Brief Intervention Guide. Protecting Children from Secondhand Smoke

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2 Brief Intervention Guide Protecting Children from Secondhand Smoke

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4 Contents Key reminders 02 What is secondhand smoke Brief intervention for reducing secondhand smoke exposure 03 First steps 04 Next steps 05 Putting it together Dealing with client responses 06 Suggested approaches Tips to help you take it outside 09 Get organised 10 Get support Benefits of making sure everyone steps outside 11 For adults, children and young people Benefits of protecting children from SHS 12 During pregnancy 13 For your children References 14 Detailed references included 1

5 Key reminders Secondhand smoke exposure has a significant negative impact on a child s health before birth, during infancy and childhood, and continues to negatively impact on their health into adulthood. The World Health Organization (WHO) has stated that there is no safe level of exposure to secondhand smoke. Secondhand smoke consists mainly of side-stream smoke (from the burning end of the cigarette) as well as mainstream smoke (the exhaled smoke by a smoker). Don t just target smokers even children of nonsmokers are exposed to SHS if visitors are allowed to smoke, or family and friends smoke when children visit them in their homes. The secondhand smoke campaign is about protecting children NOT about quitting smoking; the key message is for them to take it 7 steps outside. 2

6 Brief intervention for reducing secondhand smoke exposure First steps Raising the issue Begin with a clear statement (rather than a question) to get the key message across You may be aware that being around any secondhand smoke is unhealthy for children. 2. Providing information and advice Secondhand smoke is linked to a number of health problems in children, such as cot death, wheezing, ear infections, and general poor health (or give other examples). 3. Enhancing motivation The advice is to make sure that your child isn t exposed to any secondhand smoke, so if you do smoke you should always smoke right outside and encourage others to do the same around your child. 3

7 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 Suggesting solutions and building confidence Is there anything you can do to prevent your child s exposure? What might help you achieve this? 4

8 Putting it together This is a template which you can change and tailor when working with families: You may be aware that being around any secondhand smoke is unhealthy for children. Secondhand smoke is linked to a number of health problems in children such as cot death, wheezing, ear infections, and general poor health (or give other examples). The advice is to make sure that your child isn t exposed to any secondhand smoke, so if you do smoke you should always smoke right outside and encourage others to do the same around your child. Can you think of any times when your child is exposed to smoke in your home or in other people s houses? If yes: Is there anything you can do to prevent your child s exposure? 5

9 Dealing with client responses Brief Intervention Some suggested approaches No I m not interested. Give information and end conversation, but ensure they know where get further information from in the future. Repeat brief intervention at next contact. What do you mean? Individualised information and advice. Focus on benefits for the child of reducing secondhand smoke exposure. Sensitively relate to child s health problems if appropriate. I don t think I smoke too much in front of the kids. Enhance motivation, discuss that there is no safe level of exposure. I think I could make some changes. What could I do? If they smoke, give the message that they should take 7 steps outside. Discuss personalised options that would lead to a reduction in risk. I think it would be really hard to cut down Discuss coping strategies including the use of NRT to avoid smoking. 6

10 I m not a smoker. Discuss if the child is exposed to SHS from any other source and interventions to help prevent exposure. I am interesting in quitting. Support or refer to quit if brought up spontaneously. Promote secondhand smoke message as they may relapse and/or may not be only source of exposure. Focus on benefits for the child of reducing secondhand smoke exposure. 7

11 Take 7 steps outside The best way to protect children from SHS is to smoke right outside. Nicotine Replacement Therapy (NRT) If you/the smoker cannot go outside why not try some Nicotine Replacement Therapy (NRT) to relieve the craving until you/they can? Guests and other family members If you have any visitors make sure they don t smoke in the house. Last resort If you/the smoker cannot go outside and cannot use NRT make sure you/they only smoke in one room (preferably not a communal room) that is well ventilated with the door shut, and make sure the child is in a different, well ventilated room. 8

