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passive smoking

Southeast Asia: Indonesia lags in curbing tobacco industry interference in policy making

11 Oct, 16 | by Marita Hefler, News Editor

Indonesia has once again emerged as a clear laggard in curbing tobacco industry interference in policy-making, according to a report ranking countries in the Southeast Asia region based on their level of implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control (FCTC). It is the third annual report on tobacco industry interference prepared by the Southeast Asia Tobacco Control Alliance (SEATCA).

Indonesia is the only country whose score increased in both the 2015 and 2016 reports among the seven surveyed in all three years (Brunei, Philippines, Cambodia, Malaysia, Thailand, Lao PDR, Vietnam and Indonesia). Its 2014 score of 78 (the first year of the survey) reflected a very high level of interference, and exceeds the scores of all other countries in any year of the survey. Indonesia’s score has continued to worsen, and stands at 84 in the 2016 report. The maximum possible score is 100; a higher score reflects a greater level of interference.

fig-5-seatca-rankings

Ranking of countries in the Southeast Asia region by tobacco industry interference, as calculated by SEATCA. Source: 2015 ASEAN report on implementation of WHO Framework Convention on Tobacco Control Article 5.3.

 

 

 

 

 

 

 

 

 

 

The dismal result is a stark illustration of why Indonesia, one of only a handful of countries that has not signed the FCTC, is a tobacco control ‘rogue state’. The country achieved worldwide infamy in 2010 when a video of a smoking toddler went viral. The video prompted increased media coverage of the striking absence of effective tobacco control policies and regulation in Indonesia, a situation which tobacco companies have taken full advantage of to saturate the country in cigarette advertising.

The Global Adults Tobacco Survey (GATS) of 15 low and middle income countries with high tobacco use published in 2012 found that Indonesia was among the countries with the highest adult male smoking prevalence at 67%. The lax regulations extend to failure to protect Indonesians from secondhand smoke; the GATS also found that 85% of people who visited restaurants were exposed to tobacco smoked and 82% reported seeing cigarette advertising within the last month – exposure far higher than any other country surveyed. Unsurprisingly, Indonesia’s (male) youth smoking prevalence is among the highest in the world; according to the 2014 Global Youth Tobacco Survey, 35% of boys aged 13-15 are current smokers.

At the other end of the scale, the standout countries in the 2016 report were Brunei and the Philippines. Brunei was ranked first for the third year in a row with a score of 29, unchanged from 2014 and 2015. The Philippines has seen a dramatic improvement from a score of 71 in 2014 down to 38 in 2016. Cambodia and Malaysia have also shown consistent improvement from their 2014 scores to be ranked equal fourth at a score of 49 in 2016.

The SEATCA report can be accessed by clicking here. 

Non-smokers exposed to three times above safe levels of particles when living with smokers

20 Oct, 14 | by Becky Freeman, Web Editor

Non-smokers who live in a house with smokers are exposed to three times the officially recommend safe levels of damaging air particles, according to a study published online in the journal Tobacco Control.

Living with smokers is the same as living in smoke-free homes in heavily polluted cities such as Beijing or London, found researchers who have said moving to a smoke-free home could have major health benefits for non-smokers.

There is already strong evidence to suggest that exposure to second hand smoke is linked to a wide range of adverse health events such as respiratory and heart illness.

Accordingly, many governments have introduced measures to restrict their population’s exposure to second hand smoke within workplace and leisure settings.

Fine particulate matter (PM2.5) such as fine dust or soot suspended in the air, has been widely used as a marker for second hand smoke exposure with data from bars and restaurants showing concentrations of second hand smoke-derived PM2.5 that frequently exceed the US Environmental Protection Agency levels described as “unhealthy for sensitive groups” 24 hour limit or the World Health Organization’s (WHO) guidance limits.

Main outdoor sources of particulate matter include exhaust fumes from motor vehicles and industrial emissions and more is known about what impact this has on health than the impact within indoor environments.

Therefore, Scottish researchers set out to explore fine particulate matter less than 2.5 ìm (PM2.5) concentrations in smoking and non-smoking homes in Scotland to estimate the amount of PM2.5 inhaled by different age groups.

The researchers studied data from four linked studies carried out in Scotland between 2009 and 2013 that had real time measurements of PM2.5 in homes, and combined them with data on typical breathing rates and time-activity patterns.

In all four studies, homes that were likely to have a significant additional source of PM2.5 (such as coal or solid fuel fires) were excluded.

Three of the studies used the same method to assess and measure PM2.5 concentrations – a personal aerosol monitor that was placed in the main living area of participants’ homes for a period of 24 hours – while the other study used a new, low-cost, particle-counting device.

