{"id":5834,"date":"2017-02-07T11:41:45","date_gmt":"2017-02-07T11:41:45","guid":{"rendered":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/SHS-rev-2.pdf"},"modified":"2017-02-07T11:43:08","modified_gmt":"2017-02-07T11:43:08","slug":"shs-rev-2","status":"inherit","type":"attachment","link":"https:\/\/www.wma.net\/fr\/ce-que-nous-faisons\/education\/tabac\/shs-rev-2\/","title":{"rendered":"SHS-rev-2"},"author":2,"comment_status":"open","ping_status":"closed","template":"","meta":[],"acf":[],"description":{"rendered":"

SHS-rev-2<\/a><\/p>\n

Health Effects of Tobacco Secondhand Smoke
\n[SHS]: focus on Children Health
\nA Review of the Evidence
\nCenter for the Study of International Medical Policies and Practices
\n[CSIMPP]
\nArnauld Nicogossian, MD, FACPM, FACP
\nSchool of Policy, Government and International Affairs,
\nGeorge Mason University
\n1Revision 2
\nDisclosure\/Disclaimer
\n\uf06e No Competing Conflicts of Interest or Financial
\nSupport for this Activity
\n\uf06e Any opinions, findings, conclusions or
\nrecommendations expressed in this presentation
\nare those of the author [s] and do not
\nnecessarily reflect the views of the George
\nMason University.
\n\uf06e The author is the Director of the WMA
\nCollaborating Center on Microbial Resistance
\nand Development of Public [Health] Policy.
\n2Revision 2
\nCopy rights
\nSome of the materials included in this
\npresentations might be protected by
\ncopyrights. Any use other than for non-
\nprofit educational purposes will require
\nobtaining appropriate permissions.
\nRevision 2 3
\nOUTLINE
\n\uf06e Learning Objectives
\n\uf06e Overview
\n\uf06e Types of Smoking Implements
\n\uf06e Definitions
\n\uf06e Statements by WMA and WHO
\n\uf06e Epidemiology
\n\uf06e Health Effects of SHS
\n\uf06e Third Hand Smoke
\n\uf06e Prevention and Control of Tobacco Smoke Exposure
\n\uf06e Conclusions
\n\uf06e Points to Remember 4Revision 2
\nLearning Objectives
\n1. Understand the strength of the evidence supporting
\nthe health effects of tobacco second hand smoke
\n(TSHS) in children, and
\n2. Review the efficacy of interventions, including
\npolicies and legislations, designed to minimize TSHS
\nexposures of infants and children.
\n5Revision 2
\nOverview
\n6Revision 2
\nTobacco Smoke Delivery Systems and
\nNicotine
\nMost Common Tobacco
\nImplements
\nMajor Nicotine Health
\nHazards
\n\uf06e Nicotine is the primary addicting
\ndrug in cigarettes. When
\ncombined with other combustion
\nby-products it can result in:
\n\uf06e Cardiovascular disease.
\n\uf06e Pulmonary chronic disorders.
\n\uf06e Multi-organ cancer, and
\n\uf06e Premature births and low birth weight
\nbabies and is harmful to developing
\nbrains in women who smoke during
\npregnancy.
\n\uf06e There is no safe level of exposure
\nto SHS.
\n7Revision 2
\nDefinitions
\n\uf06e SHS Exposure can result from
\n\uf06e Mainstream smoke \u2013 the smoke that is exhaled from the smoker\u2019s
\nlungs, and
\n\uf06e Sidestream smoke \u2013 the smoke from the burning end of a tobacco
\nproduct.
\n\uf06e Third Hand Smoke [TSH] exposure results from the deposition of
\nnicotine on personal items and other surfaces.
