Reducing Secondhand Smoke on Children - Research Paper Example

Reducing Secondhand Smoke on Children Reducing Secondhand Smoke on Children Introduction Secondhand smoke (SHS) is the inhalation of others peoples smokes from tobacco. It is also known as passive smoking, environmental tobacco smoke (ETS) or involuntary smoking. Inhaling secondhand smoke is inevitable especially when one is in smoke-filled surroundings. The mainstream smoke inhaled by the smoker contains numerous particles and gases some of which cause cancer in humans. Children are most vulnerable to secondhand smoke as they breath more rapidly thus inhaling more pollutants as compared to adults. The hand to mouth behaviors also contributes to high inhalation of tobacco quantities. Finally, the vulnerability of children to second hand smoke exposure and the adverse health impacts of exposure is due to the fact that they have weak immune system compared to adult (Jones et al., 2011). Reducing exposure to secondhand tobacco smoke is key health priority that has forced many countries to enact legislation. Many policy makers and legislators focus on protecting children from exposure to secondhand smoke. To achieve this, the most important thing is to reduce secondhand smoke exposure at home since children pass most of their time there. Surveys have linked reduction in secondhand smoke exposure in children with caregiver’s ability to stop the smoking habit (Jones et al., 2011). Background Information Secondhand smoke from tobacco forms the key, and most common manmade airborne pollutant (Liu and Zhu, 2010). Secondhand smoke exposure remains the leading preventable cause of death in the USA. SHS consists of a mixture of gases that contain toxic and carcinogenic compounds that result from tobacco smoking in an enclosed area. The exposure of SHS in children has involuntary and mostly occurs when adults smoke in places where they live and in playground. Secondhand smoke exposure imposes danger to children as it linked to cardiovascular and respiratory diseases globally (Omoloja et al., 2013). These diseases form primary cause of the increasing children mortality and morbidity rates. The adverse health effects secondhand smoke exposure in children include bronchitis, pneumonia, respiratory illness, reduced pulmonary functions, ear infections and behavioral problems. The greater extent to exposure leads to higher risk of complication. World Health Organization (WHO) recommends the legislation and education on the use of tobacco to protect children from SHS. Regardless of formulation of community based policies aiming at control of tobacco use in public, children are still vulnerable to tobacco toxins at home and even when travelling. In the USA particularly, more than one third of children and teenagers live in environments where occupants and close guests smoke regularly (Tyc et al., 2013). The legislation has no much control in reducing the exposure in individual’s households. However, through educational strategies of creating awareness to the community members and in particular the decision makers in household can help eliminate the SHS in children. Significance of Problem The study will be of major use to parents/guardians being the people who spend much of their time at home with children. It will enhance their understanding of the effects of secondhand smoking and the health dangers they are exposing their children to through smoking. Understanding on the effects of secondhand smoking will help clinicians in giving counselling to parents on smoking habit cessation and smoke exposure elimination. The research will remain imperative for the government in developing interventions to improve the overall health of the children. Finally, the study will help in creating awareness of the communities on the effects of second health smoking and, as a result, reduce or eliminate the habit of indoor smoking in household settings (ASH report, 2014). Statement of the Problem Tobacco use has become worldwide concern. Globally, approximately 40 percent of children cases reported emerge from exposure to secondhand smoking. In the UK alone, report shows that 2 million children regularly have exposure to secondhand smoking at home (ASH report, 2014). This shows that homes forms main source of secondhand smoke exposure in children. The estimated figure of male and female smokers accounts approximately one billion and 250 million respectively. On a daily basis, 82000 to 99000 young people start the smoking habit (Lando et al., 2010). This number consists of children under the age of ten years who reside in low and middle income countries. Purpose of the Study The basic goals behind this study involves developing and accessing an intervention that can reduce children exposure to secondhand smoke at homes. Besides, the study will examine the effects of secondhand smoking on children’s health. The study will also explore a few social and cultural barriers and the driving force towards smoking in the homes. Literature Review Different researchers have tried to explore the issues of secondhand smoke exposure and the effect it has on children health. This review will identify some of the key findings from the literature. Additionally, the