESSIONALS Acknowledgements: SECTION 10 Practical tips on raising the issue and encouraging change Page 13 NHS Health Scotland Second-hand 10.1 The ‘REFRESH’ Flowchart Page 14 Smoke Coordinators Network NHS Rotherham SECTION 11 Raising the issue of second-hand smoke exposure in the home Page 15 Northfield Mother and Toddler 11.1 Overcoming parent barriers to creating a smoke-free home and car Page 15 Group, Aberdeen 11.2 Overcoming practitioner barriers to raising the issue with parents/carers Page 18 Gwen Russell Lorna McKenzie SECTION 12 Additional information on smoke-free homes Page 20 Kim Brannigan Lesley Young SECTION 13 Further support Page 20 SECTION 14 Further information……………………………………22 Page 20 For additional information on SECTION 15 REFRESH, please visit References Page 21 http//www.refreshproject.org.uk Getting started 1. INTRODUCTION The aim of this guide is to provide resources and support. and carers, and information and advice for practitioners better health for The information provided in this who work with families and children Scotland’s children. guide has been informed by the to help them engage effectively with For further REFRESH project (Reducing families’ parents and carers in order to reduce details on the exposure to second-hand smoke in children’s exposure to second-hand REFRESH project the home) which is funded by the smoke (passive smoking) in the home go to www. Big Lottery and managed and led by and in the car. This guide will help to: refreshproject. ASH Scotland. This three year project org.uk • enhance practitioner knowledge of is a unique partnership between second-hand smoke and effects on ASH Scotland and the Universities of children’s health Aberdeen and Edinburgh and aims • enhance practitioner confidence in to develop knowledge on reducing raising the issue with parents and second-hand smoke in the home. providing advice This should lead to better practice • provide information on further and support for smoking parents Raising the issue of second-hand smoke exposure with a parent/carer does NOT mean you are asking them to stop smoking. By raising the issue, you are informing parents/ carers of the risks caused by second-hand smoke exposure and encouraging them to create a smoke-free home and car. 3 Getting started 2. WHO SHOULD USE 3. WHY SHOULD YOU 4. HOW TO USE THE GUIDE? USE THE GUIDE? THE GUIDE This guide is for practitioners who work • Encouraging people to smoke outside The guide is a reference tool with with families and children including protects babies, children and non- evidence-based facts on second-hand professional and voluntary workers smokers from exposure to second- smoke and hints and tips to encourage in health care, early years and family hand smoke. parents to achieve a smoke-free home. support services. • Encouraging smoke-free homes helps you and your organisation This guide can be downloaded work towards the following Scottish from www.refreshproject.org.uk. Government’s National Framework Practitioners can download separate targets: pages as an aid for themselves or for parents to keep. • our children have the best start in life and are ready to succeed • we live longer, healthier lives • we have tackled the significant inequalities in Scottish society and • we have strong, resilient and It need not take long to supportive communities where ask about smoking in the people take responsibility for their home/car. You may be own actions and how they affect the first person to ever others. raise the issue with a • Encouraging smoke-free homes parent/carer, prompting and cars contributes significantly to them to think about their 4 breaking the smoking cycle between parents/carers and children/young smoking patterns and people. behaviour in a new way. The information you need 5. WHAT DOES THE EVIDENCE SAY? 5.1 What is • 70% of Scottish adults recently (WHO) recommends levels of second-hand smoke? surveyed said they did not allow indoor airborne fine particulate Second-hand smoke is a mixture of the smoking in the vehicle they regularly matter (PM2.5) should be below 25 smoke given off by the burning end of travelled in.1 micrograms per cubic metre of air (25 a cigarette, pipe, or cigar (sidestream 3 17% of all Scottish adults say they μg/m3) averaged over 24-hours. smoke), and the smoke exhaled by • are exposed to smoke in their own or The average PM level in a typical smokers (exhaled mainstream smoke). • 2.5 other people’s home.2 smoker’s home is four times higher than the WHO guidance limit. 5.2 Is smoking in the home and car common? 5.3 What do we know about • A typical car journey where one • 56% of Scottish adults recently exposure levels in person smokes exposes non-smokers surveyed said ‘people cannot smoke the home/car? to levels of PM2.5 that are about three anywhere in my home.’ 1 • The World Health Organisation times higher than the guidance limit. • SECOND-HAND SMOKE is also called WHAT IS PM2.5? environmental tobacco smoke (ETS) PM2.5 is the name for fine • Exposure to SECOND-HAND SMOKE particulate matter that is small is also known as involuntary or enough to be carried by the air passive smoking. and breathed in to the lungs. Cigarette smoking is the greatest SECOND-HAND SMOKE contains • single source of PM2.5 in homes more than 4,000 chemical and buildings where people 5 compounds of which at least 250 are smoke. known to be toxic or carcinogenic . The information you need FIGURE 1 The blue line in this graph shows levels of smoke measured inside the living room when someone is smoking only at the back door. The red line represents the World Health Organisation guidance level of 25 μg/m3 for fine particulate matter. There is no safe level of second-hand smoke but we know that the longer the amount of time someone is exposed to smoke levels above this line, the more likely they are to experience health problems related to exposure. 200 Source: REFRESH Project Source: 180 Smoking at the backdoor ) 3 160 g/m ( 140 2.5 120 100 80 Second-hand smoke 60 WHO level (25) can seep into and 40 out of open windows Smoke levels as measured by PM 20 and doorways. Even 0 when a cigarette is 9.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 1.00 1.00 1 1 10.00 12.00 10.00 12.00 extinguished, the Time of Day invisible toxins in second-hand smoke can 6 ‘After seeing that I realised it doesn’t matter if I’m standing at the back door or not, there’s still smoke in the house.’ remain in a room for REFRESH Participant several hours. The information you need cigarettes a day during pregnancy 5.4 Key facts on second- children whose parents smoke at is more than four times as likely to • hand smoke and effects home are twice as likely to have have a baby die as a cot death than on children’s health: asthma symptoms all year round4 a woman who doesn’t smoke at all Second-hand smoke exposure has been during pregnancy5 • exposure to second-hand smoke is shown to have a number of harmful associated with an increased risk of tobacco smoke can cause low birth effects on children’s health: • respiratory tract infections such as weight in babies which has been • children and infants are more coughing, wheezing and croup4 associated with coronary heart vulnerable to tobacco smoke than • approximately 9,500 children are adults. Children have smaller airways, disease, type 2 adult onset diabetes, and being overweight in adulthood4 admitted into hospital in the UK every breathe faster and their immune year because of tobacco smoke4 systems are still developing4 • middle ear infection in a child is 50% • children are three times more likely • a woman who smokes one to nine more likely to occur if one parent smokes4 to smoke when they get older if they grow up around smokers.4 5.5 Tobacco smoke Creating a smoke-free and house fires: home and car will help • smoking households are 40% more parents reduce the likely to have a house fire6 risks of ill-health in between 2005 – 2008 there were 131 their children and can • fire deaths in Scotland, 41% of deaths reduce the amount of 6 time children are absent were caused by smoking materials from nursery and school • around 7% of accidental house fires with illnesses associated are caused by smoking materials.6 with second-hand smoke 7 exposure.