Second-hand Smoking in the Home with Children

Question: Describe about second-hand smoking in the home with children? Answer: Involuntary inhalation of second-hand smoke in homes exposes children to some health risks. The second-hand smoke contains several carcinogenic compounds and makes the environment in which children live and play saturated with toxic substances because the adults are sharing the living space smoke indoors and cause exposure to tobacco smoke. According to US Environment Protection Agency, no levels of tobacco smoke are safe for human beings. The World Health Organisation estimates that half of the world's children suffer from exposure to second-hand smoking at home. Exposure increases risk of respiratory tract infections, middle ear inflammation, and affects lung function. Sudden infant death syndrome, asthma and bronchitis are also due to second-hand smoke exposure in homes. The exposure is particularly severe among infants and young children because they remain at home most of the time. Efforts are being made to intervene and counsel parents who smoke at home to limit exposure to smoke. A study in Armenia assessed the effect of counselling interventions that motivated parents to prevent the inhalation of second-hand smoke by children, mothers and one daily smoking family member was counselled and two follow-up telephonic counselling calls were made. The smoking members were motivated to reduce or quit smoking. The air quality in their homes was assessed, the concentration of nicotine was measured in the children's hair samples. The study concluded that the intervention was effective in reducing the children's exposure to second-hand smoke (Harutyunyan, 2013). Due to a ban on smoking in public spaces and work places, homes and cars are the private spaces where regulation of second-hand smoke is ineffective. But courts are known to favour granting custody of children with respiratory illnesses based on the risk of second-hand smoke exposure to the child. American law now requires foster homes to be free of smoke. (Jarvie, 2008). An increasing number of children in Wales reported that smoking in cars and homes has declined. This change was observed following a 2008 legislation that banned smoking in public spaces (Moore, 2015). In a case study, the author has questioned why repeated exposure to second-hand smoke that puts a child to considerable health risks rather be treated as a case of child abuse. With the parents and family showing little interest in smoking cessation children can end up in intensive care units choking due to repeated exposure (Goldstein, 2015). A review of fifty seven studies motivational interventions to help parents of young children to attempt cessation tried to determine the effectiveness of such programs. The review included studies that employed a range of interventions. Fourteen studies intervened through extensive counselling, nine studies gave brief counselling to parents, two employed telephonic counselling for smoking cessation, eight studies intervened through visits to residences and six studies measured biological parameters to assess the extent of exposure to children. Studies varied on whether participant families had children with illness or without any illness. Whether the children were healthy or unwell, the impact of counselling was same. Effectiveness of a particular method could not be proven as effective in reducing children's exposure to tobacco smoke although some effect on reduced exposure was reported in 7 studies (Baxi, 2014). In a study, an intervention by children's nurses was done to encourage parents to quit smoking to lower the children's risk of tobacco smoke exposure. The validated tool of SiCET (Smoking in children's environment test) for the study in Sweden was employed. Families from lower socioeconomic backgrounds were part of research. Smoking through water pipes for one-hour releases smoke equal to 4 cigarettes, the smoke also contains higher levels of carbon monoxide. Nurses usually find it difficult to start a conversation about smoking, but the SiCET tool equips them to make a discussion with parents about protecting their children from second-hand smoke in the home environment. The fact that the tool is validated gives the nurse and the parents more confidence while discussing smoking cessation or altering smoking behaviour so that exposure to children is minimum. The main objectives of the counselling were to explore the possibility of smoking cessation or altering the smoking behaviour, which meant that the smoking activity took place outdoors to protect the child from second-hand smoke (Carisson, 2011). Nurses can initiate a low-intensity programme for smoking cessation by fathers during visits of children suffering from an illness to a paediatric facility with non-smoking mothers. The latter can in such cases can be helped to promote smoking cessation by their husbands. A large randomised control trial, 1483 non-smoking mothers in Hong Kong, received counselling from nurses. 