Siddiqi, Kamran

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This is a repository copy of Protecting women and children from second hand tobacco smoke: a public health priority.White Rose Research Online URL for this paper:https://eprints.whiterose.ac.uk/145726/Version: Published VersionArticle:Siddiqi, Kamran orcid.org/0000-0003-1529-7778 (Accepted: 2019) Protecting women and children from second hand tobacco smoke: a public health priority. Pakistan Journal of Chest Medicine. pp. 1-2. ISSN 2309-9844 (In Press) eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. EDITORIALSecond hand tobacco smoke (SHS) is a mixtureof exhaled and side stream smoke releasedfrom a burning cigarette or other forms oftobacco such as shisha, cigar, pipe, bidi, etc. SHScontains 4,000 chemicals, 70 of which can causecancer. Children and non-smoking adults exposed toSHS end up inhaling carcinogens and other toxiccomponents that are present in it. SHS exposure is aserious health hazard to non-smokers, leading to anestimated 890,000 deaths and a loss of 10·9 milliondisability-adjusted life years (DALYs) globally everyyear.1Women and children are worst affected by SHSexposure: 28% of deaths from SHS exposure occur inchildren. SHS exposure impairs children's lung2development and causes immune dysregulation;therefore, increasing their risk of acquiring lowerrespiratory tract infections, tuberculosis, and3incident cases, recurrent episodes, and exacerba-tions of asthma. Parental smoking is also associated4with an increased risk of their children's admissions tohospital. Moreover, SHS exposure in children and3adolescents leads to poor cognitive functions andacademic achievements. Children living in smoking5households are at high risk of becoming adultsmokers later. SHS exposure during pregnancy is a6key and avoidable risk to foetal development andcontributes to adverse perinatal and postnataloutcomes, often with a lasting and negative impactduring infancy and beyond.Unfortunately, 40% of children are exposed to SHSworldwide amounting to a major public health threat.2Situation is worse in low- and middle-incomecountries where almost 56% children could beexposed to SHS. This is in stark contrast to figures8from the UK and Canada where only a minority ofchildren are now exposed to such risks. Smoking isnow less visible in public places, and most childrenand non-smoking adults are living in smoke-freeenvironments. Consequently, hospital admissionsdue to chest infections and heart diseases have comedown too.The south and south-east Asia region has the highestburden of disease attributable to SHS in the world.According to the Global Tobacco Surveillance Systemdata and Demographic Health Surveys, the majority ofwomen and children living in Bangladesh andPakistan are exposed to SHS. In 2014 in Pakistan,9approximately 86% of people using restaurant and76% using public transportation might have beenexposed to SHS. Nearly half of all adolescents (13-1510years old) in Pakistan could be exposed to SHS.8 In arecent survey in 12 schools in Dhaka, Bangladesh, wefound that 95% of 9-11 year old children had salivarycotinine levels consistent with recent exposure toSHS. In addition to public places, children are also11exposed to SHS in their private homes and cars. Theprevalence of daily SHS exposure during pregnancywas found greater than active tobacco use inpregnancy across many low- and middle-incomecountries ranging from 6% (95% CI 5% to 7%)(Nigeria) to 73% (95% CI 62% to 81%) (Armenia). In9Pakistan, nearly 40% of pregnant women get exposedto SHS on a daily basis.9If the above survey findings are a true reflection of thepicture for most low- and middle-income countriesincluding Pakistan, quite clearly, current measures arefailing to protect the vast majority of women andchildren from SHS and the risks it poses. This level ofexposure may well be contributing towards poorhealth and development of children in these countriesSmoking in indoor public spaces and workplaces isnow banned in many countries, including Bangladeshand Pakistan. Where comprehensive and enforced,these bans have resulted in a significant reduction inSHS exposure and associated morbidity andmortality. However, compliance to the smoke-free12legislation is problematic in countries like Pakistan.1Smoking on public transport and in the workplace isstill commonplace, and there is no restriction onsmoking in the home. There is also little evidence onThis editorial may be cited as: Siddiqi K. Protecting women and children from second hand; A . Pak J Chest Med 2019; 25(01): 1-2tobacco smoke public health priority01PJCM 2019; 25 (1)Address for correspondenceDepartment of Health Sciences,University of York, York, United