Acute Coronary Syndrome: Patterns and Correlates of Household ...

Acute Coronary Syndrome: Patterns and Correlates of Household ...

SECONDHAND SMOKE: THE IMPORTANCE OF SMOKE-FREE ENVIRONMENTS Mini-Lecture 4 Module: Tobacco and Community Medicine and Public Health Objectives of the Mini Lecture GOAL OF MINI LECTURE: Provide students with an understanding of the importance of smoke-free environments.

LEARNING OBJECTIVES: Students will be able to: Understand the definition of secondhand smoke. Review the harmful effects of secondhand smoke to adults and children. Discuss the critical importance of creating smoke-free environments. Become familiar with existing laws and policies regarding second hand smoke. Contents Core Slides

Optional Slides 1. 2. 3. 4. 5. 6. 7. 8.

1. Smoke-Free Environments (SFEs) 2. Smoke-free Homes: India and Indonesia 3. Smoke-free Initiatives: India 4. India: Current Laws Against SHS 5. Measuring SHS Exposure 6. Smoke-free Workplaces and Public Places 7. Global Youth Tobacco Survey (GYTS): Global Data on SHS

Secondhand Smoke (SHS) What is SHS? SHS and Adults SHS and Children Global Toll of SHS Global Death Toll of SHS Why Go Smoke-free? Reducing SHS Exposure in the Home 9. Household Survey Findings: India

CORE SLIDES Secondhand Smoke: The Importance of Smoke-free Environments Mini-Lecture 4 Module: Tobacco and Community Medicine and Public Health Secondhand Smoke (SHS) Also known as: Passive smoking Involuntary smoking

Environmental tobacco smoke (ETS) http://www.smokefreesouthyorkshire.com/images/beer.gif US Department of Health and Human Services (USDHHS) / Centers for Disease Control and Prevention (CDC) 2006 What is SHS? SHS = Exhaled main-stream smoke plus side-stream smoke Main stream: generated at high

temperatures, inhaled by smoker and exhaled Side stream: generated at lower temperatures and tends to have higher concentrations of all toxins US Department of Health and Human Services (USDHHS) / Centers for Disease Control and Prevention (CDC) 2006 http://1.bp.blogspot.com/_919KGO0U6Zs/SR5Ywkfin6I/AAAAAAAABjY/N39Xglz0G0Y/s400/smoke.jpg

SHS and Adults Increased risk of morbidity and premature mortality from: Lung cancer1 Chronic obstructive pulmonary diseases2,3 and asthma4 Sub-arachnoid haemorrhage and stroke5 Ischemic heart diseases1 and atherosclerosis6 Increased insulin resistance6 Increased risk of diabetes7,8 Tuberculosis3 1. Gan et al. 2008; 2. Yin et al. 2007; 3. Leung et al. 2010; 4. Aggarwal et al. 2004; 5. Anderson et al.

2004; 6. Barnoya et al. 2005; 7. Hayashina et al 2008; 8. Houston et al. 2006 SHS and Children SHS is a pediatric priority1 associated with:2 Respiratory tract infections Sudden infant death syndrome (SIDS) Bacterial meningitis Middle ear infections Asthma (increased frequency and severity)

http://i-will-quit-smoking.com/the-facts-about-smoking-that-will-make-you-quit 1. Prokhorov et al. 2006; 2. World Health Organization 2005 Global Toll of SHS Globally, 40% of children, 35% of female non-smokers, and 33% of male non-smokers were exposed to SHS (2004). In some regions (Southeast Asia, Western Pacific), more than 60% of children and more than 50% of adults were exposed to SHS. Harm from SHS disproportionally affects children and

women. Global Death Toll of SHS Exposure to SHS caused 603,000 deaths among nonsmokers (2004): 379,000 deaths from ischemic heart disease 165,000 deaths from lower respiratory infections 64,000 deaths from asthma 21,400 deaths from lung cancer 50% of deaths are women; 28% are children < 5 Why Go Smoke-Free? Protects non-smokers, which results in decreased

heart disease mortality: Reduces SHS exposure and creates conducive environment for smokers to quit. Ventilation and filtration: ineffective Fully protects workers and the public Prevents initiation of smoking among youth by normalizing non smoking 1. World Health Organization 2007 Reducing SHS Exposure in the Home Households are the main sites for SHS exposure for

women and children. Legal and regulatory policies affect worksites and public places, not homes. A 31 country study found that 88% of parents who smoked did so at home and near their children.1 Creating and enforcing smoke-free homes is critical to improve the health of women and children worldwide. Household Survey Findings: India Surveys conducted in households (n= 1306) in Kerala found that:

In over 35% (n=464) of households surveyed, there was a smoker. 95% (n=409) of women reported that they and their children were sometimes or often exposed to SHS smoke indoors or outdoors. 75% of women reported that they and their children were sometimes or often exposed to SHS smoke at home. 76% of women said they had no rules in their home about smoking. OPTIONAL SLIDES Secondhand Smoke: The Importance

of Smoke-free Environments Mini-Lecture 4 Module: Tobacco and Community Medicine and Public Health Smoke-Free Environments (SFEs) http://focus.hms.harvard.edu/2001/May18_2001/research_briefs.html Smoke-free environments (SFEs): the only proven way to adequately protect the health of all people from SHS

1. World Health Organization 2007; 2. Al-Delaimy et al. 2001 Smoke-free Homes: India and Indonesia Project QTI is empowering women to ask men not to smoke in their households. Smoke-free Initiatives: India1 A study from Bihar: Teachers smoked less in schools with a no-smoking policy. Tobacco-free town in Kerala: Koolimadu village, started

when a chain smoker from the village died of cancer. Indian railways: Banned smoking in all its service areas. Though important, such legislation is difficult to enforce. 1. Report on Tobacco Control in India 2004 India India: Current Laws Against SHS Cigarettes and Other Tobacco Products Act (COTPA) 2003: Extends to whole of India & applicable to all products containing tobacco in any forms

Section.4 - Prohibition of smoking in public places 1. Government of India: The Cigarettes and Other Tobacco Products Act, 2003 Measuring SHS Exposure Questionnaire1 Air nicotine level2 Cotinine levels in blood, saliva, or urine and nicotine levels in hair3 1. US Department of Health and Human Services (USDHHS) 2006; 2. Wipfli et al. 2008; 3. Benowitz 1999

Smoke-free Workplaces and Public Places Ireland: the first nation to create and enjoy smoke-free indoor workplaces and public places, including restaurants, bars, and pubs (March 2004).1 Other countries with smoke-free indoors: Norway, New Zealand, Italy, Uruguay, Canada (80%), USA (50%), and Australia.1 1. World Health Organization 2007

Global Youth Tobacco Survey (GYTS): Global Data on SHS1 Global Youth Tobacco Survey (GYTS) among students aged 13 to 15 years in 132 countries between 1999 and 2005 (developed by WHO and the US Centers for Disease Control and Prevention (CDC)): Students exposed to SHS at home: 43.9% Students exposed to SHS in public places: 55.8% Students expressed support for smoking bans in public places: 76.1% 1. World Health Organization 2007; 2. Warren et al. 2000

The most important health message a doctor can give to patients is to quit smoking.

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