On 24 March 2010 the Tobacco Advisory Group of the Royal College of Physicians launched its most recent report on passive smoking and children, in which it examines the case for public health action to increase the protection of children from second-hand tobacco smoke. EPHA attended the report launch, where the authors discussed their findings.
The report assessed the levels of protection afforded by the current legislation, made recommendations as to future measures to increase protection and discussed the moral and ethical considerations important to the tobacco control debate.
Throughout the report there is a clear focus on children as a vulnerable group, but the report also emphasises that children from low socio-economic backgrounds are disproportionately exposed to second-hand smoke. The policy recommendations include an extension to smokefree legislation to ensure that children are protected to the greatest possible degree.
Smoking at home and in other private enclosed areas is a major issue for children’s health. Children from low socio-economic backgrounds are excessively exposed to second-hand smoke in these environments. There is a well-established causal link between exposure to tobacco in the home and increased disease risk among children, and there are long-term costs in terms of increased uptake of smoking among children who are exposed at home and poorer health outcomes later in life.
When considering the moral and ethical concerns surrounding legislation that enters the private sphere (such as restrictions on smoking in the home or in cars), there is often an uneasy balance to be sought between the privacy of parents and the rights of the child. The objectives are clear: to protect direct harm, to prevent or limit the influence of negative health behaviour role models on the child, and to make tobacco less visible and attractive. Furthermore, public health experts argue that a proportionate reaction to the aggressive marketing and promotion of tobacco is needed to protect children.
The totality of the evidence documenting the public health impact of second-hand smoke on children is conclusive. The majority of passive smoking occurs in the home and children are the prime victim. It is therefore a legitimate public health concern. Whilst there is ongoing work focusing on the price, promotion and sale of tobacco and a sustained commitment to smoking cessation and harm reduction, there needs to be a public debate on extending smokefree environments to those areas frequented by children, including the private sphere. Smokefree public places, such as beaches and parks are an immediate aim with smokefree homes and smokefree cars also to be considered. Achieving this crucial next step will require a number of key allies, including safety groups and public service workers, and a concerted effort at the local level to mobilise local voices on this highly sensitive issue.
The launch event at the Royal College of Physicians
The Chief Medical Office for England, Sir Liam Donaldson, wrote the foreword to the report and spoke at the launch event, where he highlighted the fact that children’s health should always be a priority. Furthermore, he emphasised that the public are particularly concerned with protecting children’s health, and this should be the argument used in public campaigning for increased measures to reduce passive smoking. He also argued that by extending zonal smokefree legislation to include all public areas with a high number of children, it could encourage adult smokers to consider giving up. The more a nicotine addict is forced to withdraw from smoking (smokefree transport, smokefree workplaces) the more likely it is that there will be a tip in the balance and the nicotine addiction will be eroded.
Deborah Arnott from Action on Smoking and Health reminded the participants of the successes of the current smokefree legislation but went on to identify important situations and environments not covered by legislation. Smokefree legislation across the UK, introduced gradually from 2007, has seen high and sustained compliance, with huge improvements in air quality and a reduction in workers’ exposure. Moreover the legislation has been highly effective in reducing population-level exposure. Certain extensions to the legislation have proved popular with the public (both smokers and non-smokers), such as in hospital grounds and sports venues. Countries with similar legislation in place have also introduced popular extensions to include public parks and beaches. This is something that the UK should consider when the legislation is revised. However, she recognised that private enclosed spaces (such as homes) are a much more difficult issue to address sensitively.
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