Note: This Instructional Module information comes from our Training Manual. The complete Training Manual can be ordered from our Program and comes with a video, transparency masters, module publications, and many other educational resources. 

Module Learning Objectives

• Identify the health risks of secondhand tobacco smoke
• Identify the particular health risks of children exposed to secondhand tobacco smoke 
• Reduce children’s exposure to secondhand tobacco smoke

• Children and Secondhand Smoke, EPA 402-F-99-003, March 1999. http://www.epa.gov/iaq/
• Environmental Tobacco Smoke - Clean Indoor Air, American Cancer Society, April 1999. http://www.cancer.org/tobacco/index.html
• Secondhand Smoke: What You Can Do About Secondhand Smoke as Parents, Decisionmakers, and Building Occupants, EPA 402-F-93-004, July 1993. http://www.epa.gov/smokefree/pubs/etsbro.html
• See Home IAQ Overview Module for Indoor Air Hazards Every Homeowner Should Know About... Booklet

Additional Video and Teaching Support

• Poisoning Our Children: The Perils of Secondhand Smoke Video, American Academy of Otolaryngology (Available separately for loan from the Healthy Indoor Air for America’s Homes Program at 406-994-3451, or respective State Program Manager)
• Secondhand Smoke Education Project, National Resource Center for Health and Safety in Child Care (includes teaching outline; informational materials for daycare providers, parents, and children; some materials in Spanish; 12-minute video, Poisoning Our Children: The Perils of Secondhand Smoke). Call 1-800-598-KIDS (5437) to order a copy.

Notes to the Program Leader:

The format is to provide a series of masters for making overhead transparencies (or slides) and a script to accompany each visual. The script is presented in outline form to encourage you to present information in a conversational style and to avoid reading an exact script during the program presentation.

In preparation, read the reference materials. It is a good idea to find out about local smoking ordinances. Also, you may want to find out about local programs that help people quit smoking so that you can make a referral if requested. Described on the next page is some important background information as well as details about secondhand smoke and lung cancer. 

This teaching module is about secondhand smoke -- the smoke in room air that comes from smoking and burning tobacco products. The purpose is to alert your audience to the health risks of secondhand smoke, particularly for children, and to address ways to reduce this risk. This lesson does not address ways to stop smoking, nor does it make a value judgment about smokers. The focus is on secondhand smoke as an indoor air pollutant and emphasizes healthy indoor air for everyone’s homes.

The interrelationship of tobacco smoking and health is a topic that generates strong opinions. The various views of government agencies, advocacy organizations, and the tobacco industry on these issues are often in the news. Tied up with the issue of the health effects of tobacco smoke are our society’s concerns about personal freedom and free enterprise. Secondhand smoke can be a particularly difficult issue to address because it is not about someone’s personal decision to smoke. 

The U.S. Environmental Protection Agency (EPA) firmly maintains that the bulk of the scientific evidence demonstrates that secondhand smoke (environmental tobacco smoke, or ETS) causes lung cancer and other significant health threats to children and adults. EPA's report was peer-reviewed by 18 eminent, independent scientists who unanimously endorsed the study's methodology and conclusions. Since EPA's 1993 report, which estimated the risks posed by ETS, numerous independent health studies have presented an impressive accumulating body of evidence that confirms and strengthens the EPA findings. It is widely accepted in the scientific and public health communities that secondhand smoke poses significant health risks to children and adults.

A U.S. District Court decision has vacated several chapters of an EPA scientific risk assessment document that served as the basis for EPA’s classification of secondhand smoke as a Group A carcinogen and estimates that ETS causes 3,000 lung cancer deaths in non-smokers each year. The ruling was largely based on procedural grounds. EPA is currently appealing this decision. None of the findings concerning the serious respiratory health effects of secondhand smoke in children were challenged.

Additional References Used in Preparation of this Teaching Module:

 
• Aligne, C. A. & Stoddard, J. J. (1997). "Tobacco and Children: An Economic Evaluation of the Medical Effects of Parental Smoking," Archives of Pediatric and Adolescent Medicine, 151 (648-653).
• American Academy of Pediatrics, Committee on Environmental Hazards (1986). "Involuntary Smoking - A Hazard to Children," Journal of Pediatrics. 77(5): 755.
• Barnes, D.E. & Bero, L.A. (1998, May 20). "Why Review Articles on the Health Effects of Passive Smoking Reach Different Conclusions," Journal of the American Medical Association, 279 (19), 1566-1571.
• Lesmes, G.R. & Donofrio, K.H. (1992, July 15). "Passive Smoking: The Medical and Economic Issues," The American Journal of Medicine, 93 (suppl 1A), 1A-38S - 1A-42S.
• Respiratory Health Effects of Passive Smoking, Fact Sheet, U.S. Environmental Protection Agency (1993).
• Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders, U.S. Environmental Protection Agency (1992).
• Setting the Record Straight: Secondhand Smoke is a Preventable Health Risk, U.S. Environmental Protection Agency (1994).

Script for Transparency #1

Secondhand tobacco smoke is the smoke inhaled by nonsmokers -- smoke in the air from someone smoking cigarettes, cigars, or pipes in the indoor environment.

Secondhand smoke is sometimes called "environmental tobacco smoke," "ETS," "involuntary smoking," or "passive smoke."

