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4.2.3 Smoking Policy

AMENDMENT

This chapter was updated in May 2016 to acknowledge that it is now illegal to smoke with a child under 18 yrs in a car; both the driver and passenger could be fined. See Section 1, How Smoking Affects Health to access UK Gov and DoH sites for further information. See Section 2, Practice Guidelines for Placing Children with Adopters who Smoke.


Contents

  1. How Smoking Affects Health
  2. Practice Guidelines for Placing Children with Adopters who Smoke
  3. References


1. 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.

It is now illegal to smoke in a car with anyone under 18 yrs. Both the driver and the smoker could be fined. However, it does not apply to e-cigarettes or a driver of 17 yrs who is on their own. (See Gov.UK Smoking in Vehicles (August 2015).

Also, DoH, Rules about tobacco, e-cigarettes and smoking: 1 October 2015.

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. However, it should be remembered that cannabis is an illegal substance.

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 child hood 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.

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.

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.


2. Practice Guidelines for Placing Children with Adopters who Smoke

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 and from October 2015 it is now illegal. Both the driver and the smoker could be fined. However, it does not apply to e-cigarettes. (See Gov.UK Smoking in Vehicles (August 2015) and DoH, Rules about tobacco, e-cigarettes and smoking: 1 October 2015.

  • Prospective adopters 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 adopters who smoke will be provided with Stop Smoking information packs;
  • Where there are prospective adopters 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 adopters, 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;
  • Adopters 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;
  • When assessing adopters 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 of that placement e.g. adopters who have adopted a sibling or foster carers adopting;
  • An individual smoking policy for all adopters who smoke, should be developed and kept on file, which states the age of the children being placed, where the adopters and other household members smoke and how this affects their ability to provide a smoke free environment;
  • The wishes of children and their parents should be considered when making a choice about whether children are to be placed in families where smoking occurs.


3. 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