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Protecting Children from Secondhand Smoke

March 5, 2007: Reducing Exposure to Secondhand Smoke

Elizabeth Cotsworth, M.A., Director, Office of Radiation and Indoor Air, EPA

Ms. Cotsworth began her remarks by noting that there have been several published reports over the last couple of decades that have validated the adverse effects of exposure to secondhand smoke, including the 1992 EPA Environmental Tobacco Smoke Risk Assessment, 1986 Surgeon General Report on Involuntary Smoking and the 1997 and 2005 California EPA reports.

The EPA primarily focuses its efforts on the health effects experienced by young children exposed to secondhand smoke, which include acute and chronic respiratory symptoms, slowed lung growth, and SIDS. Some of the reasons that children and infants are so vulnerable include:

  • Respiratory, immune and nervous systems are still developing
  • Greater doses are absorbed from the same exposure
  • Closer proximity to maternal smoking in the home

Because the home is the primary location where children and infants are exposed and because of preschool-age children's unique vulnerability, the EPA has focused its efforts on this population through its Smoke-free Homes Program launched in 2001. This program seeks to motivate parents and caregivers to protect young children from secondhand smoke exposure.

Findings from an EPA commissioned survey on asthma management and secondhand smoke included:

  • Confirmation that parents account for the vast majority of exposure for in the home—almost 90%
  • The majority of exposure occurs regularly—four or more days a week
  • Exposure is higher and asthma is more likely in homes with low-income and low-education levels

As mentioned earlier in the meeting, the science concerning the most effective interventions for promoting adoption of smoke-free home practices is not yet sufficient. However, progress has been made reducing exposure as indicated in the National Health and Nutrition Examination Survey (NHANES), National Health Information Survey (NHIS) and EPA surveys. In the 2005 NHIS, eight percent of children six and younger are regularly exposed in their homes, down from 11% in 2003 and 20% in 1998.

Ms. Cotsworth continued by talking about a newly formalized partnership between the EPA and HHS to address the reduction of secondhand smoke and other asthma triggers for the nearly one million children enrolled in Head Start and Early Head Start. This nationwide campaign will provide local Head Start programs with bilingual education tools and resources to help reduce risks associated with exposure to secondhand smoke. The Head Start population represents many ethnically diverse and economically disadvantaged populations including American Indian, Alaska Native and migrant workers.

The EPA is also in the process of revising the Smoke-Free Homes and Cars Program to focus more attention on exposure in vehicles in addition to continuing its focus on homes. One of the ways this will happen is by partnering with organizations that educate families about child safety seat installation. If the message is child safety in cars, then coupling the smoke-free car with a child car safety message makes perfect sense.

Another important partnership exists between EPA and other organizations that train healthcare providers to make members aware of the importance of providing secondhand smoke messages to patients—both smoking and nonsmoking— about the dangers of secondhand smoke exposure. The American College of Preventive Medicine and the American Medical Association are two such organizations that are providing training to physicians and developing tools to incorporate into this training. To address the pediatric population, the American Academy of Pediatrics, Children's National Medical Center, pediatric allergists, family physicians and others are working on the identification of best practices, promotion of systems changes and creation of a network of pediatric champions to educate parents.

To illustrate some of the work being done by the American Academy of Pediatrics, Ms. Cotsworth introduced the next speaker.

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