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How Can I Quit Passive Smoking?

Posted on: Friday, 21 October 2005, 03:01 CDT

By Richardson, George; Eick, Susan

ENVIRONMENTAL HEALTH

Abstract

Passive smoking is a topical subject and there is a concerted movement to increase public understanding of the dangers of passive smoking. Although it looks likely that smoking could be banned in public places in the UK by the year 2008, it will still be difficult to enforce smoking bans in the last bastion for the smokers - their homes. Many smokers are aware of the risk their smoking causes their families through passive smoking but do not realise that the only true method for them to reduce exposure for their family is to smoke outside the home. This is partly because of a lack of understanding of the behaviour of environmental tobacco smoke and how smoking in restricted areas alone will not eliminate passive smoking for other family members in their homes.

Key words: environmental tobacco smoke, passive smoke, home smoking bans, smoking restrictions

Community practitioner 2005; 78, 10: 356-357

Introduction

Passive smoking is detrimental to health, particularly for young children1 and it is estimated that 11,000 people in the UK die from the effects of passive smoking at home each year.2

There is now a strong emphasis on educating people about the negative health effects of passive smoking, take for example, the shocking national television campaign showing infants exhaling smoke, right.

Passive smoking can be defined as the involuntary act of inhaling environmental tobacco and/or cannabis smoke, released both from the burning end of a cigarette and the smoker's exhaled smoke.

The combustion processes, which occur during smoking, produce a complex toxic aerosol containing vapours, particles and gases.3

The decision to ban smoking in public places in England by 2008, will help to highlight the risk of passive-smoking in general. The impending ban may reduce the number of smokers as the stigma of smoking increases. For some family members however, it may lead to an increased risk of having to endure increased passive smoking in an already highly polluted environment - their homes,4 since zealous smokers will insist on smoking somewhere indoors.

The Imperial Cancer Research Campaign found 'damning' evidence that family members living with a smoker have a fourfold increased risk of passive smoking, compared to non-smoking families.5 The new legislation will provide non-smoking family members with a strong argument to ban smoking in their homes.6

The importance of reducing exposure to environmental tobacco smoke is appreciated by the public and there is an increasing acceptance of smoking bans in public places.7

Confusion over smoking restrictions

Despite extensive public campaigns, there is still confusion about the measures that should be taken in the home to reduce passive smoking.

Presently, the anti-smoking campaign literature as offered by the Department of Health8 states that smoking should not take place at all in the home environment. The Department of Health is correct in its approach, since there is no 'safe' place to smoke indoors, without environmental tobacco smoke spreading throughout a home, including upstairs bedrooms.

During recent research involving quantitative environmental measurements in >200 homes,9-10 the authors have had first-hand experience of the confusion that exists over smoking restrictions. Many of the participants who smoked proudly proclaimed that they no longer smoked in front of their children and only smoked in one room, Although there is tremenpus merit to be awarded these families, as they had reduced their children's direct exposure to environmental tobacco smoke, they were convinced that they had eliminated their family's exposure throughout their homes.

The families were shocked when shown the number of smoking- related particles in their children's bedrooms and throughout the house despite their best endeavours to restrict the effect of smoking. The concentration of fine particles (with a diameter of <2.5m) found in a smoker's home is normally considerably higher than background outdoor concentrations.11

Our observations about smoking restrictions are similar to results established by a study conducted in the West Midlands of 314 households with smokers and infants.12 It was found that although 86% (264/307) of the parents in the study realised that passive smoking was harmful to their infants, only 18% (58/314) banned smoking in their home.

Restriction strategies were used by 65% (205/314) of the parents to reduce exposure, but this had no effect on cotinine levels in the participant's urine confirming that there is a misconception that smoking in restricted areas indoors will prevent exposure to environmental tobacco smoke.

Characteristics of environmental tobacco smoke

Ventilation can remove odour and visible smoke but is normally inefficient at removing some of the toxic components of environmental tobacco smoke, notably fine particles from indoor air.13-14

Some components of environmental tobacco smoke react with other pollutants in ambient air and sunlight, producing further chemicals with toxic properties.15 People are not aware of the possible combined negative health effects of other pollutants in combination with tobacco smoke ie, radon decay products,16 allergens, mould spores.17 Environmental tobacco smoke in rooms other than the main smoking area is not easy to detect or remove because:

* The movement of the finest (particle) components of environmental tobacco smoke are mainly influenced by Brownian motion (molecules 'bouncing' off each other) and electrostatic forces (static on walls, television screens etc, attracting or repelling the particles),18 therefore the particles remain airborne for long periods and spread easily around the home.

* Aged smoke, partially diluted by indoor air, is difficult to smell since the aromatic volatiles quickly disperse.19 This is further compounded by the fact that the tobacco industry has made concerted efforts to mask the odour of environmental tobacco smoke,20 making it even less detectable indoors.

