Make Your Home and Car Smoke-free

A Message to Readers

This guide is intended to help families reduce the risks of second-hand smoke in their homes and cars. If you are a smoker, you may have heard that second-hand smoke is harmful to your family, but you may not be aware of the extent of harm it could cause. This guide will give you practical tips about what you can do to eliminate the harm caused by breathing in second-hand smoke in your home and car. We hope it will raise new issues that you may not have thought about, help you talk to your family about smoking and establish a plan to make your home and car smoke-free to improve your overall health and that of your family.

Introduction

In Canada, one in eleven homes (9%) have at least one regular smoker who smokes inside every day or almost every day.^{Footnote 1} Among homes where smoking is allowed inside or where someone smokes inside regularly, fewer than half (42%) place some restrictions on smoking indoors, such as restricting smoking to a certain room. Even in homes where regular smoking does not take place, one in sixteen (6%) still allow smoking inside.^{Footnote 1} Additionally, more than one in six (18%) Canadians reported being exposed to second-hand smoke in a car or vehicle in the past month.^{Footnote 1} Exposure to second-hand smoke is a serious public health hazard and smoke-free environments are the most effective way to reduce exposure.

In 2012, 3% of Canadian children under 12 years old and 6% of children and youth between 12 and 17 years old were exposed to second-hand smoke in their homes from cigarettes, cigars or pipes.^{Footnote 2} Although this number is declining, children continue to be exposed regularly to second-hand smoke at home and this remains an important issue.

Did you know that daily smokers on average smoke 15 cigarettes per day? This means that if a smoker living with a child smokes about half of their cigarettes in the home every day, their child could be exposed to the smoke from an average of over 2,700 cigarettes in a year.^{Footnote 3}

What do these statistics mean to you? Well, for one thing, they mean that you are not alone. Across Canada, other families are struggling with the issue of second-hand smoke and are looking for ways to protect their children from its harmful effects. This guide has been developed to give families the information they need to make their home and car smoke-free.

The Truth about Second-hand Smoke

Second-hand smoke is the combination of smoke coming directly from a burning tobacco product and the smoke exhaled by a smoker.

Did you know?

• There is no safe level of exposure to second-hand smoke. It is hazardous for everyone, especially for children.^{Footnote 4}
• Second-hand smoke has been confirmed as a cancer-causing substance.^{Footnote 4}
• Second-hand smoke contains over 7000 chemicals.^{Footnote 5} More than 70 of these are known to cause, initiate or promote cancer and are called “carcinogens”.^{Footnote 6},^{Footnote 7}
• The toxic and cancer-causing chemicals found in second-hand smoke include arsenic, carbon monoxide, ammonia, formaldehyde, cyanide, and benzene, just to name a few.^{Footnote 8},^{Footnote 9}
• Nicotine, carcinogens and toxic chemicals found in tobacco smoke are inhaled when people breathe second-hand smoke and reach every organ in the body.^{Footnote 6},^{Footnote 8}
• The majority of the smoke from a lit cigarette is not inhaled by the smoker, but enters the air around the smoker. As a result, the majority of nicotine and tar enters the air from the burning cigarette as second-hand smoke. ^{Footnote 8},^{Footnote 10}
• The concentration of many cancer-causing and toxic chemicals can be higher in second-hand smoke than in the smoke inhaled by smokers.^{Footnote 11}
• Smoking in an enclosed space such as a car greatly increases the concentration of harmful chemicals produced by second-hand smoke.^{Footnote 12}
• All forms of smoke are harmful. Numerous toxic chemicals are formed during combustion so that many of the chemicals created when tobacco burns are also created when other plants burn.^{Footnote 13}

The Health Effects of Second-hand Smoke

There is no safe level of exposure.^{Footnote 4} The health impacts of second-hand smoke may affect your family members differently depending on their age and their health.

Second-hand smoke hurts everyone, but is especially dangerous to infants and children because their lungs are still developing. Babies and young children breathe more quickly and take in more harmful chemicals relative to their body weight than adults do.^{Footnote 14} In addition, there is evidence that tobacco smoke impairs children's immune systems, limiting their ability to fight sickness.^{Footnote 15} According to one study, children who lived in a home where at least one parent smoked inside daily reported missing significantly more days of school because of health-related illness than children who lived in a smoke-free home.^{Footnote 16}

Before a baby is born …

Second-hand smoke is extremely harmful to unborn babies.

