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NO SAFE LEVEL

March 5, 2007: Reducing Exposure to Secondhand Smoke






Jonathan Winickoff, M.D., Tobacco Consortium, American Academy of Pediatrics

Dr. Winickoff began by dedicating his remarks to Dr. Julius Richmond who encouraged him to pursue his goal of eliminating secondhand smoke exposure in children.

Data from the American Academy of Pediatrics (AAP) suggest that counseling by doctors might encourage nonsmokers to protect themselves from smokers by enforcing a no-smoking rule in the house. However, the data also suggest that many clinicians miss the opportunity to provide this advice. Dr. Winickoff suggested to the Committee that systematic assessment and counseling for secondhand smoke exposure be made a priority.

While many parental smokers continue to fall through the healthcare "cracks" because they don't often see their own primary doctor, this is not the case for their interaction with pediatricians. In fact, most parents will see their child's doctor 15 times in the first two years of each child's life. Therefore, to treat parental smokers and to protect children, the child healthcare setting should be used to establish no-smoking rules in the home and car and link parents to available quitlines and other cessation services in the state.

Similar to the approach for lead poison testing, Dr. Winickoff suggested an approach to testing for secondhand smoke exposure. A nationally representative survey conducted by Mississippi State University found that 78% of nonsmoking parents and 82% of smokers would accept a blood test to measure secondhand smoke exposure in their children. This kind of documentation of exposure might help non-smoking parents better advocate for safer environments for their children.

A surprising finding from AAP's 2006 survey found that health beliefs about secondhand smoke are not associated with home and car smoking bans. People know that secondhand smoke is dangerous and have known it for years. However knowing that contamination continues to exist after the cigarette is extinguished is a newer concept to many and appears to lead to a 2-3 fold increase in support for smoking bans in public places.

Dr. Winickoff closed his remarks by reiterating his vision and his desire to help people understand there is "NO SAFE LEVEL" from exposure to secondhand smoke. His vision focuses on using the child healthcare setting as a point of access to the families of every child exposed to secondhand smoke, and every parental smoker. The clinical tools exist for this effort but they must be tailored by each state and then widely disseminated.

Following Dr. Winickoff's remarks, Dr. Noonan introduced the next speaker.

 
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