\n\uf06e About 15% of SHS exposures is mainstream and 85% is sidestream
\nthough the composition of toxins in both sources is similar
\n8Revision 2
\nWMA [2006] and WHO [2009]
\nWorld Medical Association
\n\uf06e Recognizing the abundant evidence linking
\nadverse health outcomes and exposure to
\nsecond-hand smoke; and
\nNoting that despite this new evidence many
\ncountries still allow smoking in public areas;
\n\uf06e The World Medical Association:
\n\u2022 Congratulates the French government and
\nFrench physicians for the introduction of
\nlegislation that would ban smoking in public
\nareas; and
\n\uf06e Urges other National Medical Associations to
\nadvocate for similar legislative changes in their
\nown countries if such legislation does not exist.
\nWorld Health Organization
\n\uf06e Second-hand smoke
\naccounts for one in 10 tobacco-
\nrelated deaths.
\n\uf06e Creating 100% smoke-free
\nenvironments is the only way
\nto protect people from the
\nharmful effects of second-hand
\ntobacco smoke.
\n9Revision 2
\nEpidemiology
\n10Revision 2
\nTobacco Smoke Affects Most Body
\nOrgans [CDC. US\/Gov.]
\n11Revision 2
\n12Revision 2
\nSHS Health Effects Sources and Strength of Evidence
\n[see Review Document]
\nIn Adults [Good Evidence]
\n\uf0b7 Coronary heart disease (Japuntich et
\nal. 2015)
\n\uf0b7 Stroke (Olasky et al. 2012)
\n\uf0b7 Dementia (Barnes et al. 2010).
\n\uf0b7 Breast cancer (WHO 2007)
\n\uf0b7 Chronic respiratory illnesses (WHO
\n2007)
\n\uf0b7 Decline in pulmonary function (WHO
\n2007)
\nIn Children [Fair to Good
\nEvidence]
\n1. Sudden Infant Death Syndrome [USSG
\n2006 Report].
\n2. Low Birth Weight [USSG 2006 Report].
\n3. Pulmonary and Cardiovascular
\ndevelopmental risks [Kabir et al. 2009,
\nTanski and Wilson 2012].
\n4. Otitis media [Muller 2007].
\n5. Neurological and mental disorders [Rao et
\nal. 2009, Brooks et al. 2011, Evlampidou
\net al. 2015, Padron et al. 2015].
\n6. Lifelong risk of obesity [McConnell et al.
\n2015].
\n[Evidence for detrimental effects from SHS exposure
\nin children and infants is expanding]
\n13Revision 2
\nHealth Effects fromThird Hand Smoke [THS]
\nfrom Tobacco
\n\uf06e Growing evidence for health effects from the remaining tobacco residues
\ndeposited on surfaces, smokers\u2019 clothes and hair.
\n\uf06e Nonsmokers who are exposed to such environments are considered to be
\nvictims of third-hand tobacco smoking (THS) [Escoffery et al. 2013].
\n\uf06e Trace levels of nicotine remains in the air, dust, and surfaces of
\nresidential settings which can be harmful especially to children.
\n\uf06e Nonsmokers who reside in homes previously occupied by smokers have
\ndemonstrated elevated levels of nicotine on hands and in urine compared
\nto those residing in homes where no one has smoked [Matt et al. 2011].
\n\uf06e The role of particulate in the smoke such as polycyclic aromatic
\nhydrocarbons (PAHs), from incomplete combustion of carbon-
\ncontaining materials, is suspected to be carcinogenic [Fleming et al.
\n2012].