review will examine a few social and cultural barriers and the motivators towards smoking in the home (Kanire, 2012). Summary of the Confirmation for the Proposed Study This section summarizes the key findings from the literature review. The literature review in this study has grouped into the following subtopics Effects of exposure to secondhand smoke on child health and in the fetus The prevalence of secondhand smoking in the home Interventions and restrictions on smoking in the home Views of health specialists on interventions of ensuring homes are smoke free The effect of the legislation on exposures to secondhand smoking in homes Smoking and stigma The prevalence of secondhand smoking in the home According to IARC (2009), 44 percent of children aged between 13 to 15 years worldwide exposed to secondhand smoke exposure in their homes.43.9 percent of the children reported to have secondhand smoke exposure at home while 46.5 percent reported having one or both of the parents who smoke. The narrow gap between those children with secondhand smoke exposure at home and those children reporting to have one or parents who smoke shows that there exist a close correlation between secondhand smoke exposure in dwelling places and population smoking prevalence. The rate of smoking in destitute areas rises higher above the average rate. The high rate of smoking increases the risks of secondhand smoke exposure in children. Socio economic status found to predict the rates of smoking in the community. High smoking rates linked to issues such as poor housing, unemployment, low income, overcrowding, sole parenthood and homelessness (Akhtar et al., 2009). In their study of primary school pupils in Scotland after the enacting of smoke free legislation (Akhtar et al., 2009) noticed that cotinine levels were high in children from low income backgrounds as compared to children from high income backgrounds. A more recent survey in primary schools in Scotland specifically in Wales and North Ireland showed social inequalities in secondhand smoke exposure in children from different social economic backgrounds before and after the enacting of the smoke free legislation (Moore et al., 2012). The measure of cotinine level from the children showed there was no detectable cotinine after the implementation of the legislation. Hennessy, Bleakley, Mallya, and Romer (2014) noted that messages that show negative health impacts secondhand smoke exposure in children increases the incidences of indoor smoking ban in the homes. Effects of exposure to secondhand smoke during pregnancy Exposure to secondhand smoke during pregnancy has detrimental impacts to the mother as well as the fetus. These effects range from low birth weight, preterm delivery and even impaired fetal growth. (Wahabi et al., 2013) conducted a study in Saudi by on the effects of secondhand tobacco smoke exposure on newborns. In their survey, the 31 percent of the mothers in the sample shows their exposed to secondhand smoke. The mean weight of the infants from the exposed mothers was considerably lower by 35g and the average length of the infants was shorter by0.261 centimeters as compared to the infants whose mothers did not subjected to secondhand smoke exposure. The study revealed that those women exposed to secondhand smoking involves young women, has low parity and the likelihood that they illiterate as compared to unexposed mothers and less likely to be the first time mothers. The major source of secondhand smoke exposure in non-smoking expectant women is from their husbands. A study conducted in China by Lian, Tong, Zhengzhong and Teh-Wei, (2010) reported that 75.1% of non-smoking women with husbands who smoke have regular secondhand smoke exposure. In their analysis, the researchers found increased level of nicotine concentration in hair in women based in rural areas. The women had little knowledge on SHS; low negative attitude towards secondhand smoke exposure and their homes did not have smoking rules. Exact identification of secondhand exposure among expectant women forms a key step to preventing negative impacts on maternal and infant health (Eiden, et al. 2011). Effects of exposure to secondhand smoke on child health Essentially, children occupy most of their available time at residence. Therefore, their chances of experiencing extreme and even persistent secondhand smoke exposure are high especially where the parents are smokers. Exposure to secondhand smoke also referred to as environmental tobacco smoke or passive smoking. As said earlier, children exposure to secondhand smoking associated with the rise in risks of respiratory tract infections, ear infections, sudden unexpected death in children and asthma. A review conducted (Orton, Jones, Cooper, Lewis and Coleman, 2014) found the existence of a link between secondhand smoke exposure at home and factors such as parental smoking, low literacy levels and low socioeconomic status (Bolte and Fromme, 2009). In addition, the review showed that children whose parents have a negative attitude towards secondhand smoke were less likely to be exposed. Data collected from 54 homes in Scotland shows that in 89 percent of the homes the concentration of the particulate matter PM was higher