Roundtable Discussion on Ways to Work Together
September 18, 2007: Reducing Children's Exposure to Secondhand Smoke
Moderator: Elizabeth Cotsworth, M.A., Director, Office of Radiation and Indoor Air Environmental Protection Agency
- Debbie Montgomery, M.P.H.: Director, Secondhand Smoke Initiatives, Colorado Department of Health and Environment
- Brenda Bell Caffe: Executive Director, Not in Mama's Kitchen
- Jesse Nodora, DrPh: Research Assistant Professor, Arizona Cancer Center
- Amanda Bryans: Director of the Educational Development and Partnership Division, Office of Head Start, Administration for Children and Families
- Jonathan Winickoff, M.D., M.P.H.: American Academy of Pediatrics Tobacco Consortium
- Cathy Backinger, Ph.D., M.P.H.: Tobacco Control Research Branch, NCI
Ms. Cotsworth introduced the afternoon panelists and provided a brief bio-sketch of each member. She then posed a series of questions to the panel and a summary of panelist responses follows.
Question: Ms. Cotsworth asked the panelists to briefly describe their experience and involvement in reducing children's exposure to secondhand smoke.
Response: Panelists' experience working to reduce childhood exposure to secondhand smoke ranges from working directly with families in community-based settings to overseeing a state tobacco control program where addressing secondhand smoke exposure is one element of a comprehensive tobacco control program. Panelists also discussed their experience in helping parents move along the continuum in their readiness to quit through the Head Start program as well as in physician's offices. One panelist talked about her work in addressing the issue from a research perspective.
Question: Panelists were asked to describe effective approaches to working with parents and the elements that make these approaches effective.
Response: Involving parents in changing norms around tobacco use is critical and when physicians (and other trusted sources) provide parents with information about the health risks from exposure and/or advice to quit. Because information and education alone doesn't change behavior, policies that eliminate exposure and increase cessation (tax increases, systems changes, clean indoor air laws) are critical. Mass media campaigns can also be very powerful and because behavior change is a long and difficult process, consistent messages delivered over a long period are very important.
Question: Panelists were asked to comment on barriers to advising caregivers to quit and to identify effective strategies for providing this advice.
Response: When pediatricians provide parents with advice to reduce exposure or to quit and offer medication to assist them, a majority of parents accept this assistance. Pediatricians can be effective in helping parents understand that there is NO safe level of exposure and that smoking in the home—even when children are not at home—is polluting the environment with "3rd hand smoke."
Question: Noting that Admiral Moritsugu began the meeting with a charge to the Committee to reconvene in two years to discuss progress made around decreasing children's exposure to secondhand smoke, Ms. Cotsworth asked panelists to share ideas about ways progress could be made in the intervening two-year period.
Response: Although significant barriers exist to addressing this problem, it is important that progress continues even though the evidence base is still not sufficient about effective approaches. For example, the problem of drifting smoke in apartment buildings was noted. It was suggested by some that we consider implementing promising approaches and evaluate the results.
Question: The final comment posed to panelists and the entire ICSH Committee was to consider commitments that could be made on behalf of individuals and/or organizations to eliminate the problem of secondhand smoke exposure among children.
Response: Committee members offered to share the meeting information with colleagues but acknowledged that most were not able to offer commitments on behalf of the agencies/organization that they represent until first discussing it with leadership.
Following the roundtable discussion, Admiral Moritsugu asked for public comments.
Dana Best, Children's National Medical Center, commended the Committee for addressing the issue and confirmed that secondhand smoke exposure is a major public health problem that continues in day care centers, foster family settings and other places where children continue to be exposed.
Jeannette Noltenius, Strategic Solutions, noted that Congress was currently considering legislation to raise the federal tobacco tax to fund the children health insurance program S-CHIP. Relating to the issue of sustainability, she added that a portion of the proposed tax increase should be used to support comprehensive tobacco control programs.
Jack Henningfield, Pinney Associates, questioned whether smokeless tobacco use should perhaps be advocated for as a way to address secondhand smoke concerns. He encouraged the Committee to consider adding this issue to a future agenda.
Following public comments, Admiral Moritsugu thanked speakers, panelists and Committee members for their participation. He also acknowledged Simon McNabb, OSH Policy, Planning, and Coordination Unit Team Lead, for his work with the Surgeon General's Office in producing the most recent report The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Mr. McNabb was presented with a plaque.
In the coming two year period Admiral Moritsugu encouraged the Committee and meeting participants to continue to move research and science into practice, involve communities most directly affected by the epidemic in these efforts, and continue to consider what action can be taken both by the private and public sectors to change the culture around this issue. He suggested the possibility of creating a "list-serve" as a forum for continuing discussion of this issue among ICSH Committee members. Finally, Dr. Moritsugu thanked Committee members for their commitment and expressed appreciation for the opportunity to chair this meeting for the last time before his retirement.
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