José Alberto Gomes Precioso
(Instituto de Educação)
Smoking Prevention.
Children Secondhand smoke exposition
prevention
09 de Novembro 2013
UMinho
WHO estimates that half of children (700 million), breathe
air polluted by ETS, especially in their homes (WHO,
2007).
In Portugal, few studies have assessed ETS children
exposure in the home.
None had evaluated ETS children exposure in the car,
neither the rules nor restrictions of smoking behavior in
the home and in the car, in a representative sample of
Portuguese children.
AIM
To describe the prevalence of Environmental Tobacco Smoke (ETS) exposure
among Portuguese children at home and in the car, in Portugal.
METHODS
Participants: 2999 4th grade children (1 462 boys girls and 1 534) aged 9.50±0.68
years old (mean±SD), recruited in the project “Prevention of the Environmental
Tobacco Smoke exposure among children at home” (PTDC/CPE-CED/098281/2008)
in the 2010/2011 school year.
Materials: A validated self-administered questionnaire filled out at school by children,
anonymously.
3.2- Amostra
Tabela 1- Caraterização socio-demográfica da amostra
Sexo
Masculino
Feminino
Idade
n (%)
1534(51.1)
1462(48.7)
Média
(Desvio-Padrão)
9.49(0.68)
Moda
Masculino
Min.-Máx.
8-11
3- Metodologia
- Estudo quantitativo (transversal descritivo);
- Aplicação de um questionário anónimo, de auto
preenchimento, construído para o efeito;
- Amostra representativa
(3000 alunos do 4º ano )
Braga (463)
Porto (516)
Viana do Castelo (240)
Covilhã (167)
Lisboa (943)
Évora (146)
Faro (163)
Funchal (207)
Angra do Heroísmo (154)
Procedure:
• Descriptive cross-sectional study
• Representative sample of school-aged children in the 4th grade of nine portuguese
counties: Braga, Porto and Viana (North); Covilhã (Center), Évora (South inland), Faro
and Lisbon (South littoral), and the islands Madeira (Funchal) and Azores (Angra do
Heroísmo)
• Response rate of 77.5%
• Schools randomly selected from a list provided by the Office of Statistics and the
Planning Department of the Ministry of Education
• Ethical approval of the Direção Geral de Inovação e Desenvolvimento Curricular
• Informed consent from the parents/educators was required
• Descriptive statistics were performed through Statistical Package of Social Sciences,
19.0 version for Windows.
3.1- Questionário
Variáveis
-Sociodemográficas;
-Exposição das crianças ao FAT no domicílio;
-Exposição das crianças ao FAT no carro;
-Sintomatologia respiratória relacionada com a
exposição.
1- Results
Tabela 2. Prevalence of regular and occasional smokers in
the household declared by the sample students
Smoked daily at
Smoke
home 33.9%occasionally at
home
Do not smoke or
do not smoke at
home
Familiar
n
f
%
IC (95%)
f
%
IC (95%)
f
%
IC (95%)
mother
2853
221
7.7
6.7-8.7
308
10.8
9.7-11.9
2324
81.5
80.1-82.9
father
2690
279
10.4
9.2-11.6
370
13.8
12.5-15.1
2041
75.9
74.3-77.5
siblings
2207
34
1.5
1.0-2.0
59
2.7
2.0-3.4
2114
95.8
95.0-96.6
At least one
cohabitant
Another person go
home
2951
467
15.8 14.5-17.1
533
18.1
16.7-19.5
1951
66.1
64.4-67.8
1932
140
7.2
511
26.4
24.4-28.4
1281
66.3
64.2-68.4
6.0-8.4
33,9%
Tabela 5: Prevalência de crianças asmáticas expostas ao FAT, de pelo menos um dos
conviventes em casa.