above the health based guidance depending on the time of the day. The concentration was highest between 6pm to midnight (Mills et al., 2012). The survey revealed that the concentration of cotinine in saliva was high in younger children as compared to the older ones. A number of survey data reveal that parents may have insufficient knowledge about the health impacts of children exposure to secondhand smoking. A household survey covering 318 households with a minimum of one child who is less than 16 years shows that a vast number of the participants knew of the negative impacts of secondhand smoke exposure irrespective of whether they are smokers or not. However, when asked about the effects of secondhand smoke exposure on children a large number of the participants gave breathing problem and passive smoking as the major adverse impacts on children’s health (Alwan, Siddiqi, Thomson, and Cameron, 2009). Legislation to ensure smoke free environment Legislation that prohibits smoking in public areas has been associated with a reduction in secondhand smoke exposure in children. A survey conducted in South Africa on secondhand smoke exposure and voluntary adoption of smoke free rules on smoking shows that 70.6 percent of South African adults has 100 percent smoke free rule in their personal cars, 62.5 percent of their homes and 63.9 percent worked in places with 100 percent smoke free policies. In total, 55.9 percent of all nonsmokers reported secondhand exposure from at least one source either in the home, hospitality venue or at the workplace. 18.4 percent exposed to secondhand smoke at the place of work, 25.2 percent in their homes, 33.4 percent in a restaurant and 32.7 percent in a bar. ( Ayo-Yusuf, Olufajo, and Agaku, 2014). Smoke free legislation is an effective intervention for ceasing the smoking habit. After the implementation of smoke free legislation, surveys have revealed that states such the US, Italy, Scotland and Canada have reported a reduction in smoking prevalence. In England, Scotland and Ireland smoke fee legislation have seen smoking citizens quit the smoking habit (Chan et al., 2014). The effect of tobacco legislation on exposures to secondhand smoking in homes A number of studies on tobacco smoke exposure in children points out parental smoking as the key contributor of secondhand smoke exposure in the home and specifically maternal smoking (Abidin et al., 2011). The most effective way of preventing secondhand smoke exposure in children is by reducing the prevalence of tobacco use among parents and guardians. Since the enacting of tobacco legislation in 2007, countries like the UK have reported a reduction in in smoking prevalence among adults. The policies put in place include the tax increase in tobacco products, health warnings, mass media campaigns and cessation services. A follow-up survey after the tobacco legislation implementation (Mons et al., 2010) showed an increase in absolute outlaw on smoking in homes and a decrease in the rate of smoking even without the restrictions. An actual observation of parental smoking by children in the homes may create a strong signal of approval to the smoking habit than just knowing the parents are smoking habit (Wang, Ho, and Lam, 2011). Smoking and stigma A number of cultural and social factors are influencing women’s smoking habits and exposure to secondhand smoke. For instance, a large number of low and medium class countries have long considered tobacco use in women and girls as a culturally inappropriate habit. The stigma that was associated with this behavior reserved the start of the smoking habit in women and girls. The effects of globalization and modernization is eliminating the traditional cultural barriers on the behavior of women include the issue of tobacco use in women. Low and medium income countries face problems when trying to maintain and minimize the low prevalence of tobacco smoking in women while at the same time reducing their high frequency of their exposure to secondhand smoking as the rate of men smoking are high in many countries. High-incomecountries are facing a decrease in tobacco use by both men and women. The reduction has led the tobacco companies to target women and girls in low and medium income countries being unexploited and a potentially massive market. The tobacco marketing strategy has taken the Western style that associates tobacco smoking to sophistication, independence, sex appeal and fashion. The images of tobacco use in movies and media are likely to increase the view of smoking as a healthy habit in low and medium income countries (Bloch et al., 2010). Views of professional regarding smoke free home interventions Research on policy makers and other professionals on secondhand smoke exposure in the homes have become minimal. Their say in policies and interventions aiming at reducing secondhand smoke exposure in the homes is also limited. A study conducted (Ritchie, Amos, Phillips, Cunningham-Burley, and Martin, 2009) on the views of experts concerning tobacco control and community development showed that the experts are aware of the existence of sensitive boundary between home based interventions and the public health interventions. The experts agreed that education program on the issue needs to be extended to reach a large population of the communities. The survey identified gaps in the professional knowledge of the adverse impacts of exposing children to secondhand smoke. Besides, the study noted that some professional workers are unwilling to address the issue to their clients who happen to be the parents in fear of damaging the relationship between clients and workers. Research Questions 1. Is there any difference in secondhand smoke exposure before and after implementation of smoke free legislation? 