Salford Children's Services Procedures Manual Salford City Council website
Greater Manchester SCB Procedures
Greater Manchester SCB Procedures Greater Manchester SCB Procedures

3.13.9 Smoking Policy

AMENDMENT

This chapter was updated in October 2014 to reflect that there should be no smoking in private vehicles where there are children (i.e. young people under 18 yrs) present. See Section 2, How Smoking Affects Health and Section 6, Interim Plan for Foster Carers who Smoke.


Contents

  1. Introduction
  2. How Smoking Affects Health
  3. Carers are Role Models
  4. Young Smokers
  5. Practice Guidelines for Placing Children with Foster Carers who Smoke
  6. Interim Plan for Foster Carers who Smoke
  7. References


1. Introduction

Salford City Council is committed to working in partnership to improve health in Salford and a key aim is to reduce the number of people who smoke.

As corporate parents Salford City Council has a responsibility to protect all aspects of the health, safety and well being of our looked after children, making sure they have the support they need to be healthy and stay healthy.

We want our looked after children to live in an environment that promotes their health and well being and believe that foster carers have a key role to play in protecting and promoting children's health.

Public awareness of the potential health risks from smoking has increased in recent years and attitudes towards smoking have changed radically. Through legislation virtually all enclosed public places and workplaces have been smoke free since July 2007. This policy must therefore be set in this wider context.

Foster carers are performing a public duty in their own homes, but, while a foster carer's home is not a workplace, the City Council has to ensure that policies and practices offer children equal protection from health risks regardless of their care placement. As a public body the City Council may be liable for legal challenge if the health of former looked after young people becomes compromised as a result of their placement experiences.

We do not wish to exclude smokers from fostering but have to take into consideration the effects of smoking on children. We are mindful of the need to recruit more foster carers in order to offer more looked after children the opportunity to experience stable family life and recognise that the risk of placing a child in a smoking household is only one factor among many. However the scientific evidence set out below and used to inform this policy is very strong and must be given sufficient weight in decision making.

The aim of this policy is to move towards a position where the health of every child looked after in foster care is promoted through placement in a smoke free home.

Stopping smoking will protect not only the health of children but also the health of their carers. Looked after children will already have suffered loss and it is important that this is not compounded by the illness or premature death of their carer.

We are therefore committed to supporting people who wish to foster and approved foster carers in giving up smoking through education, information and access to smoking cessation services.


2. How Smoking Affects Health

Background

The harmful effects of smoking on health have long been recognised. However, over the last few years the scientific evidence of the dangers from inhaling second hand smoke has increased. The Department of Health recognises second hand smoke as a serious potential health problem from which the public needs to be protected and in July 2007 legislation was implemented to prohibit smoking in enclosed public spaces and in the work place.

The World Health Organisation recognises that second hand smoke is a real and substantial threat to child health causing a variety of adverse effects. Second hand smoke is a controllable and preventable form of air pollution. There is no safe level of exposure.

Important Note: Under the Children and Families Act 2014 (section 95) there is a restriction on smoking in private vehicles where a person under the age of 18 is present in the vehicle.

Health impacts of smoking

Tobacco smoke contains more than 4000 chemicals many with irritant properties and 60 which are either known or suspected to be carcinogens. Smoking tobacco causes lung cancer, heart disease, stroke, chronic bronchitis, emphysema, diabetes and stomach ulcers leading to premature death.

Cannabis can be smoked with tobacco or alone and contains the same constituents (apart from nicotine) as tobacco and additional carcinogens and insoluble particles. Smoking 3-4 cannabis containing cigarettes a day is equivalent to smoking 20 tobacco cigarettes a day. It can cause irritation and damage of the respiratory system and is associated with an increased incidence of cancers of the mouth and oesophagus. Cannabis use can affect attention and memory and the ability to process information not only when taken but these effects can last for many weeks and possibly longer. The health risks to children from cannabis smoke exposure are the same if not greater than tobacco alone. One major difference between cannabis and tobacco is that cannabis is illegal, and therefore should not be used by foster carers or anyone else in the household.

