Protecting children from second-hand smoke

Abstract

@ERSpublicationsEffects of smoke-free legislation on paediatric RTIs: more evidence that child health can be easily improved http://ow.ly/OPcWdSince the 1970s, we have known that second-hand smoke (SHS) makes children sick, but we have only recently begun to quantify tobacco-related ill health, and to monitor the effects of public health interventions. In this issue of the European Respiratory Journal, BEEN et al.[1] quantify, for the first time, the effects of smoke-free legislation on hospitalisations for paediatric respiratory infections.In 1974, two Lancet papers found that infants with smoking parents had higher hospital admission rates and higher risks of pneumonia and bronchitis [2,3]. Since then, an accumulating body of evidence has confirmed a higher incidence of cough, wheeze, asthma, upper and lower respiratory tract infections (RTIs), preterm birth, and sudden infant death [4][5][6]. Globally, ∼40% of children are exposed to SHS [7]. OBERG et al. [7] conservatively attributed 603 000 deaths (1% of all deaths) and 10.9 million disability-adjusted life years (DALYs) (0.7% of all DALYs) to SHS, based on area-specific prevalence of those exposed, and on disease-specific risk estimates for lower respiratory infections, otitis media, asthma, lung cancer and ischaemic heart disease. For this assessment, the authors considered only the listed outcomes with level "A" evidence; real numbers will be higher. Children accounted for 166 000 (28%) deaths and for 6.6 million (40%) DALYs caused by SHS; and within childhood disease, lower respiratory infections were most relevant. SHS is a group 1 carcinogen with no safe levels, and children with their immature immune system and developing lungs are particularly vulnerable [8].Parents, who smoke at home or in the car, are responsible for children's exposure to SHS [9]. To improve child health, we therefore need interventions targeted at adults: preventing them from taking up smoking, or helping them quit. One approach is that of individual prevention, which attempts to change parents' attitudes and educate them through individual counselling, education or smoking cessation programmes. A second approach is structural, which depends on changing the environment and organisational structures by methods such as economic incentives, reducing the availability of cigarettes, tobacco-free advertising, or smoke-free public spaces [10].Individual prevention remains important in clinical practice. Combining medication and counselling by a physician doubles the chance that individual smokers will quit, and is more cost-effective than other clinical interventions [10]. However, absolute rates of quitting remain low and smoking cessation programmes, including nicotine replacement therapy, electronic cigarettes and nicotine vaccines have small effects [11][12][13]. Even when patients are severely ill with COPD [14], or are offered financial rewards for successful quitting [15], quit rates hardly exceed 15%. Families of lower socioeconomic status (SES), who have a higher prevalence of...

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