12 Tips to help you take it outside Get organised As with any new habit, making sure everyone steps outside the home and car to smoke will take some getting used to. Use the health of your children as motivation and try these tips to get started: Create a smokefree home and car policy. Let everyone in your household and any visitors know about the new rules. If you can, place an ashtray and chair outside to create an area for smoking. Keep a jacket (just for smoking) and umbrella near the doorway to make it easy to step outside in colder months or when it s raining. Keep lighters and cigarettes outside your door (and out of reach of the children) so no-one can light up a cigarette indoors. 9

13 Get support Team up with another parent who smokes. Together make a commitment to make sure everyone steps outside for your children and agree to help watch each other s kids during any smoke breaks. Ask for the support of your children and other people in your life to encourage you/ other people who smoke to step outside, and offer the same support to them. 10

14 Benefits of making sure everyone steps outside For you (if you smoke): Have five minutes away just for you. Reduce your own secondhand smoke exposure by not being in an enclosed space. Keeps your home smelling and looking fresh and smokefree. May help you cut down the number of cigarettes you smoke. For your kids: Prevent their exposure to secondhand smoke which will improve their health. Reduce their risk of health problems including wheezing, glue-ear, meningitis, and asthma. They won t see smoking as much which may help stop them starting smoking themselves. Having a smokefree home means your children are likely to choose to live in a smokefree home when they grow up. 11

15 Benefits of protecting children from SHS During pregnancy It is important to quit smoking altogether if you are pregnant and avoid any secondhand smoke exposure. NRT and support is available to help you quit. Ensure partners or family members who smoke to take 7 steps outside to help prevent SHS exposure. By stopping smoking and avoiding SHS when pregnant you can help improve: Your baby s weight when it is born [2-5] By stopping smoking and avoiding SHS when pregnant you can help avoid the risk of: Having a premature baby [2-3, 6] Having a stillbirth [7-8] The baby being admitted into intensive care after birth [9] Sudden Infant Death Syndrome [10-12] 12

16 For your children By making sure everyone smokes outside you can help improve their: Asthma symptoms [13-14] Dental health [15] School attendance [16] Chances of growing up to be a non-smoker [14] By making sure everyone smokes outside you can help reduce the risk of: Sudden Infant Death Syndrome [17-19] Middle ear infections [14, 20] Lung infections such as bronchiolitis [14, 21] Wheezing [22-23] Meningitis [14, 24] 13

17 References 1. Colorado Department of Public Health and Environment. Raise Smokefree Kids 2010; Available from: 2. Agrawal, A., Scherrer, JF, Grant, JD, Sartor, CE, Pergadia, ML, Duncan, AE, Madden, PAF, Haber, JR, Jacob,T, Bucholz, KK, Xian, H, The effects of maternal smoking during pregnancy on offspring outcomes. Preventive Medicine, (1-2): p Braun, J., Daniels, JL, Kalkbrenner, A, Zimmerman, J, Nicholas, JS, The effect of maternal smoking during pregnancy on intellectual disabilities among 8-year-old children. Paediatric and Perinatal Epidemiology, (5): p Malik, S., et al., Maternal Smoking and Congenital Heart Defects. Pediatrics, (4): p. e Vardavas, C., Chatzi, L, Patelarou, E, Plana, E, Sarri, K, Kafatos, A, Koutis, A, Kogevinas, M, Smoking and smoking cessation during early pregnancy and its effect on adverse pregnancy outcomes and fetal growth. European Journal of Pediatrics, (6): p McCowan, L., Dekker, GA, Chan, E, Stewart, A, Chappell, LC, Hunter, M, Moss-Morris, R, and North, RA, On behalf of the SCOPE consortium, Spontaneous preterm birth and small for gestational age infants in women who stop smoking early in pregnancy: prospective cohort study. BMJ, Gray, R., Bonellie, SR, Chalmers, J, Greer, I, Jarvis, S, Kurinczuk, JJ, and Williams, C, Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland : retrospective population based study using hospital maternity records. BMJ, (oct01_1): p. b Salihu, H.M., et al., Prenatal Tobacco Use and Risk of Stillbirth: A Case--Control and Bidirectional Case-- Crossover Study. Nicotine Tob Res, (1): p Stavrou, E., D. Baker, and J. Bishop, Maternal smoking during pregnancy and childhood cancer in New South Wales: a record linkage investigation. Cancer Causes and Control, (9): p