KingdomE-mail: kamran.siddiqi@york.ac.ukKamran SiddiqiProtecting women and children from second hand;tobacco smoke A public health prioritythe effectiveness of non-legislative interventions toprotect women and children from SHS exposure.Implementing smoke-free laws should remain apriority to curb exposure for non-smokers in low- andmiddle-income countries, including policies topromote smoke-free environments in multi-unithousing, in vehicles and in open public spaces suchas children's play areas. Public awareness campaignsare also needed to raise awareness about the harms ofSHS exposure in women and children. In low- andmiddle-income countries, nongovernmentalorganisations should support a grassroots movementto change smoking norms in communities.An important first step would be to recognise thatprotecting women and children from exposure to SHSis key to improving maternal and child health.Healthcare professionals working with pregnantwomen and children should be aware of these issuesand be proactive in offering advice and support towomen and children who are exposed to SHS.1. World Health Organization. WHO report on theglobal tobacco epidemic, 2017: Monitoringtobacco use and prevention policies. WorldHealth Organization, 2017.2. Oberg M, Jaakkola MS, Woodward A, Peruga A,Pruss-Ustun A. Worldwide burden of diseasefrom exposure to second-hand smoke: aretrospective analysis of data from 192 countries.Lancet (London, England). 2011; 377(9760): 139-46.3. Cook DG, Strachan DP. Health effects of passivesmoking: Summary of effects of parental smokingon the respiratory health of children andimplications for research. Thorax. 1999; 54(4):357-66.4. Burr ML, Anderson HR, Austin JB, Harkins LS,Kaur B, Strachan DP, et al. Respiratory symptomsand home environment in children: a nationalsurvey. Thorax. 1999; 54(1): 27-32.5. Chen R, Clifford A, Lang L, Anstey KJ. Is exposureto secondhand smoke associated with cognitiveparameters of children and adolescents?--asystematic literature review. Ann Epidemiol. 2013;23(10): 652-61.6. Consortium PHR. A review of young people andsmoking in England. 2009.7. Rogers JM. Tobacco and pregnancy. ReprodToxicol. 2009; 28(2): 152-60.8. Xi B, Liang Y, Liu Y, Yan Y, Zhao M, Ma C, et al.Tobacco use and second-hand smoke exposurein young adolescents aged 12-15 years: data from68 low-income and middle-income countries.Lancet Glob Health. 2016; 4(11): e795-e805.9. Reece S, Morgan C, Parascandola M, Siddiqi K.Secondhand smoke exposure during pregnancy:a cross-sectional analysis of data fromDemographic and Health Survey from 30 low-income and middle-income countries. TobControl. 2018.10. Saqib MAN, Rafique I, Qureshi H, Munir MA,Bashir R, Arif BW, et al. Burden of Tobacco inPakistan: Findings From Global Adult TobaccoSurvey 2014. Nicotine Tob Res. 2019; 21(1): 136.11. Shah S, Kanaan M, Huque R, Sheikh A, Dogar O,Thomson H, et al. Secondhand Smoke Exposurein Primary School Children: A Survey in Dhaka,Bangladesh. Nicotine & Tobacco Research. 2017:ntx248-ntx.12. Been JV, Nurmatov UB, Cox B, Nawrot TS, vanSchayck CP, Sheikh A. Effect of smoke-freelegislation on perinatal and child health: asystematic review and meta-analysis. Lancet.2014; 383(9928): 1549-60.13. Siddiqi K, Sarmad R, Usmani RA, Kanwal A,Thomson H, Cameron I. Smoke-free homes: anintervention to reduce second-hand smokeexposure in households. Int J Tuberc Lung Dis.2010; 14(10): 1336-41.14. Siddiqi K, Khan A, Ahmad M, Dogar O, Kanaan M,Newell JN, et al. Action to stop smoking insuspected tuberculosis (ASSIST) in Pakistan: acluster randomized, controlled trial. Ann InternMed. 2013; 158(9): 667-75.15. Baxi R, Sharma M, Roseby R, Polnay A, Priest N,Waters E, et al. Family and carer smoking controlprogrammes for reducing children's exposure toenvironmental tobacco smoke. In: CochraneDatabase of Systematic Reviews. John Wiley &Sons, Ltd, 2014.16. Daly JB, Mackenzie LJ, Freund M, Wolfenden L,Roseby R, Wiggers JH. Interventions by HealthCare Professionals Who Provide Routine ChildHealth Care to Reduce Tobacco Smoke Exposurein Children: A Review and Meta-analysis. JAMAPediatr. 2016; 170(2): 138-47.17. Rosen LJ, Myers V, Winickoff JP, Kott J.Effectiveness of Interventions to Reduce TobaccoSmoke Pollution in Homes: A Systematic Reviewand Meta-Analysis. Int J Environ Res PublicHealth. 2015; 12(12): 16043-59.02PJCM 2019; 25 (1)Protecting women and children from second hand tobacco smoke  A public health priority;

Protecting women and children from second hand tobacco smoke: a public health priority

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Protecting women and children from second hand tobacco smoke: a public health priority

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