\n14Revision 2
\n\uf06e Prevention and Control of Tobacco Smoke
\nExposure
\n15Revision 2
\nControl Measures
\nWHO FCTC [Introduced 1993]
\n\uf06e Measures relating to reducing the demand for
\ntobacco
\n\u2022 Price and tax measures
\n\u2022 Protection from exposure to environmental tobacco smoke
\n\u2022 Regulation and disclosure of the contents of tobacco
\nproducts
\n\u2022 Packaging and labelling
\n\u2022 Education, communication, training, and public awareness
\n\u2022 Comprehensive ban and restriction on tobacco advertising,
\npromotion, and sponsorship
\n\u2022 Tobacco dependence and cessation measures
\n\uf06e Measures relating to reducing the supply of
\ntobacco
\n\u2022 Elimination of the illicit trade of tobacco products
\n\u2022 Restriction of sales to and by minors
\n\u2022 Support for economically viable alternatives for growers
\nImplementing FCTC [WHO 2011]
\n\uf06e Smoking bans in bars and restaurants have been
\nenacted in
\n\uf06e Norway,
\n\uf06e New Zealand,
\n\uf06e England, Scotland, Wales, Northern Ireland,
\n\uf06e Italy,
\n\uf06e Spain,
\n\uf06e Malta,
\n\uf06e USA, and
\n\uf06e France.
\n\uf06e By 2010, 31 countries have taken steps to
\nprovide the highest level of protection against
\nSHS for their citizens.
\n\uf06e Has been signed by168 countries and is legally
\nbinding in 180 ratifying countries, and countries
\nmeet the best practice for pictorial warnings
\n[2015].
\n16
\nSource; Kenji Shibuya et al. BMJ. 2003 Jul
\n19; 327(7407): 154\u2013157
\nRevision 2
\nControl and Interventions
\n[ADVERTISING, PROMOTION AND SPONSRSHIP POLICIES, BY WHO REGION, 2014]
\n17
\nAs at December 2014, only 29 WHO Member States had comprehensive bans on tobacco advertising, promotion and
\nsponsorship
\n(% of Countries categorized by WHO Regions 2014)
\nRevision 2
\nInterventions\/Policies
\nWHO 2006
\n\uf06e MPOWER Principles
\n1. Monitoring tobacco use and
\nprevention policies.
\n2. Protecting people from tobacco
\nsmoke.
\n3. Offering help to quit tobacco use.
\n4. Warning about the dangers of tobacco
\n5. Enforcing bans on tobacco
\nadvertising, promotion and
\nsponsorship, and
\n6. Raising taxes on tobacco.
\n18Revision 2
\nArticle 11 of FCTC
\n\uf06e Article 11 of the WHO FCTC
\nrequires that health warning labels on
\ntobacco packaging (to):
\n\uf0b7 Be approved by the competent
\nnational authority;
\n\uf0b7 Should cover 50% or more of the
\nprincipal pack display areas, but
\nshould be no less than 30%;
\n\uf0b7 Be large, clear, visible and legible;
\n\uf0b7 Not use misleading terms like \u201clight\u201d
\nand \u201cmild\u201d;
\n\uf0b7 Be rotated periodically to remain
\nfresh and novel to consumers;
\n\uf0b7 Display information on relevant
\nconstituents and emissions of tobacco
\nproducts as defined by national
\nauthorities;
\n\uf06e Appear in the principle language(s)
\n19
\nUS FDA proposed graphic warning labels on tobacco
\nproducts packages. On august 24, 2012 the US Court
\nof Appeals for the District of Columbia issued a
\nruling to block the use of graphic warning labels on
\nall cigarette packages, upholding a ruling by the US
\nDistrict Court on November 7, 2011. Further court
\nrulings is expected in 2016.
\nRevision 2
\nOn November 12, 2015, the U.S. Department of Housing and Urban
\nDevelopment (HUD) issued its proposed rule that will require 3,100
\npublic housing agencies across the country to go smoke free. Public
\nhousing agencies will need to implement smoke free policies in their
\ndevelopments within 18 months of the final rule. This equates to
\nover 1 million people protected from secondhand smoke in their
\nhomes, including 760,000 children
\n20Revision 2
\nUse of Mass Media Campaigns
\nStrength of Evidence
\n1. Mass media campaigns and financial support have also been explored as ways to encourage smoking cessation.