The effects of smoking on others (passive smoking)

A smoker produces 'side stream' smoke, from the burning tip which constitutes 85% of the smoke in a room and has a higher concentration of many potential toxic gases than 'mainstream' smoke, the smoke that has been inhaled and then exhaled by the smoker.

This second hand smoke can last for up to two and a half hours in a room and 85% of the smoke can not be seen or smelt. A non smoker or child breathing in this smoke is passive smoking and is being exposed to many adverse health effects.

  • Sudden infant death in infancy is the commonest cause of death in children aged 1-12 months. Infants exposed to passive smoking are 5 times more at risk of dying form cot death compared to infants cared for in smoke free environments.
  • Lower respiratory tract infections, pneumonia and bronchitis, are more frequent in preschool children exposed to passive smoking with a 20 - 40% increase in the frequency of wheeze, cough and phlegm production.
  • Asthma and respiratory infections in school age children are more common if they have been exposed to passive smoke. It is estimated that between 1,600-5,400 new cases of asthma per year are as a result of a smoking parent.
  • There is a 20-40% increased risk of middle ear disease with hearing loss, speech delay and the need for surgery in children exposed to passive smoke.
  • There is thought to be an increase risk of childhood meningitis and possible effects on mental ability from exposure to passive smoke, with reduced reading and reasoning skills. Further research is currently underway.

All of these effects will lead to an increase in absence from school compared with peers growing up in a smoke free environment.

The long term effects of growing up in a smoking household are not yet known but there is clear evidence that adults living with partners who smoke have increased risks of cancer ( by 24%) and heart disease (by 25%). It is therefore possible that children may have similar long term risks.

Vulnerable groups of children

Children under 5-years-old are particularly vulnerable to the effects of passive smoke as they are likely to spend more of the day physically close to their carers and in the same room. Their lungs and airways are small and their immune systems immature, they breathe at a faster rate and so will take in more harmful chemicals and are more susceptible to the effects. In the UK 17,000 children under 5 years are admitted to hospital every year with illnesses resulting form exposure to passive smoking.

Children with existing respiratory disease such as asthma tend to have more exacerbations of their illness which is more severe than if they were in a smoke free household. Similar effects are seen with children with heart disease and middle ear infections.

Children with disabilities are also more vulnerable to the effects of passive smoking as they may be physically unable to play outside and often spend more time in close proximity to their carers for their needs to be met.


3. Carers are Role Models

Children living in smoking households are three times more likely to become smokers themselves than if they are from smoke free households. The carers / parents approval or disapproval of the habit is a significant factor in determining whether a child will eventually become a smoker. There is little evidence that knowledge of the health risks associated with smoking influences children to be non smokers.


4. Young Smokers

The health implications for young smokers are more serious. The earlier in life they start smoking the greater the risk of developing heart disease and lung cancer in later life. These young people are 2 -6 times more susceptible to coughs, wheeze and shortness of breath compared to their non smoking peers and consequently have more time off school. There is also an increased risk of subarachnoid haemorrhage (a form of brain haemorrhage), increased blood coagulability and adverse effects are seen on body lipids (fats). They are generally less physically fit compared to their peers, the skin ages and wrinkles faster and girls are more likely to be infertile compared to their non smoking peers.


