Children : the victims of the silent killer ?

The adverse impact of Second Hand Tobacco Smoke (SHS):

by Indeewara Thilakarathne

[email protected]

Speaking on the current rate of tobacco prevalence in Sri Lanka Director National Curative Diseases Dr. Lakshmi Somatunga stated that tobacco prevalence among men is 25 per cent and it is less than 1 per cent among women. Thus children are at a risk of being exposed to Second Hand Smoke (SHS).

Though there are no short cuts to stop passive smoking, the answer to these issues lie in the creation of a total tobacco free environment in indoor work places and public places.

Over the last 50 years, scientific studies have proved the adverse impact of Second Hand Tobacco Smoke (SHS) on children and the impact of tobacco smoke by mothers on the fetus.

According to the WHO report on Protection from Exposure to Second Hand Tobacco Smoke, scientific evidence gathered by medical bodies worldwide such as WHO, IARC, the United States Surgeon General, the United States Environmental Protection Agency (EPA), Cal/EPA, have proved the adverse effect s of SHS on the respiratory and circulatory systems.

There are bodies of scientific evidence that SHS has adverse effects on blood lipids, clotting systems (platelets) and arterial wall function within minutes. Significantly many of those outcomes are almost similar to those seen in active smokers.

Current scientific evidence shows that SHS causes heart diseases and significantly increases the risk of death due to coronary diseases by about 30 per cent. It is also linked to lung cancer.

Studies by scientific bodies including the IARC, the United States Surgeon General and the United States EPA, arrived at the conclusion that SHS causes lung cancer in nonsmokers.

Naturally the impact of SHS on children is far reaching as they are exposed to tobacco smoke by parents.

The exposure resulted in causing lower respiratory tract illnesses such as bronchitis and pneumonia, particularly during the first year of life.

Some of the common symptoms in children of smokers, which recur in greater frequency are cough, phlegm and wheeze. In addition exposure to SHS worsens the asthma in children and causes new-onset asthma.

The cost of SHS exposure

Exposure to SHS has wider economic repercussions than it is thought of. Besides significantly reducing efficiency in productivity both at individual and community levels, it has long term indirect medical costs. It also incurs additional expenses on renovation and cleaning costs and also increases risks of fire.

Though there are no available statistics on cost of SHS exposure in Sri Lanka, studies have been conducted and evaluated the cost of SHS in Australia, Canada, Hong Kong Special Administrative Region (Hong Kong SAR), Ireland, the United Kingdom and the United States.

Though the cost varies on many factors, it has been established that SHS exposure causes significant losses to economy in terms of reduction of productivity and increasing health care budget.

In United States, a recent study conducted by the Society of Actuaries estimates that SHS exposure responsible for over US$ 5 billion in direct medical costs and in over US$ 5 billion in indirect medical costs (such as disability, lost wages and related benefits).

In Hong Kong SAR, the annual value of direct medical costs, long-term care and productivity loss due to SHS exposure is estimated to be US$ 156 million.

The most effective protection strategy is the creation of smoke free environment in public and work places. Though the separation of smokers and non-smokers within the same space will not reduce level of non-smokers' exposure to SHS, it is by and largely dependent on other factors such as the amount of smoking and ventilation apparatus in use.

Benefits of smoke-free environments

One of the direct health benefits of the smoke free environment is the drastic reduction of toxic level in the environment which was earlier exposed to SHS.

This has been observed in public places such as in restaurants and bars where non-smoking hospitality workers health has been significantly improved following the implementation of the law banning smoking in public places.

For instance, reported respiratory symptoms among Irish bar workers decreased by 16.7 per cent after the law came into effect. In addition to improving health, smoke free environment has yielded significant economic benefits in terms of lowering direct medical costs to care for conditions attributable to SHS exposure and also reducing insurance costs (the higher insurance cost for smokers includes health, fire, accident and life insurance).

The other benefits includes increased productivity among those who quit smoking and among workers no longer exposed to second-hand smoke (time saved on smoking breaks and absenteeism due to illness), lower building maintenance costs.

Sometimes economic benefits can be substantial. For instance, it is estimated that that smoke-free environments would save employers the equivalent of 0.515per cent to 0.77per cent of the GDP in Scotland and between 1.1per cent and 1.7per cent of GDP in Ireland.

The United States Occupational Safety and Health Administration (OSHA), has estimated that clean air increases productivity by 3per cent.

Legislation to curb the menace

Though legislations on banning smoking in public places and places of work are often perceived as causing negative effects on business and hospitality industry, it has proved that they have a positive effect, significantly contributing to the reduction of risks associated with SHS.

Effectively implementing the mandatory legislations in banning smoking in public places, places of work, though opposed at the implementation stage, have yielded positive results, creating total smoke free environment not only in places of work but also in public transport.

In order to minimize the obvious opposition from the tobacco industry, it is imperative that policy decisions are made to educate the public on the negative effect of smoking on individuals health in general and SHS on non-smokers and children in particular.

Community involvement and implementation and enforcement plan is necessary to ensure smooth implementation of legislations on banning and curbing smoking in addition to setting up monitoring mechanism to oversee the progress.