2. Is there a relationship between secondhand smoke exposure and cardiovascular diseases in children? 3. Is there a correlation between secondhand smoke exposure in dwelling places and population smoking prevalence? Hypothesis To achieve the objectives of this survey, we test the following two main hypotheses Null hypothesis H1- There is an inverse relationship between secondhand smoke exposure in children and the enacting of smoke free legislation Alternative hypothesis H2- There is no inverse correlation linking secondhand smoke exposure in children and smoke free legislation Variables with Operational Definitions The study will use the independent variables, and it will introduce the theoretical analysis of each variable. The analysis will show the importance of these variables and the relationship between secondhand smoke exposure and the quality of health in children. The study will also show how to measure the variables (Kanire, 2012). The independent variables for this study are 1. The availability smoke free regulations 2. The literacy level of the parent/guardian 3. Attitude of the parent towards smoking 4. Knowledge of the parent about the effects of SHS exposure 5. The prevalence of smoking at home Theoretical Context: Summary and Guiding Propositions(s) Described in Theory In the literature review above, a number of theoretical approaches adopted shows some of which the study authors have clearly stated. Counselling may see as the most common approach used in the design of the interventions. Education is another approach that has been included. According to a survey conducted (Hovel et al., 2009) based on behavioral ecological model BEM, inclusion of smoke cessation services such counselling to secondhand smoke exposure interventions may encourage parents to stop the smoke habit. The services may contribute to long-term abstinence from smoking than using bare secondhand smoke exposure interventions. Smoke free laws have a beneficial effect on the public especially because of the fact that no safe level of exposure to secondhand smoke is available (Agakuand Vardavas, 2013). Such laws do not only protect the non-smokers but also help in changing norms and motivates smokers to quit the habit. This in turn may influence individuals to adopt smoke free rules voluntarily, in their homes,cars and micro surroundings that are out of reach of smoke free laws. (Ayo-Yusuf, Olufajo, and Agaku, 2014). Methodology Sampling Strategy The sample size for this survey includes 50 nonsmoking men and women and 20 children less than10 years in a small town in the USA. The reason for using nonsmokers in the sample was to get enough evidence on the effects of SHS on current smokers. To measure the concentration of nicotine in households, the study used passive air monitors and hair tests to measure personal exposure to secondhand smoke. This is because hair nicotine provides a lengthy exposure assessment when compared with urinary, salivary and blood concentrations of nicotine. (Groner et al., 2012). In addition, use of hair cotinine as biomarkers can accurately show an internal dose incorporating all sources of exposure. (Kalkbrenner et al., 2010) Research design The study will adopt the descriptive design methodology since it involves conducting the survey and at the same time searching for facts about thedifferent phenomenon through inquiries (Kanire, 2012). The method will make it easy to measure and analyze the situation. Research instruments The study used data from secondary sources through the sampled health annual accounts and reports. The study will also use other secondary sources such as journals, books, web pages and statistics Sources of data in addition to those obtained from previous household surveys, Scientifics projects that include SHS. In addition, I will administer questionnaires to the key male and females’ caregivers in the each household population will assist in getting the opinion about secondhand smoke exposure in children (Kanire, 2012). The questionnaire had four key sections, which are personal and socioeconomic characteristics, smoking history, exposure to SHS and personal beliefs about the adverse effects of smoking and tobacco control policies. Data collection procedures The survey used passive air monitors installed in the main room where family meet in each household for one week. The monitors were not easily accessible and visible to the residents to avoid interference. Hair samples collected from key female caregiver who forms a non-smoker and from one child younger than 11 years. The hair samples then put in labelled plastic bags immediately and sealed for transport (Chan et al., 2014). Data analysis for