Pelo menos um dos conviventes fuma no
domicílio
Sim
Não
Diagnóstico de asma
n
f
%
IC (95%)
f
%
IC (95%)
p
Sim
308
185
60.1
54.6-65.6
123
39.9
34.4-45.4
0.798
Não
1405
832
59.2
56.6-61.8
573
40.8
38.2-43.4
Sim
260
150
57.7
51.7-63.7
110
42.3
36.3-48.3
Não
1332
781
58.6
56.0-51.2
551
41.4
38.8-44.0
Sim
400
240
60.0
55.2-64.8
160
40.0
35.2-44.8
Não
1205
703
58.3
55.5-61.6
502
41.7
38.9-44.5
Uso de inalador
0.784
Uso de medicação
0.598
4- Resultados
Tabela 3. Prevalence of smoking mothers and fathers, who
smoke at home, declared by the sample students
Fuma diariamente
no domicílio
Familiar
n
f
%
IC (95%)
Fuma
ocasionalmente no
domicílio
f
%
IC (95%)
Não fuma no domicílio
f
%
IC (95%)
Mãe
780
221 28.3 25.1-31.5 308 39.5
36.1-42.9
251
32.2
28.9-35.5
Pai
1036 279 26.9 24.2-29.6 370 35.7
32.8-38.6
387
37.4
34.5-40.3
67.8%
62.6%
4- Resultados
Tabela 4. Locais do domicílio mais frequentemente utilizados
para fumar
Mãe
Pai
Visitante
f
%
IC (95%)
f
%
IC (95%)
f
%
IC (95%)
À janela ou perto
de portas abertas
para o exterior
Cozinha
203
26.3
23.2-29.4
261
28.2
25.0-31.4
197 39.5
36.0-43.0
229
29.7
27.9-31.5
218
23.6
21.9-25.3
145 29.1
27.3-30.9
Sala de jantar
78
10.1
6.5-13.7
111
12.0
8.2-15.8
47
9.4
5.9-12.9
Sala de estar
113
14.7
11.2-18.2
153
16.6
12.9-20.3
73
14.6
11.1-18.1
Casa-de-banho
67
8.7
4.5-12.9
76
8.2
4.1-12.3
14
2.8
0.4-5.2
Quartos
81
10.5
6.8-14.2
105
11.4
7.5-15.3
23
4.6
2.0-7.2
4- Resultados
Tabela 5. Smoking in the car, stated that the children usually
go by car
Crianças que
costumam andar de
carro
Fumam sempre
dentro do carro
Fumam
ocasionalmente
dentro do carro
n
f
%
IC (95%)
f
%
IC (95%)
f
%
IC (95%)
2810
137
4.9
4.1-5.7
683
24.3
22.7-25.9
1990
70.8
69.1-72.5
29.2%
Não fumam
dentro do carro
CONCLUSION
• One third of the children in this study is daily or occasionally exposed to ETS at
home and in car.
•Prevalencie of asmatics children exposed is the same of non asmatics.
•Although there are differences in the prevalences among counties, parents and
other inhabitants usually smoke at home and often in the car.
• Portugal implemented a smoking partial ban in 2008. This study may show that
the ban is not effective in protecting children in private places as the home and the
car.
• These findings highlight the need to implement preventive educational actions to
promote 100% smoke-free environments, including smoke-free homes and cars..
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16
17
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Proibido fumar!
no carro!
In June of 2008, Ontario, Canada officially banned smoking in vehicles if a child
aged 16 or under is present. Ontario is the third Canadian province to pass this
ban, following Nova Scotia and British Columbia.
SAÚDE
Governo vai proibir fumar nos carros com
crianças
por Ana Maia, DN.pt com Lusa11 abril 2012
O ministro da Saúde anunciou hoje no parlamento que o Governo vai proibir o
fumo do tabaco nos veículos que transportem crianças. Também a publicidade
nos maços de tabaco vai ser mais explícita.
22
2. Grounding
Disadvantages of environmental tobacco smoke for
children
High prevalence of children exposed
Relation between parental smoking at home and
children’s tobacco consumption
Strategy
1. Brief theoretical approach to the consequences of active/passive
smoking
2. Elaboration of preventive materials (stickers to put at home)
3. Shipping, to parents, of a leaflet about the consequences of
secondhand smoking
4. Role playing, in which children should use their persuasion power
asking parents not to smoke at home
5. Signing a statement in which the father/mother commits him/herself to
create a free-smoke household
6. Putting stickers at home and in the car stating that smoking is
prohibited
7. Displaying of posters in strategic places, targeting parents.
Brief theoretical approach
to the consequences of
active/passive smoking
Existem evidências suficientes para inferir uma relação causal entre fumo do
tabaco e um desenvolvimento e função pulmonar diminuída, sintomas
respiratórios (tosse, expectoração, pieira e dispneia) (U.S. Department of
health and human Services, 2004).
No relatório de do Surgeon
General de 2004, pode ler-se que
as crianças expostas ao fumo
passivo têm um maior risco de
sofrer infecções respiratórias,
problemas de ouvidos e ataques
de asma mais graves
Elaboration of
preventive materials
Forbidden to smoke!
at home!
Shipping, to parents,
of a leaflet about the
consequences of
secondhand smoking
Teachers should hand out the
leaflets to students
Students should take them home
and give it to their
father/mother!
Role playing, in which
children should use their
persuasion power asking
parents not to smoke at
home
TEACH CHILDREN TO PERSUADE THEIR
PARENTS TO NOT SMOKE AT HOME
TEACH CHILDREN TO PERSUADE THEIR PARENTS
TO NOT SMOKE AT HOME.