• » Nicotine found in the blood of a pregnant woman who smokes or is exposed to second-hand smoke can cross the placental barrier and decrease the blood flow to her unborn baby. This can affect the unborn baby's heart, lungs, digestive system and central nervous system.^{Footnote 17}
• » Carbon monoxide contained in cigarette smoke can affect an unborn baby's growth and lead to low birth weight.^{Footnote 4}
  » Nicotine exposure before birth can damage the unborn baby's pancreas and increases the likelihood of diabetes and obesity in childhood and adulthood.^{Footnote 18}
• » Mother's exposure to second-hand smoke can increase the risk of stillbirth and of delivering a baby with a physical defect (congenital malformations).^{Footnote 19}
• » Mother's exposure to second-hand smoke during pregnancy may increase the risk of leukemia, lymphomas, and brain tumours in her child.^{Footnote 4}

After a baby is born …

Children don't have as much control over their environment as adults. Babies and toddlers can't complain about smoke and older children may not feel comfortable saying anything. This is unfortunate because the negative health effects of second-hand smoke are greater for infants and children.

• » Babies who breathe in second-hand smoke have a higher risk of dying from sudden infant death syndrome (SIDS), also known as crib death.^{Footnote 4}
• » Babies and children exposed to second-hand smoke have more frequent lower respiratory tract illnesses, such as coughs, pneumonia, bronchitis and croup.^{Footnote 4}
• » Children who are exposed to second-hand smoke are more likely to develop asthma, and more frequent and severe asthma attacks may occur among children with asthma who are exposed to second-hand smoke.^{Footnote 4}
• » Second-hand smoke increases the risk of developing ear infections in children.^{Footnote 4}

Adults are affected too!

Adult non-smokers who live with smokers also suffer the harmful effects of second-hand smoke.^{Footnote 4}

• » If you are a healthy non-smoker, exposure to second-hand smoke can cause lung cancer, heart disease, and respiratory problems.^{Footnote 4}
• » Exposure to second-hand smoke causes substantial and immediate harm to the cardiovascular system.^{Footnote 4}
• » Second-hand smoke damages the heart muscle and the blood vessels.^{Footnote 4},^{Footnote 8}
• » Second-hand smoke can lead to the formation of blood clots that can lead to heart attacks and strokes.^{Footnote 20}
• » Exposure to second-hand smoke increases your risk of developing:
  • Nasal irritations and sinus cancer^{Footnote 4}
  • Stroke^{Footnote 4}
  • Acute respiratory symptoms - coughing, wheezing, tight chest, and difficulty breathing (among both healthy people and asthmatics)^{Footnote 4}
  • Coronary heart disease^{Footnote 4}
  • Adult onset asthma^{Footnote 4}
  • Chronic Obstructive Pulmonary Disease (COPD) (respiratory illness that comprises bronchitis and emphysema)^{Footnote 4}

Second-hand smoke and your pets

Although there are not many studies on the effects of second-hand smoke on pets, it has been shown that second-hand smoke can cause leukemia and oral cancer in cats,^{Footnote 21} and that dogs in smoking households have a greater risk of lung cancer.^{Footnote 22} And your furry friends don't just inhale smoke, the smoke particles are also trapped in their fur and ingested when they groom themselves with their tongues.^{Footnote 21}

The Truth about how Second-hand Smoke Travels in your Home and Car

With smoking bans in workplaces, restaurants, bars, and public places, the primary place of exposure to second-hand smoke nowadays is at home.^{Footnote 23}

The number of Canadians exposed to second-hand smoke in vehicles has fallen since 2003.^{Footnote 24} However, approximately one-third (30%) of children aged 12-19 are exposed to second-hand smoke in vehicles and/or public places.^{Footnote 25}

Second-hand smoke in cars is concentrated since it is a small enclosed space.^{Footnote 26},^{Footnote 27} The levels of second-hand smoke inside cars exceed the international indoor air quality guidance values, which is a significant health hazard.^{Footnote 26}

Many people are misinformed about how they can protect their families from second-hand smoke. Do any of these myths sound familiar?

Myth #1: If I smoke in another room, I'm not harming anyone.