demographic variables (descriptive statistical tests) The households’ participants covered a range of socioeconomic levels within the town. 50percent of the sampled male caregivers in the households had completed secondary school education while 53 percent of the sampled female caregivers had post-secondary school education. Approximately 40 percent of the women in the city worked outside the household. The smoking households in the sample indicated that one or more of the residents are smokers. Data analysis for study variables (Descriptive and Inferential Statistical Tests) The data collected in the databases checked and reviewed to ensure they are complete and consistent, and then merged with hair and air nicotine concentrations data from the laboratory. We then calculated percentages, central tendency measures and interquartile ranges for housing and demographic characteristics, smoking habit and self-exposure to secondhand smoke. The relationship between nicotine levels of concentration in the air and hair were examined using Pearson correlation coefficient. Ethical Issues In this exercise, ensuring the confidentiality of the participants’ information was very crucial. Assuring the participants of confidentiality helped in opening productive dialogues with them without any fear. High level of integrity also observed during the exercise, as this would help ensure consistency throughout the project. In addition to ethical issues, the survey made sure that respondent’s participation was voluntary throughout the project (Chan et al., 2014). Limitation of Proposed Study There exist a number of limitations and gaps in the study on secondhand smoke exposure. A number of studies include smokers self-reports which may underestimate the prevalence of smoking at home and in the presence of the children. In literature reviews, there exists a gap between children’s experience. The reviews have not shown any papers that have children views. This area, therefore, needs revisiting to assess children experiences from secondhand smoke exposure in their homes. In addition, most surveys have concentrated on mothers views leaving those of the fathers (Chan et al., 2014). Implications for Practice Currently, there is no sufficient evidence that one can use to recommend an intervention that can help reduce secondhand smoke exposure in children. Some researchers suggest that motivational counselling of parents on secondhand smoke exposure in children may be effective in reducing the effects of exposure in children. Others suggest on public education programs could help reduce the exposure in children in the homes. World Health Organization (WHO) recommends on the need to ensure smoke free environments and ventilation. In addition, WHO recommends universal protection by law in enacting legislation that requires all public places and indoor working places to remain smoke free environment. Finally World Health Organization WHO emphasizes on proper implementation and adequate enforcement of the law whether a country is low or high income (WHO, 2010). A survey conducted (Chan et al., 2014) showed that publicity campaigns and policy implementation as effective strategies for promoting smoke cessation and in the utilization of cessation service especially in regard to smoke free legislation Interventions Clinical based interventions Some studies have shown some extent of effectiveness in reducing children exposure to secondhand smoke in clinical settings example a study (Wilson et al., 2011). The interventions are a combination of approaches such as motivational interviews, education, behavioral counselling and creation of awareness, Community based interventions Studies conducted in community settings reported some level of effectiveness in reducing secondhand smoke exposure in children example is that survey (Hovel et al., 2009). The interventions are a combination of counselling, awareness creation, bio chemical feedback and indoor air quality measures. In the UK, smoke free homes visited primary schools, and they used a tool kit that has activities with schoolchildren between 9 and 11 years. The tem gave the children pledge forms to take to their parents for them to make a promise to ensure smoke free homes. The team also trained community workers and health professionals to for them to influence the community members to impose smoke restrictions at their homes. References Abidin, E. Z., Semple, S., Omar, A., Rahman, H. A., Turner, S. W., & Ayres, J. G. (2011). 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Parental Smoking, Exposure to Secondhand Smoke at Home, and Smoking Initiation among Young Children. Nicotine & Tobacco Research, 13(9), 827-832. Wilson, I., Ritchie D. Amos A., Shaw, A., O’Donnell, R., Mills, L.M., Semple, S., Turner, S. (2012b) ‘I’m not doing this for me’: mothers’ accounts of creating smoke-free homes, Health Education Research. July 2012 http://her.oxfordjournals.org/content/early/2012/07/26/her.cys082.full.pdf?keytype=ref&ijkey=KDRRVzJYAfoYH1p World Health Organization (WHO). 2010. Secondhand smoke, assessing the burden of disease at national and local levels. March 28, 2015. Web. Retrieved from http://www.who.int/quantifying_ehimpacts/publications/SHS.pdf. Read More