76% of women in the intervention group helped their husbands to quit smoking than the 65% women in the control group. Their knowledge about the hazardous effects of smoking on children's health equipped them better to convince their husbands to stop smoking. (Chen, 2013). There are instances where family members other than parents are smokers, such as grandparents. In such a scenario the parents are aware and want to protect the child from harm, but since it is a sensitive issue, they do not know how to go about it. Nurses can in certain cases such as these suggest ways, methods and means to handle the issue which may bring about the possible respite to children from second-hand smoke in the home environment. Since homes are private spaces, it is difficult to ban smoking through legislation. However, some governments are considering a ban on smoking in cars where children are travelling with adults and are also private spaces. Smoke-free homes are ideal for bringing up children. As the legislation against smoking in public and work spaces has caused some people to quit smoking, safeguarding kids from the effects of smoking at home may also help parents to quit smoking. Smoke-free home environments for infants and young children have been the focus of several studies. A review of studies on interventions carried out from 2000 to 2014 analysed parents who were counselled to stop smoking and their new born to one-year-old children were part of most of these studies. The parents were more likely to alter smoking behaviour to reduce the child's exposure are more likely than to achieve total cessation. When children are living with asthma they can possibly die if the parents' smoking behaviour does not change. Even third-hand smoke (toxic remnants of tobacco smoke on clothes, hair and other surfaces) is deleterious to the health of children. Growing children with parents who smoke are more likely to start smoking as adolescents. When both parents are smokers the likelihood of such impact on behaviour is considerably higher (Brown, 2015). Conclusion The harmful effects of passive smoking and second-hand smoke on children' s health are manifold. From respiratory problems to behavioural impact, smoking with-in- the- home environments is found to have serious consequences concerning the physical and mental health of growing children. The point of contact of parents with nurses offers ample chance for the nurse to intervene and make provision to follow-up the motivation for parents so that they can stop smoking or, at least, alter their behaviour and smoke outdoors. A suffering child can create an adequate impact on parental smoking behaviour if the paediatric nurse intervenes at the right juncture. The nursing staff educates about the actual harm that second-hand smoke can cause. Intervention can be done through counselling, telephonic follow-ups, pamphlets, books and videos. References: Baxi, R., Sharma, M., Roseby, R., Polnay, A., Priest, N., Waters, E., Spence, N. Webster, P. (2014). Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane database systemic review, 3, CD001746. Brown, N., Luckett, T., Davidson, P.M., Giacomo, M.D. (2015). Interventions to Reduce Harm from Smoking with Families in Infancy and Early Childhood: A Systematic Review. International journal for environmental research and public health, 12(3), 30913119. Carisson, N. A., Alegahan, S., Gare, B.A., Johansson, A., (2011). "Smoking in Children's Environment Test": a qualitative study of experiences of a new instrument applied in preventive work in child health care. BMC Pediatrics, 11(113). Chen, S.S., Wong, D.C.N., Lam, T.-H. (2013). Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial. BMC Pediatrics, 13(50), 13: 50. Goldstein, A. (2015). Is Exposure to Secondhand Smoke Child Abuse? Yes. Annals of family medicine, 13(2), 103104. Harutyunyan, A., Movsisyan, N., Petrosyan, V., Petrosyan, D., Stillman, F. (2013). Reducing Childrens Exposure to Secondhand Smoke at Home: A Randomized Trial. Pediatrics, 132(6), 1071-80. Jarvie, J. A., Malone, R.V. (2008). Children's Secondhand Smoke Exposure in Private Homes and Cars: An Ethical Analysis. American journal of public health, 98(12), 21402145. Moore, G.A., Moore, L., Littlecott, H.J., Ahmed, N., Lewis, S., Sulley, G., Jones, E., Holliday, J. (2015). Prevalence of smoking restrictions and child exposure to secondhand smoke in cars and homes: a repeated cross-sectional survey of children aged 10-11 years in Wales. BMJ Open, 5(1), e006914.