Presently smokers have difficulty in understanding the need to physically leave a building if they wish to smoke, when traditionally air filters, ventilation systems, designated smoking rooms have been offered to them as the way to avoid exposing others to their smoke. It might well be that information about the behaviour of environmental tobacco smoke needs to be incorporated into smoking awareness programmes and a family may require personalised counselling from health professionals in their own homes to fully appreciate the behaviour of environmental tobacco and cannabis smoke.21

Conclusions

Comprehensive information needs to be given to smokers about the behaviour of tobacco smoke in their homes for them to appreciate the requirement to stop smoking at home altogether.

In the UK, such counselling might be carried out by frontline health professionals, such as health visitors and community nurses, family support workers and others who are already spreading the message of antismoking campaigns.

Passive smoking is detrimental to health, particularly for young children1 and it is estimated that I 1,000 people in the UK die from the effects of passive smoking at home each year2

Although it looks likely that smoking could be banned in public places in the UK by the year 2008, it will still be difficult to enforce smoking bans in the last bastion for the smokers - their homes

References

1 Witorsch RJ, Witorsch P. Environmental tobacco smoke and respiratory health in children: A critical review and analysis of the literature from 1969 to 1998. Indoor and Built Environment2000; 9,1: 246-264.

2 Jamrozik K, Estimate of deaths attributable to passive smoking among UK adults: database analysis. British Medical Journal 2005; 330, 7495: 812-815.

3 Gold DR. Indoor air pollution. Clinics in Chest Medicine 1992; 13,2: 2151-2229.

4 Mumford EA, Levy DT, Romano EO. Home smoking restrictions. Problems in classification. American Journal of Preventative Medicine 2004; 27, 2: 126-131.

5 BBC News. Passive smoking greater in the home. 2005. http:// news.bbc.co.Uk/l/hi/health/1752754.stm [Accessed 11 July 2005].

6 Action on Smoking & Health, Passive smoking: The impact on children. 2002. http://www.ash.org.uk/ html/passive/html/ kidsbrief.html [Accessed 1 July 2005].

7 McKee M, Hogan H, Gilmore A. Why we need to ban smoking in public places now. Journal of Public Health 2004; 26,4: 325-326.

8 Department of Health. P is for protecting babies and children from second hand smoke, London: Department of Health, 2003.

9 Richardson G, Barton A, Basham M, Foy C, Eick SA, Somerville M, on behalf of the Torbay Healthy Housing Group, Torquay, UK. The Watcombe Housing Study: the short-term effect of improving housing conditions on the indoor environment. Science of the Total Environment 2005; In press.

10 Richardson G, Eick SA. A breath of fresh air: Project Findings. In Proceedings; A Breath of Fresh Air Conference, Goonhilly Satellite Earth Station, Lizard Peninsula, Cornwall, UK; 2 September 2004. p21-30.

11 He C, Morawska L, Hitchins J, Gilbert D. Contribution from indoor sources to particle number and mass concentrations in residential houses. Atmospheric Environment 2004; 38, 21: 3405- 3415.

12 Blackburn C, Spencer N, Bonas S, Coe C, Dolan A. Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey. British Medical journal 2003; 327: 257-260\.

13 Carrington I, Watson APR, Gee IL. The effects of smoking status and ventilation on environmental tobacco smoke concentrations in public areas of UK and bars. Atmospheric Environment 2003; 37, 23: 3255-3266.

14 Harrje DT, Janssen JE, A standard for minimum ventilation. In Proceedings: 5th AIVC Conference. The implementation and effectiveness of air infiltration standards in buildings. Reno, Nevada, US; 1984. p3.1-3.16.

15 California Environmental Protection Agency. Proposed identification of environmental tobacco smoke as a toxic air contaminant. California, US: California Environmental Protection Agency, 2004.

16 Tekbas F, Vaizoglu SA, Glec M, Gler C. Effect of smoking on the level of ionising radiation in student rooms, indoor and Built Environment 2003; 12, 1: 197-200.

17 Strachan DP. The role of environmental factors in asthma. British Medical Bulletin 2000; 56, 4: 865-882.

18 Pethig R. Survey of the methodology for evaluating negative air ions: Relevance to biological studies. Methods in Enzymology 1984; 105: 238-247.

19 Baek SO, Jenkins RA. Characterization of trace organic compounds associated with aged and diluted sidestream tobacco smoke in a controlled atmosphere - volatile organic compounds and polycyclic aromatic hydrocarbons. Atmospheric Environment 2004; 38, 38: 6583-6599.

20 Connolly GN, Wayne GD, Lymperis D, Doherty MC. How cigarette additives are used to mask environmental tobacco smoke, Tobacco Control 2000; 9: 283-291.

21 Hovell MF, Zakarian JM, Matt GE, Hofstetter CR, Bernert JT, Pirkle J. Decreasing environmental tobacco smoke exposure among low income children: preliminary findings. Tobacco Control 2000: 9: 70- 71.

George Richardson

PhD student

Faculty of Health & Social Work, University of Plymouth

Email: ionian@tiscali.co.uk

Susan Eick

Resource and resolutions officer

AC & TLtd

Copyright TG Scott & Son Ltd. Oct 2005

Source: Community Practitioner

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