1) Ask students to think about arguments to
convince their parents to not smoke at home.
2) In class, do role-playing exercises in which
teacher plays the role of father/mother and the
student try to convince him/her to not smoke at
home!
3) Register the best arguments on the board
4) Each student should choose the arguments
that best fit in their context and use them at
home
SOME ARGUMENTS THAT CHILDREN CAN
USE TO CONVINCE THEIR PARENTS NOT TO
SMOKE AT HOME!
“Father/Mother don’t
smoke at home because it
damages your health and
mine.”
“Stop smoking because
you are polluting the air.”
“You are causing an
unbearable smell inside
the house.”
Signing a statement in
which the father/mother
commits him/herself to
create a free-smoke
household
I,_____________________________,,
PROMISE
to
protect
my
children
________________________________
from the health risks related to passive
smoke, keeping my house and car smokefree!
January, 2007
_________________ _________________
Children’s signature
Father/Mother’s signature
Teacher should hand out the
statements to the students. Those
should take them home and ask to
their father/mother to sign it.
After signed, the statements should
be given to the teaher.
Teacher give back the statement to
the student so that him/her can
give it to their father/mother.
Putting stickers at
home and in the car
stating that smoking
is prohibited
Forbidden to
smoke…
at home!
Teacher should hand out the
stickers to the students. They
should take it home and ask
their father/mother’s to affix it
at home and in the car!
Displaying of posters in
strategic places,
targeting parents
METHODS - PARTICIPANTS
School Area
Number of
Schools
Participants
Maximinos
6
122
André Soares
5
279
Lamaçães
6
151
Gualtar
9
130
Palmeira
9
111
TOTAL
35
793
Table 4. Participants by school
METHODS - PARTICIPANTS
Pretest
Posttest
n= 795
n= 737
n (%)
Mode
n (%)
Mode
Gender
1-Female
374 (48.6%)
2-Male
396 (51.4%)
Mean (SD)
Age
9.14(0.65)
2 (Male)
333 (47.0%)
2 (Male)
375 (53.0%)
Min.-Max.
7-13
Mean (SD)
9.63 (0.7)
Table 5. Socio-demographic caracteristics of participants
Min.-Max.
8-14
METHODS – PROCEDURE AND MATERIALS
Pretest
Teachers
training
35 schools of
1st cycle of
Braga
Posttest
“Smoke-free
Homes
Programme”
implementation
Self-report
questionnaire
35 schools of
1st cycle of
Braga
Self-report
questionnaire
Materials: questionnaire to assess the SHS at home
Calheiros, & Macedo, 2005)
The data were analyzed using SPSS Statistics.
(Precioso,
RESULTS
Prevalence of smokers at home (%)
Chart 1. Differences in the prevalence of daily
and occasional smokers (parents, siblings or
others) at home, between pre and posttest
45
42,2
40
35
32,6
28
30
24,1
25
Pretest
Posttest
20
15
10
14,2
8,5
5
p=0.001
0
Daily
Occasionally
Total
Smoking at home frequency
Prevalence of smokers at home (%)
RESULTS
Chart 2. Differences in the prevalence of
daily and occasionally smokers (mothers) at
home, between pre and posttest
80
67,1
70
62,4
60
50
40
42,2
34,8
32,3
30
20
20,3
Pretest
Posttest
10
0
Daily
Occasionally
Total
Smoking at home frequency
p=0.191
RESULTS
Prevalence of smokers at home
Chart 3. Differences in the prevalence of daily
and occasionally smokers (fathers) at home,
between pre and posttest
80
68,7
70
60
51,6
50
43,7
35,8
40
30
20
25
15,8
Pretest
Posttest
10
0
Daily
Occasionally
Total
Smoking at home frequency
p=0.003
RESULTS
Prevalence and differences in smoking mothers and fathers between
pre and posttest
Smoker*
Parent
Pre
Nonsmoker
n
%
CI (95%)
f
%
CI (95%)
f
(760)
15.5
(13.0 – 18.3)
118
84.5
(81.7 – 87.0)
642
p
0.886
Mother
Post
(706)
15.9
(13.2 – 18.8)
112
84.1
(81.2 – 86.8)
594
Pre
(745)
37
(33.6 – 40.6)
276
63
(59.4 – 66.4)
469
Father
0.511
Post
(697)
35.3
(31.7 – 39.0)
246
64.7
(61.0 – 68.3)
451
Table 6. Prevalence of smoking mothers and fathers between pre and posttest
*Smoker= the one who smokes daily, weekly or occasionally
There aren’t statistically significant differences between pre and
posttest
http://webs.ie.uminho.pt/prevencaotabagismo/