The truth: Second-hand smoke is airborne and spreads from one room to another even if the door of the smoking area is closed.^{Footnote 23} In addition, toxic chemicals from second-hand tobacco smoke remain in rugs, curtains, clothes, food, furniture, skin, hair and other materials in the house long after the cigarette is extinguished.^{Footnote 29},^{Footnote 30},^{Footnote 31},^{Footnote 32} The only way to protect non-smokers from indoor exposure to second-hand smoke, is to completely eliminate indoor smoking.

Myth #2: If I open a window or turn on a fan in my home or car, I can get rid of the second-hand smoke.

The truth: You may think that opening a window or turning on a fan clears the smoke from a room or your car, but that is not the case. Extensive studies have shown that there is no level or type of ventilation that eliminates the harmful effects of second-hand smoke.^{Footnote 4} In addition, opening a car or room window may cause the smoke to be blown back into the car or room.

Myth #3: If I smoke when my children aren't home or in the car, it can't hurt them.

The truth: Many parents think that it's all right to smoke in their car or home when their children aren't around. What they may not know is that second-hand smoke lingers long after they finish a cigarette. Researchers found that second-hand smoke remains in contaminated dust and surfaces, even if smoking took place days, weeks or months earlier.^{Footnote 29},^{Footnote 30},^{Footnote 31} Since children crawl on carpeting, lie on the floor and sofas or place items in their mouths, they are exposed to more second-hand smoke deposits on surfaces than adults.^{Footnote 33}

Myth #4: If I use an air freshener or air filter, my second-hand smoke won't hurt anyone.

The truth: Air fresheners only mask the smell of the smoke but do not reduce the harm of second-hand smoke in any way. The truth is that even air filters (air purifiers) make little difference. Second-hand smoke is composed of both particles and gases. Most air filters are designed to remove large particles in the air, but they do not remove the smaller particles and gases that are contained in second-hand smoke.^{Footnote 4} Conventional air cleaners cannot remove all the poisons, toxins, gases and particles found in second-hand smoke.^{Footnote 4} Exposure to second-hand smoke cannot be controlled by air cleaning or air exchange.^{Footnote 4}

Myth #5: If I smoke outside it won't harm others.

The truth: Even if you ban smoking inside your house but continue to smoke outside, it can still affect others. While smoking outside reduces exposure, it does not completely protect others, especially infants and children, because of tobacco smoke residues and toxins that may be brought inside on clothes, skin and hair.^{Footnote 34} In addition, if you are smoking outside, it is important to be several metres away from any doorway, window, or vents so the smoke does not drift inside the house. You should also stay several metres away from other people when you smoke outdoors, as outdoor exposure can be harmful when smoking in close proximity to other people.

Further Benefits of a Smoke-Free Home and Car

Besides the obvious health benefits, there are many other reasons why you should keep your home and car smoke-free:

• » You will be a healthier role model for your children. Children who are exposed to smoking by their parents are at an increased risk of becoming smokers themselves.^{Footnote 35}
• » Smoking around youth and young adults increases its acceptability. Young adults and adolescents are very susceptible to social and environmental influences of tobacco. When youth and young adults see others smoking, it can influence them to start smoking and gives the perception that it is acceptable.^{Footnote 36}
• » A smoke-free home and car will decrease your own cigarette consumption^{Footnote 37} and may even help you successfully quit smoking.^{Footnote 37},^{Footnote 38}
• » You will lower the risk of fire in your home.
• » You will save time, money and energy by not having to clean your curtains, walls, windows and mirrors, or even having to paint as often.
• » The resale value of your home and car will likely be greater.^{Footnote 39},^{Footnote 40}
• » You will avoid potential cigarette burn marks on your car upholstery and on carpets and furniture in your home.
• » The air in your home and car will be much fresher and cleaner.
• » You will be less distracted while driving and lower the chances of traffic violations and collisions.^{Footnote 41}
• » Your car will be cleaner and you won't have to empty the ashtray in your car anymore.

Several provinces and territories across Canada have already implemented laws that ban smoking in vehicles when children are in the car; depending on the province or territory the age ranges from 16 to 19. Check your province or territory's Ministry or Department of Health to find out if a law has been implemented where you live.

Working Together as a Family to Plan for a Smoke-free Home and Car

The best way to protect your family from second-hand smoke is to not smoke. If you smoke and are not ready to quit, you should refrain from smoking in your home or car. Once you have made the decision to make your home and car smoke-free, reaching your goal may be much easier if you make it a family project. You will need to make a firm step-by-step plan and stick to it, even when your children aren't around. This guide will help you.