\nSuch campaigns can be effective when combined with other interventions but their effects on smoke cessation alone
\nare difficult to determine. In April 2013, the Community Preventive Services Task Force, established by the US
\nDepartment of Health and Human Services (USDHHS), an equivalent of a ministry of health, issued a statement
\nrecommending mass-reach health interventions. Their systematic review of over 90 studies showed strong evidence
\nof effectiveness in
\nDecreasing the prevalence,
\nIncreasing quit rates, and
\nDecreasing smoking uptakes (Community Preventive Services Task Force 2013).
\n2. A review of eleven trials involving financial interventions suggests that provision of full financial coverage for
\ncessation treatments significantly increased the intention to and success rates of quitting compared to interventions
\nwithout financial support (Reda et al. 2012).
\n3. Antismoking legislation is effective based on the systematic review of 50 studies in 5 countries showed consistent
\nevidence of reduction of SHS exposure in workplaces, restaurants, bars and in public places (Callinan et al. 2010).
\n4. Interventions to encourage smoking cessation and reduce exposure to SHS vary widely and involve many
\nstakeholders and components. Due to the lack of standard definitions of components such as smoking, smokers, and
\nquit attempts as well as the lack of sufficient number of similar interventions, there is, to date, little evidence of
\neffectiveness of one type of intervention over others.
\n21Revision 2
\nConclusions
\n22
\n1. Robust evidence links tobacco use to respiratory and cardiovascular diseases, including cancer.
\n2. Good evidence links SHS tobacco exposures to medical problems in infants, children and
\nadults.
\n3. SHS tobacco exposures in private place continues to be a major health threat to pregnant
\nwomen, infants and children, and in several US litigation case were labeled as child neglect
\n[rarely as abuse].
\n4. Developing market economy countries continue to have higher tobacco use and SHS exposure
\nlevels.
\n5. According to the American Cancer Society (ACS 2015) the estimated health care costs for
\ntobacco use between 2000 and 2012 in billions of dollars, in several countries, amounted to:
\na. USA 133
\nb. France 16.6
\nc. United Kingdom 9.5
\nd. China 6.2 (conservative estimates)
\ne. Canada 2.8
\n6. There is no single effective preventive intervention, but rather a combination of measures such
\nas smoking bans, taxations, education, systematic and sustained outreach campaigns, package
\nlabeling, and improved health literacy.
\n7. Several countries including US are considering legislations to prohibit smoking in private
\nspaces
\nRevision 2
\nPoints To Remember
\n[ABCE\u00b2]
\n1. Avoid Exposure with
\nfocus on maternal and
\nchild health
\n2. Best practices
\nsupported by evidence
\n3. Consistent
\nadministrative policies
\nand legislations
\n4. Enforcing policies
\nbased on the
\nInternational
\nConventions
\n5. Education
\n23
\nSchools of Public Policy
\nProfessional Schools
\nAcademic Health Centers
\nConsumers
\nFood Producers
\nPolicy Makers
\nAdvocates
\nSocieties
\nRevision 2<\/p>\n"},"caption":{"rendered":"

SHS-rev-2 Health Effects of Tobacco Secondhand Smoke [SHS]: focus on Children Health A Review of the Evidence Center for the Study of International Medical Policies and Practices [CSIMPP] Arnauld Nicogossian, MD, FACPM, FACP School of Policy, Government and International Affairs, George Mason University 1Revision 2 Disclosure\/Disclaimer \uf06e No Competing Conflicts of Interest or Financial Support […]<\/p>\n"},"alt_text":"","media_type":"file","mime_type":"application\/pdf","media_details":{},"post":701,"source_url":"https:\/\/www.wma.net\/wp-content\/uploads\/2016\/11\/SHS-rev-2.pdf","_links":{"self":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media\/5834"}],"collection":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/media"}],"about":[{"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/types\/attachment"}],"author":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.wma.net\/fr\/wp-json\/wp\/v2\/comments?post=5834"}]}}