Yesterday another advertisement appeared on the television on secondary smoke exposure in the home. The BBC also interviewed the Chief Medical Officer beside a parent whose son's asthma recovery was put down to her success in giving up smoking.
The CMO declares that 80 per cent of smoke is invisible (yes, nitrogen, carbon dioxide and water vapour are invisible). She also scoffs at the idea that other pollutants are a significant problem, claiming that the UK meets European standards and that tobacco smoke adds 'dramatically' to pollution levels.
There has never been a satisfactory answer to why governments have waited six years after the smoking ban in public places to remind us how vulnerable children are and to mount sustained campaigns regarding smoking in the home. Rather than an authentic health campaign, this resembles more an attempt to extend the bounds of what kinds of intervention are politically acceptable, starting with 'public' and progressing to domestic.
Dave Atherton has written an open letter to Dame Sally Davies (CMO) and Professor Terence Stephenson, Head of Royal College of Paediatrics and Child Health. This spells out more of the fallacies behind the current campaign.
Showing posts with label asthma and exposure to smoke. Show all posts
Showing posts with label asthma and exposure to smoke. Show all posts
Sunday, 1 April 2012
Thursday, 4 August 2011
Air quality quandary
A study has been published that sets out to measure the impact of providing air cleaning equipment and a health coach to families with a smoker, on secondary smoke exposure in the home. The results are shown here and discussed here.
Dividing the participants three ways, they discovered points of note. The groups included two (out of three) that were provided with air cleaners and professional coaching on smoke exposure. The third group had neither equipment nor coaching provided. Concerning symptoms experienced by the children involved, who were asthmatic, the difference between the two groups provided with air-cleaning equipment was negligible. Provision of a health coach, whose advice was confined to the issue of secondary smoke exposure, did not make any difference to the children's symptoms.
Only smoking households were included and so no comparison was made between smoking and non-smoking households using air-cleaning equipment.
The authors still felt they could conclude: 'Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke.' Their reasoning was that they could still detect nicotine in the children even though the air cleaning equipment was in use.
This is where my understanding of the issues is somewhat patchy. I am struggling a little to see what damage is being done in the context of this study if the symptoms of subjects are being relieved. So what, if there is trace cotinine in the urine of those children?
The study itself was set up by a body known as PREACH (yes, PREACH): Particulate Reduction Education in City Homes. In terms of a study it is deliberately vague, for example it says that people are given HEPA air cleaners, but this isn't very useful information as even a brief search will show quite a few different models. Since the study seems designed to show, not that air cleaning systems work but that they are of limited use against secondary smoke, it is interesting that they don't specify which model they are using – they would surely have indicated if they had used a top-of-the-range model. In fact they are not interested in the technicalities, only in the goal of reducing parental smoking.
Perhaps they were irked by the results, especially that providing a health coach didn't improve the children's symptoms! Their focus on smoke as the only relevant pollutant is quite marked as we see in the press release linked above. For example:
It is excellent that at least they have started looking into the use of these machines to help relieve air quality problems in people's homes. It would be even more productive to abandon attempts to re-educate parents into reducing the time they spend with their offspring if such education, as in this study, makes no clear difference to the outcome.
Dividing the participants three ways, they discovered points of note. The groups included two (out of three) that were provided with air cleaners and professional coaching on smoke exposure. The third group had neither equipment nor coaching provided. Concerning symptoms experienced by the children involved, who were asthmatic, the difference between the two groups provided with air-cleaning equipment was negligible. Provision of a health coach, whose advice was confined to the issue of secondary smoke exposure, did not make any difference to the children's symptoms.
Only smoking households were included and so no comparison was made between smoking and non-smoking households using air-cleaning equipment.
The authors still felt they could conclude: 'Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke.' Their reasoning was that they could still detect nicotine in the children even though the air cleaning equipment was in use.
This is where my understanding of the issues is somewhat patchy. I am struggling a little to see what damage is being done in the context of this study if the symptoms of subjects are being relieved. So what, if there is trace cotinine in the urine of those children?
The study itself was set up by a body known as PREACH (yes, PREACH): Particulate Reduction Education in City Homes. In terms of a study it is deliberately vague, for example it says that people are given HEPA air cleaners, but this isn't very useful information as even a brief search will show quite a few different models. Since the study seems designed to show, not that air cleaning systems work but that they are of limited use against secondary smoke, it is interesting that they don't specify which model they are using – they would surely have indicated if they had used a top-of-the-range model. In fact they are not interested in the technicalities, only in the goal of reducing parental smoking.
Perhaps they were irked by the results, especially that providing a health coach didn't improve the children's symptoms! Their focus on smoke as the only relevant pollutant is quite marked as we see in the press release linked above. For example:
Parents should be counseled to implement a total ban on indoor smoking and use air cleaners only as a temporary tool on the way to achieving a smoke-free household, the Hopkins team concludes in the Aug. 1 issue of the Archives of Pediatrics & Adolescent Medicine. [emphasis added]and:
Because smoking is a main driver of indoor air pollution, the researchers recommend the use of air cleaners even in smoke-free homes if they are part of multi-family dwellings in which second-hand smoke can easily seep in from surrounding units.This even though the single greatest difference made to symptoms in the study was made by the provision of air-cleaning equipment. It is quite extraordinary to advise parents to dump the air cleaning equipment once they have managed to stop smoking, and shows pretty near tunnel vision and misunderstanding of the purpose of the equipment. They only use they perceive for this equipment in non-smoking households is to protect against smoke entering the apartment from other flats ... this eventuality in itself probably a fantasy.
It is excellent that at least they have started looking into the use of these machines to help relieve air quality problems in people's homes. It would be even more productive to abandon attempts to re-educate parents into reducing the time they spend with their offspring if such education, as in this study, makes no clear difference to the outcome.
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