Script for Transparency #2

Tobacco smoke contains over 4,000 chemicals, 200 of which are known poisons. About 40 of these chemicals could cause cancer.

In the late 1980s, the Surgeon General and the National Academy of Sciences National Research Council reported involuntary smoke could cause cancer in healthy nonsmokers.

Script for Transparency #3

Secondhand smoke can be an irritant to the body -- it can cause other acute and chronic health problems. 

For example, exposure to secondhand smoke increases irritation of the eyes, nose, and throat. Lung irritation from exposure to secondhand smoke can cause coughing, excess phlegm, chest discomfort, and reduced lung capacity.

Newer studies show secondhand smoke could increase the risk factors for heart disease. Also highly important, secondhand smoke causes serious health problems in children.

Script for Transparency #4

Secondhand smoke actually includes 2 types of smoke:  

• "Mainstream smoke" is the smoke that the cigarette, pipe, or cigar smoker inhales and exhales.
• "Sidestream smoke" is the smoke which goes directly into the air from the burning cigarette, pipe, or cigar while it rests in the ashtray or is held by the smoker. Sidestream smoke is the primary source of smoke in room air. Sidestream smoke has a high concentration of dangerous chemicals.

Script for Transparency #5

Secondhand smoke is a health concern, especially for young children. 

The lungs of young children are still developing and are particularly sensitive to the effects of secondhand smoke.

Children are also vulnerable to exposure to secondhand smoke because they must depend on parents, care-givers, and other adults to keep their environment healthy. Children are typically exposed involuntarily to secondhand smoke.

The next several transparencies will focus on the concerns of young children and secondhand smoke.

Script for Transparency #6

In 1986, the American Academy of Pediatrics (AAP) estimated that 9-12 million children under age 5 are exposed to secondhand smoke in the home. The health consequences are immense. 

For example, from 200,000 to 1 million children with asthma have had their condition worsened by exposure to secondhand smoke.

Script for Transparency #7

As we will discuss in the next few transparencies, children of smokers experience a wide variety of acute and chronic health risks:

 
• Increased instances of disease and hospitalization
• Increased risk of premature death
• Increased medical expenses
• Interference with growth and development
• Hindered quality of life

Script for Transparency #8

A recent article in Archives of Pediatric and Adolescent Medicine reviewed all research on children’s health and tobacco smoking from 1980 to 1996.

This article concluded that parental smoking is a major health risk for children and results in annual direct medical expenses of $4.6 billion in their children -- 8% of all pediatric medical spending. This includes 5.4 million excess cases of disease and 6,200 excess childhood deaths.

Script for Transparency #9

The Archives of Pediatric and Adolescent Medicine article also showed that as a group, children of smokers who are regularly exposed to secondhand smoke experience:

 
• Higher rates of bronchitis and pneumonia, especially in the first 2 years
• Impaired lung function as they get older
• Asthma episodes aggravated or triggered by secondhand smoke
• Increased likelihood to develop asthma
• Increased numbers of acute respiratory illnesses
• More ear infections and hearing problems
• Longer recovery from colds and other illnesses
• More days of school missed due to illnes

Script for Transparency #10

In addition, the same article reviewed medical research that strongly suggests infants of women smokers have an increased risk of Sudden Infant Death Syndrome (SIDS).

Script for Transparency #11

A 1997 California EPA study on children’s health reinforced many of the findings in the Archives of Pediatric and Adolescent Medicine article, and uncovered some additional, definitive results as well.

The California EPA study found that secondhand smoke exposure to children also causes lung and nasal sinus cancer and heart disease. 

Script for Transparency #12

Another study links secondhand smoke exposure and children with asthma. U.S. EPA’s 1992 Risk Assessment on secondhand smoke found that exposure:

 
• Caused additional episodes and increased severity of symptoms in children with asthma
• Worsened physical conditions in an estimated 400,000 to 1 million children with asthma

Script for Transparency #13

If you are a parent: 

If you cannot quit smoking, then make every effort to remove secondhand smoke from your children’s environment.

Script for Transparency #14

What can parents do to reduce their children’s exposure to secondhand smoke?

 
• Do not smoke in the home
• Do not smoke in cars that children ride in
• Ask others to avoid smoking in the home or car
• Investigate the smoking policies of the places where your children spend time -- such as schools, pre-schools, daycare providers, homes of friends, and community centers -- to make sure that children are guaranteed a smoke-free environment.

Script for Transparency #15

Ask your health care provider about the health risks to your children if they spend time in a home with a smoker. 

If a child does live with a smoker, ask that this be noted on their medical records. This will be useful information if the child develops health problems in the future.

Script for Transparency #16

What can you do to reduce your and your family’s exposure to secondhand smoke and the resulting health risks?

Secondhand smoke is a major health risk, especially to children. It is a health risk that is preventable. Although you can take measures to reduce exposure to secondhand smoke, such as increasing ventilation, opening windows, or using exhaust fans, nothing is as effective as simply not smoking in the home.

Note to the Program Leader: 
You may wish to summarize the key points of this module after you have shown the transparencies. Encourage discussion among program participants. A good activity is to share ideas about how to ask people not to smoke in their home, car, or near their children. Participants could role play different techniques.