Collectively, the four linked studies produced air quality data from 93 smoking homes with a further 17 non-smoking households. Most sampling was for a 24-hour period with the exception of one study data, which was generally carried out over a period of 6–7 days.

The results showed that the average PM2.5 concentrations from the 93 smoking homes were about 10 times those found in the 17 non-smoking homes.

Non-smokers living with smokers typically had average PM2.5 exposure levels more than three times higher than the WHO guidance for annual exposure to PM2.5 (10 ìg/m3).

Many non-smokers living in smoking homes inhaled similar quantities of PM2.5 to non-smokers who lived and worked in smoke-free environments in cities such as Beijing or London with high levels of air pollution.

The researchers also calculated that overall, homes where unrestricted, heavy-smoking activity took place produced second hand smoke concentrations that were, on average, about 10 times higher than homes where efforts to reduce or restrict second hand smoke exposure were more common.

Some homes studied had particularly high rates of smoking. Around a quarter of homes had 24 hour average concentrations in excess of 111 ìg/m3, more than 11 times that recommended as an annual average concentration by WHO.

The researchers also estimated that the overall mass of PM2.5 inhaled over an 80-year period for a person living in a typical smoke free home was about 0.76g compared with a similar person living in a smoking home, who would inhale about 5.82g.

Non-smokers living in smoking households would experience reductions of over 70% in their daily inhaled PM2.5 intake if their home became smoke-free, the researchers calculated, and the reduction was likely to be greatest for the very young and for older members of the population.

They concluded: “These findings ultimately support the need for efforts to reduce SHS [second hand smoke] exposure in the home, most notably through the implementation of smoke free home rules and smoke free multi-unit housing policies.”

Dr Sean Semple of University of Aberdeen and lead author, said: “Smokers often express the view that outdoor air pollution is just as much a concern as the second-hand smoke in their home.

“These measurements show that second-hand tobacco smoke can produce very high levels of toxic particles in your home: much higher than anything experienced outside in most towns and cities in the UK. Making your home smoke-free is the most effective way of dramatically reducing the amount of damaging fine particles you inhale.”

Passive smoking linked to increased miscarriage, stillbirth, and ectopic pregnancy risk

3 Mar, 14 | by Becky Freeman, Web Editor

BMJ Press Release

Associations of lifetime active and passive smoking with spontaneous abortion, stillbirth and tubal ectopic pregnancy: a cross sectional analysis of historical data from the Women’s Health Initiative

Passive smoking is linked to a significantly increased risk of miscarriage, stillbirth and ectopic pregnancy, finds a large observational study, published online in Tobacco Control.

The risk appears to be cumulative, with risk heightened in parallel with the  length of time exposed to second hand smoke, the findings indicate. It is well known that smoking during pregnancy significantly increases the risks of miscarriage and birth complications. What is less clear is whether passive smoking exerts similar effects, and if there are particularly critical periods of exposure to second hand smoke.

The researchers drew on historical data from a large sample of more than 80,000 women who had gone through the menopause, and been part of the Women’s Health Initiative (WHI) study. Just over 5000 of the women (6.3%) were current smokers; just under 35,000 (43%) were ex-smokers, who had smoked at least 100 cigarettes; and just under 41,000 (50.6%) were non-smokers. All had been pregnant at least once.

The group of non-smokers was then categorised according to the level of second-hand smoke they had been exposed to during childhood, as an adult at home, and as an adult at work. The pregnancy outcomes showed that almost one in three of the entire sample (32.6%, 26,307) said they had miscarried at least once. Some 3552 (4.4%) had experienced a stillbirth, while 2033 (2.5%) had had a tubal ectopic pregnancy.

Not unexpectedly, younger and/or better educated women were less likely to miscarry or have birth complications; women of black and minority ethnic backgrounds and those who were overweight were more likely to do so. Women who had never smoked were less likely to miscarry, have a stillborn child or an ectopic pregnancy than either current or former smokers, the data showed. Compared with non-smokers, women who had ever smoked during their reproductive years were 16% more likely to miscarry, 44% more likely to have a stillborn child, and 43% more likely to have an ectopic pregnancy.

And these associations were also evident for non-smokers who had breathed in other people’s cigarette smoke compared with non-smokers who had not been similarly exposed. The longer the period of exposure, the greater was the risk for non-smokers.

Those who had experienced the highest levels of lifetime exposure, including more than 10 years as a child, or more than 20 years as an adult at home, or more than 10 years in the workplace were 17% more likely to miscarry, 55% more likely to give birth to a stillborn child, and 61% more likely to have an ectopic pregnancy.

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