18 10. Blair, P., Sidebotham, P, Berry, J, Evans, M, and Fleming, PJ, Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. The Lancet, (9507): p Blair, P., Sidebotham, P, Evason-Coombe, C, Edmonds, M, Heckstall-Smith, EMA, Fleming, P, Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ, (oct13_1): p. b Ostfeld, B., Esposito, L, Perl, H, and Hegyi, T, Concurrent Risks in Sudden Infant Death Syndrome. Pediatrics, (3): p Gerald, L., Gerald, JK, Gibson, L, Patel, K, Zhang, S, & McClure, LA, Changes in Environmental Tobacco Smoke Exposure and Asthma Morbidity among Urban School Children. Chest, : p RCP, Passive smoking and children. 2010, Royal College of Physicians: London. 15. Aligne, C., Moss, ME, Auinger, P, Weitzman, M, Association of Pediatric Dental Caries With Passive Smoking. JAMA, (10): p Gilliland, F.D., et al., Environmental Tobacco Smoke and Absenteeism Related to Respiratory Illness in Schoolchildren. Am. J. Epidemiol., (10): p Bergman, A.B. and L.A. Wiesner, Relationship of Passive Cigarette-Smoking to Sudden Infant Death Syndrome. Pediatrics, (5): p Gergen, P.J., et al., The Burden of Environmental Tobacco Smoke Exposure on the Respiratory Health of Children 2 Months Through 5 Years of Age in the United States: Third National Health and Nutrition Examination Survey, 1988 to Pediatrics, (2): p. e Tappin, D., Ecob, R, and Brooke, H, Bedsharing, Roomsharing, and Sudden Infant Death Syndrome in Scotland: A Case-control Study. The Journal of Pediatrics, (1): p

19 20. Lieu, J.E.C. and A.R. Feinstein, Effect of Gestational and Passive Smoke Exposure on Ear Infections in Children. Arch Pediatr Adolesc Med, (2): p Li, Y., Gilliland, FD, Berhane, K, McConnell, R, Gauderman, J, Rappaport, EB, Peters, JM, Effects of In Utero and Environmental Tobacco Smoke Exposure on Lung Function in Boys and Girls with and without Asthma. Am. J. Respir. Crit. Care Med., (6): p Lewis, S.A., et al., Secondhand Smoke, Dietary Fruit Intake, Road Traffic Exposures, and the Prevalence of Asthma: A Cross-Sectional Study in Young Children. Am. J. Epidemiol., (5): p Pattenden, S., Antova, T., Neuberger, M., Nikiforov, B., De Sario, M., Grize, L., Heinrich, J., Hruba, R., Janssen, N., Luttmann- Gibson, H., Privalova, L., Rudnai, P., Splichalova, A., Zlotkowska, R., and Fletcher, T., Parental smoking and children s respiratory health: independent effects of prenatal and postnatal exposure. Tobacco Control, : p Iles, K., N. Poplawski, and R. Couper, Passive exposure to tobacco smoke and bacterial meningitis in children. Journal of Paediatrics and Child Health, (4): p

20 If you wish to cite this document we recommend: Laverty, L, and Robinson, J (2010). Brief Intervention Guide: Protecting Children from Secondhand Smoke, University of Liverpool, prepared for Smokefree North West. This and other useful documents are available at materials-for-healthcare-professionals 17