Your family is unique. Making your home and car smoke-free will be an ongoing project. If you are going to reach your goal as a family, you must talk, as well as listen. Everyone will have to cooperate. Above all, be ready for challenges that will come up.

Steps in planning for a smoke-free home and car:

Step 1: Hold a family meeting

The first step is to call a family meeting to discuss making your home and car smoke-free. This will give you an opportunity to talk openly about how you are going to work together. Even before you actually meet, you may want to talk individually to family members. Show them this guide and ask them how they feel about having a smoke-free home and car. This may help you prepare for any problems that may arise. If you smoke, be prepared to be honest with your family about the harmful health effects of smoking and second-hand smoke. Tell them what you are ready to do about the issue. During the meeting, get everyone's input, even those who may not agree with the decision.

Step 2: List your family's reasons for a smoke-free home and car

During this step, it is important that you let everyone speak up about their feelings on making your home and car smoke-free. Write down the top five reasons why your family wants to have a smoke-free home and car. Remember, this subject might be more difficult for members of your family who smoke, even if they are cutting back or trying to quit. If they are opposed to the idea, you will need to talk it through as a family. Listen to the reasons why they are opposed and show them the facts in this guide about the dangers of second-hand smoke. Remind them that living in a smoke-free home can increase their chances of successfully quitting.^{Footnote 38} Be supportive, but firm about the whole family's right to live in a smoke-free home. Let them know how much you appreciate what they will be doing and offer to help in any way you can.

Step 3: Set a date and make a family smoke-free pledge

An effective way to get everyone on board is to develop and write down a family smoke-free pledge. Everyone should have a chance for input, including smokers and non-smokers, parents and children. You could involve your children by asking them to create artwork for your pledge or even add a picture of your family to remind you of the reason you are making your home and car smoke-free and that it is a goal you are reaching as a family.

Your pledge might say something like this:

Our family believes that everyone has a right to clean and fresh air. As of (date), smoking is no longer allowed in our home and car.

Setting a date is also important. Don't put it off too long after your meeting.

Step 4: Take Action!

All the talking and planning in the world won't take the place of action. Once your family has considered the challenges, written its pledge and set a date, it's time to take action.

Here are some specific actions your family can take:

In your home:

• » Make sure that everyone in the house knows that they have to go outside to smoke, away from all entrances, vents, and windows. This also includes visitors.
• » Post a smoke-free sign on your front door and fridge to let people know that you do not allow smoking.
• » Remove all ashtrays from inside your home, even decorative ones.
• » Post your smoke-free pledge on your fridge or bulletin board.
• » Ensure your children's caregivers or babysitters do not smoke around your children.
• » Leave a copy of this Guide in a place where your family and friends will see it.

In your car:

• » Post a smoke-free sign in your car window and let everyone know that you do not allow smoking in your car.
• » Wash your car and give it a good cleaning, including shampooing carpets and upholstery seats. It is very difficult to remove all traces of smoking, but whatever you can do will help.
• » Get rid of your car's ashtray. If you can't get rid of it, clean it and fill it with change or potpourri.

Step 5: Celebrate!

You've done it! Your home and car are smoke-free! Now it's time to celebrate! Treat this like a special occasion. Think about things you do during these occasions and choose to do something everyone really enjoys.

Don't forget to pay special attention to those family members who may have had a tough time adjusting to the newly smoke-free home and car... the smokers. They deserve a special reward!

Step 6: Dealing with setbacks

Making your home and car smoke-free and keeping it that way may not be easy. It's a good idea to have a follow-up meeting to discuss how everyone is doing.

If you need help to stay on track, your Public Health Department may be able to refer you to other resources and agencies in your community that can help.

If you encounter serious family conflict issues over going smoke-free, you may want to contact your family counsellor for help.

Real Life Situations - How to Manage Challenges

Your family will need to discuss the difficulties in staying smoke-free and how to manage them. You may want to write down these challenges. If you understand everyone's feelings and are prepared, it will be easier to stay committed to a smoke-free home and car.

Here are some challenges you might face and how you might deal with them:

You have young children who need your supervision.

It's important not to leave small children alone when you go outside to smoke. You should make arrangements with a neighbour or an older sibling to watch younger children while you are outside smoking. Cutting down on the number of cigarettes you smoke and how often you smoke may also make it easier to keep your home smoke-free. During those times, find ways to deal with the cravings, such as a breath mint, chewing gum or nicotine gum.

