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The need to protect children from second-hand tobacco smoke

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Sinead Jones, PhD, MPH

Director, BMA Tobacco Control Resource Centre, Edinburgh

Second-hand tobacco smoke is the main source of indoor air pollution in the UK. This chemical cocktail contains more than 50 ingredients which cause cancer. Yet, even though for two decades scientific evidence has demonstrated that exposure to second-hand smoke is harmful, children are still exposed every day.

Second-hand tobacco smoke is the main source of indoor air pollution in the UK. This chemical cocktail contains more than 50 ingredients which cause cancer. Yet, even though for two decades scientific evidence has demonstrated that exposure to second-hand smoke is harmful, children are still exposed every day.

The British Medical Association (2002) estimates that at least 1000 people die annually in the UK due to second-hand smoke. Children, pregnant women and people with cardiovascular, cerebrovascular or respiratory disease are particularly vulnerable.

Risks to children
For infants and children, the effects of exposure to second-hand smoke can be both serious and long-lasting. Their lungs are less well-developed than adults, they breathe faster and inhale a higher dose of toxins in proportion to their body weight. A World Health Organization (1999) expert group concluded that second-hand smoke can cause asthma in children and increase the severity of attacks in those affected. It is estimated that each year more than 17 000 preschool children are admitted to UK hospitals due to respiratory illness caused by exposure to cigarette smoke (Royal College of Physicians, 1992).

Many expert panels and government committees have emphasised the need to protect non-smokers from second-hand smoke. The BMA believes legislation to ban smoking in public places is needed to achieve this. Although progress has been made, public places are a major source of exposure to second-hand smoke. As Finland, Norway, Holland, New Zealand and Ireland legislate to make public places smoke-free, the UK is falling behind.

Smoke-free policies enjoy widespread - and growing - support in the UK. In December 2003, more than 80% of people polled in a survey carried out for the Daily Telegraph supported legislation to ban smoking in shops, shopping centres, restaurants, offices and public buildings.

Yet the government continues to back voluntary measures that rely largely on ventilation. These measures are simply not working - ventilation does not remove most of the toxins involved.

The Public Places Charter, agreed by the Department of Health and the hospitality trade, is backed by the Tobacco Manufacturers' Association. Why does the tobacco industry put large sums of money into sustaining smoking in public places? One answer may lie in the fact that smoke-free places support the seven out of 10 smokers who want to quit, helping them to stop. It has been estimated that smoke-free public places could cut smoking rates by 4% and tobacco consumption by almost 30% (Fichtenberg and Glantz, 2002). That would mean an annual loss of some £310 million for the UK tobacco industry and - the Royal Medical Colleges estimate - a saving of at least 160 000 lives (Royal College of Physicians, 2003).

Legislation
In its report Towards Smoke-free Public Places, the BMA (2002) called on the government to increase public awareness of the health risks of second-hand smoke. We welcome the campaign informing adults of the risks it poses to children's health, but they also need protection in public places. That is why the BMA has written to MPs who were successful in the ballot for Private Member's Bills urging them to back draft legislation - the Tobacco Smoking (Protection of Children) Bill - that seeks to ban smoking in all enclosed public places to which children have access.

Our health - and that of our children - is at risk from passive smoking. The government should dissociate itself from the Public Places Charter and introduce legislation for smoke-free public places. After years of failed voluntary measures, the UK's children deserve better.

British Medical Association (2002) Towards Smoke-free Public Places. London: BMA.

Fichtenberg, C.M., Gantz, S.A. (2002)Effect of smoke-free workplaces on smoking behaviour. British Medical Journal 325: 188.

Royal College of Physicians (1992)Smoking and the Young. London: RCP.

Royal College of Physicians (2002)Tobacco Smoke Polution: the hard facts. London: RCP.

World Health Organization (1999)International Consultation on Environmental Tobacco Smoke and Child Health. Geneva: WHO.

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