5. Practice Guidelines for Placing Children with Foster Carers who Smoke

  • Prospective foster carers should be made aware of the department's smoking policy at the time of the initial visit and given an opportunity to discuss the implications of smoking on their application.
  • The department's smoking policy is discussed further during the preparation groups. At this stage of the application process, any prospective foster carers who smoke will be provided with Stop Smoking information packs and given the opportunity to access support from the Stop Smoking Advisor.
  • The Stop Smoking advisor offers support and advice about giving up to foster carers, prospective foster carers and other household members who smoke. Referrals to the Stop Smoking Advisor can be made by the preparation group trainers, family placement social workers or foster carers themselves.
  • In the case of a Looked After child or other young person in the household who smokes, advice and support is also available from the Stop Smoking Advisor. Referrals should be made in the same way as for foster carers.
  • Where there are prospective foster carers or other household members who smoke, this will be addressed during the assessment.
  • No children who are under the age of 5, disabled or have respiratory problems should be placed with non-related foster carers, where there are household members who smoke, unless in exceptional circumstances. This is due to the particularly high health risk for very young children and toddlers who spend most of their day physically close to their carers.
  • In all planned long term placements and in those placements which are not planned as long-term but become long-term, the additional health risks to children of being placed in a household where smoking occurs needs to be carefully considered.
  • Foster carers who smoke need to maintain a smoke free home. This includes other household members and visitors to the home, who should be asked to smoke outside. Advice and support is available from Salford City Council's Smoke Free Homes Coordinator and can be accessed via the family placement team.
  • When assessing relatives as foster carers for a specific child, there are additional issues to consider if the applicants are smokers. Potential risks to a child's health as a result of the placement will need to be weighed against the potential benefits to a child of being placed with people who are part of their family (or friends) and where there is likely to be a pre-existing bond.
  • As with any applicants who smoke, family and friends foster carers should have the same access to advice and support from the Stop Smoking Advisor. An individual smoking policy should be developed to address the effects of passive smoking on the child.
  • An individual smoking policy for all foster carers who smoke, should be developed and kept on file, which states the age of the children being placed, where the carers and other household members smoke and how this affects their ability to provide a smoke free environment.
  • The issue of smoking and the individual smoking policy will be considered as part of the foster carers' annual review. Regular training on the health risks and impact of smoking will be provided by the department for foster carers where there are household members who smoke.
  • In all circumstances, foster carers should promote nonsmoking in the vicinity of children, either at home or other places.
  • The wishes of children and their parents should be considered and adhered to when making a choice about whether children are to be placed in families where smoking occurs.


6. Interim Plan for Foster Carers who Smoke

  • Important Note: there is a restriction on smoking in private vehicles where a person under the age of 18 is present in the vehicle (Children and Families Act 2014). Foster Carers should not smoke when accompanying foster children in a car;
  • In most cases, the need for children to remain in a family setting with their current foster carers who smoke, will out-weigh the potential risk to their health. Many good foster carers smoke and while the risk of passive smoking is well documented, smoking status is not an indicator of parenting skills.
  • There are currently a small number of children under 5, who are placed with foster carers, where there are household members who smoke. Although consideration must be given to the risk to a child's health, it is unlikely there will be justification to move the child to another placement. However, no new placements of children under 5 should be made with non related foster carers who smoke, unless in exceptional circumstances.
  • In all cases, where smoking occurs in the household, an individual smoking policy should be developed with foster carers and considered at their annual review. Foster carers should also be encouraged to access support from the Stop Smoking Advisor and attend training opportunities provided by the department.
  • Family placement social workers will be expected to promote non-smoking in foster placements and offer advice and support to carers who wish to give up.
  • Training on the risks and impact of smoking on health will be offered to all existing foster carers who smoke.
  • All foster carers will now be expected to maintain smoke free homes in order to reduce the risks of passive smoking to children in their care. Advice and support to do this is available from Salford City Council's Smoke Free Homes Coordinator and be obtained via the family placement team.
  • This guidance should be followed when placing children in independent agency placements. However, support and advice from the Stop Smoking Advisor and Smoke Free Homes Coordinator is only available to Salford Local Authority foster carers or agency foster carers who are residents of Salford City Council.


7. References

BAAF - practice note 51 (2007) Reducing the risks of environmental tobacco smoke for looked after children and their carers.

Cosgrove, Hill and Charles, 'The effects of smoking Tobacco' in Children exposed to parental substance misuse. Phillips 2004, BAAF

Department of Health, Scientific Committee on Tobacco and Health, review of evidence of passive smoking, 2004

WHO (1999) International Consultation on Environmental Tobacco and Child Health, Consultation report, Geneva.

Charlton and Blair 'Absence form school related to children's and parental smoking habits', British medical Journal, 298, p90-92

Smoking and the Young - Royal college of Physicians, 1992

Fielding and Phenow (1988) 'Health effects of involuntary smoking', N England Journal of Medicine, 319, p1452 - 60

Spencer, Blackburn, Bonas, Coe and Dolan, 'Parent reported home smoking bans and toddler smoke exposure, a cross sectional survey' Archives of Diseases of childhood, 90 p670-74

End