Passive smoking at home

Harri Vertio[6]

hildren spend much of their early life in the presence of their parents, and if their parents smoke, these children can be exposed to long periods of environmental smoke (ETS).

The Royal College of Physicians in the UK (1992) has reviewed over 120 papers published since 1980 on the subject of passive smoking and the health of children. Some of the main finding of their review were that:

Infants of parents who smoke are twice as likely to suffer from serious respiratory infection;
Symptoms of asthma are twice as common in children of smokers;
One third of cases of 'glue-ear', the commonest cause of deafness in children, can be attributed to parental smoking;
Passive smoking during childhood predisposes children to developing chronic obstructive airway disease and cancer as adults;
Maternal smoking during pregnancy and infancy is one of the most important avoidable risk factors for infant death.

While the findings above tend to emphasise a potential risk of tobacco smoke exposure in children, Murray & Morrison (1993) have found that parents who smoke who have been urged by a doctor not to smoke in the vicinity of their children, eventually will expose their children to fewer cigarettes.

A questionnaire and stamped envelope were sent to a random sample of 1,000 households in each Nordic country with children born in 1992. The total response rate was 65.2% and numbered 3,547 households.

Smokers and respondents with smoking partners were asked how many cigarettes they themselves and/or their partner usually smoked during a week while being indoors with their child. In order to obtain further information about tobacco smoke in children's surroundings, all respondents were asked how often the child was present if someone smoked in the car, the room where the child slept, the room where the TV was located, the room where most meals were eaten, other indoor places at home, and other indoor situations at home.

All subjects were asked whether they had put into practice any rules to limit smoking indoors in their own homes, with responses in a yes/no format.

Prevalence of smoking and potential exposure

Data concerning individual smoking habits was available from 1,182 men and 2,338 women distributed by country as shown in Table 1. The average prevalence of daily smokers across country samples was 20.2% in men and 19.2% in women, but levels varied in both sexes.

Table 1. Smoking habits among male and female parents in five Nordic countries.
Male parents Female parents

Daily smokers Occasional smokers Daily smokers Occasional smokers

TOTAL 20,2 8,5 19,2 10,4

Denmark 20,6 5,8 22,5 8,2

Finland 24,7 11,7 13,5 12,2

Iceland 22,5 10,7 23,7 9,2

Norway 24,0 10,5 25,4 11,1

Sweden 13,5 7,0 17,8 10,6

Table 1. Smoking habits among male and female parents in five Nordic countries.
	Male parents	Female parents
	Daily smokers	Occasional smokers	Daily smokers	Occasional smokers
TOTAL	20,2	8,5	19,2	10,4
Denmark	20,6	5,8	22,5	8,2
Finland	24,7	11,7	13,5	12,2
Iceland	22,5	10,7	23,7	9,2
Norway	24,0	10,5	25,4	11,1
Sweden	13,5	7,0	17,8	10,6

Both parents were found to be smoking daily in 6.9% of households, while one parent was a smoker in 22.4% of households. This means that nearly one third of the children are at risk from ETS exposure in the 3,493 households from which information was forthcoming. A total of 7.6% (comprising a strong majority of women) were reported as living alone with their offspring. The prevalence of daily smoking in these single parent households run by women was especially high: 46.6%.

Table 2. Does indoor smoking exist in the house where your child usually is placed during daytime on weekdays?

Does indoor

smoking exist?
During daytime on weekdays, the child is usually placed:

in a kindergarden with a child minder with their parents all arenaes

Yes 8,1 10,4 8,6 8,7

No 89,8 88,5 90,5 89,8

I do not know 2,1 1,0 0,9 1,4

N 1498 600 1343 3441

Distribution 43,5% 18,1% 38,4% 100%

Table 2. Does indoor smoking exist in the house where your child usually is placed during daytime on weekdays?
Does indoor smoking exist?	During daytime on weekdays, the child is usually placed:
in a kindergarden	with a child minder	with their parents	all arenaes
Yes	8,1	10,4	8,6	8,7
No	89,8	88,5	90,5	89,8
I do not know	2,1	1,0	0,9	1,4
N	1498	600	1343	3441
Distribution	43,5%	18,1%	38,4%	100%

Some 43.5% of the parents usually had their child placed in a kindergarten during daytime on weekdays. 18.1% had their child looked after by a minder, while 38.4% minded the child themselves (Table 2). When asked of indoor smoking took place where the child usually spend his/her daytime hours on weekdays, a total of 8.7% answered yes, 1.4% did not know, while 89.8% replied that no indoor smoking took place.

Considering the amount of time parents spend with their children throughout the week, it seems that parents themselves are the main source of ETS exposure for their children.

Nearly 75% of the households reported having implemented some kind of limits to curtail smoking indoors. Over eight out of ten smokers had tried to change their smoking habits because of their children. This percentage was higher among daily smokers (84.8%) than among occasional smokers (74.7%) and ex-smokers (76.1%).

Opinions on the implications of ETS from among the survey
respondents reflect strong views on the subject.
Agree

Smokers Non-smokers

Children should have the right to live in a smoke-free home 87% 94%

An act should be passed which forbids all indoor smoking in the vicinity of children 53% 70%

Indoor smoking in the vicinity of children is child abuse 44% 59%

Adults have a right to smoke wherever they want in their own homes 31% 24%

Opinions on the implications of ETS from among the survey
respondents reflect strong views on the subject.
	Agree
	Smokers	Non-smokers
Children should have the right to live in a smoke-free home	87%	94%
An act should be passed which forbids all indoor smoking in the vicinity of children	53%	70%
Indoor smoking in the vicinity of children is child abuse	44%	59%
Adults have a right to smoke wherever they want in their own homes	31%	24%

[6] Based on a study by K.E. Lund, A. Helgason & H. Vertio, Nordic Cancer Union.

Smoke Free Europe - A Forum for Networks - 14 AUG 1997

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