NOTE: According to the Canada Safety Council, the legal age at which a child can be left alone for short periods of time varies from province to province and ranges between 10 and 12 years old.^{Footnote 42}

Your child becomes ill and you are extremely busy caring for him. You feel stressed and tired and are not able to take him outside so you can smoke.

It is situations like this that will really test your resolve to keep your home smoke-free.

When confronted with these situations, remind yourself of the reasons why you chose to make your home smoke-free. Your child's health is very likely the number one reason why you chose not to smoke indoors. If a child is sick, it's even more important that you don't smoke in the house. Remind yourself that your child will probably get better faster if you are not smoking inside the house. Try a nicotine replacement product to control cravings and find healthier ways to handle stress, such as deep breathing, listening to soft music, reading a good book, doing yoga, practicing relaxation or taking a walk.

Guests arrive to stay for the weekend. They smoke.

You may feel uncomfortable telling friends or family not to smoke in the house. Remember, most people expect a smoke-free environment today, and most smokers are used to not smoking when they are indoors with other people. You should inform visiting family members and guests ahead of time that your family has made a decision to keep your home smoke-free. Tell them they are welcome to smoke outside, away from the house and family members. Remember, your family's health depends on this.

An adult family member insists on smoking indoors and after repeated discussions, you are not able to convince them otherwise.

If a family member insists on smoking indoors, you need to have an open and honest discussion about the issue. You may want to obtain the support of other family members or friends to help you. Your family doctor or counsellor could also be of assistance. Review the importance that the whole family be protected from the effects of second-hand smoke. Reassure them that the whole family is there to help and that you are not judging them.

If it appears the smoker is not going to budge, and keeping in mind that not allowing smoking in your home and car is the only way to protect your family from second-hand smoke, it may be necessary to establish a transition period with one of your family members. When setting the transition period, make sure to agree on well-defined rules regarding where and when the smoker is allowed to smoke. Make it clear that it is a temporary deal and agree on a date for your home and car to become completely smoke-free.

If your family member is annoyed by having to go outside to smoke, remind them of the top five reasons for having a smoke-free home, or encourage them to quit completely. For more information on quitting smoking, turn to the last page of this guide.

Your child becomes angry with you when you are found smoking a cigarette in the house or car.

Today, parents tend to be quite willing to talk things out with their children. This honest and open approach encourages children to speak their minds.

Sometimes, the most powerful parent-child conversations take place in situations where you are forced to be honest with each other. If you feel angry with your child for challenging you, stay calm. Take a few deep breaths and remind yourself that you agreed that your children have a right to a smoke-free home and car, and that your child is simply asserting that right. Use this as an opportunity to tell your child how smoking is addictive and the only way to guarantee they never become addicted is to never start smoking themselves.

You commute to work every day and drop off your children at a day care. You are having trouble maintaining your resolve not to smoke in the car, especially at the end of the day.

Like most Canadians, your workplace is probably smoke-free. Since your car is a direct extension of your home environment, you should follow the same rules that you use in your home. Instead of smoking in your car, try to leave home a few minutes earlier to give you time for a cigarette outside before going into work. After work, take a few minutes to smoke outside before getting into your car or try using a nicotine replacement therapy product to help with cravings.

You're on a roll! What else can you do?

Once you have established your smoke-free home and car, you may want to take it one step further. Here are some ideas for things you can do to keep the momentum going:

Talk it up!

Tell your friends, family and neighbours about your decision to live in a smoke-free home and car. Be honest with them about the challenges and offer your support if they seem interested in doing the same thing.

Keep talking!

Keep talking as a family. If you are going to stick to your decision, you will need to keep the dialogue going. Talk to your children about smoking and its harmful effects. Tell them about your own challenges with smoking and accept their help when they offer it.

Quit Smoking!

Now that your home and car are smoke-free, you may decide that this would be a good time to quit smoking for good. You will find that living in a smoke-free home presents fewer cues and reminders to smoke and that quitting could be much easier than it has been in the past.

Talk to your healthcare provider about options that can make it easier. You can also call the pan-Canadian toll free quitline at 1-866-366-3667 to obtain support in your efforts to quit smoking or visit www.gosmokefree.gc.ca/quit. To order a copy of On the Road to Quitting, Health Canada's guide to quitting smoking, visit canada.ca/tobacco.

References