''Don't poison the air I breathe''

Environmental tobacco smoke (ETS) consists off more than 4.000 chemical compounds, many of which are endocrine disruptors and more than 40 are known carcinogens. The International Agency for Research on Cancer and the US Environmental Agency classifies ETS as a ''group A carcinogen'', which is defined as a substance known to cause cancer in humans, with no safe level of exposure.


Exposure to ETS, also known as passive smoking, is assotiated with adverse health effects in children and non-smoking adults, such as respiratory disorders, middle ear disease, sudden infant death syndrome (SIDS), compromised cognitive abilities, heart disease and cancer. Children are more vulnerable because:

a) of differences in their pulmonary physiology and their higher respiratory ventilation rate per minute

b) their body is under rapid development

c) their biochemical defence mechanisms are still immature

Foetuses are at even greater risk and therefore pregnant women must eliminate their exposure to ETS. It is estimated that almost half of the children in the world are exposed to ETS and that in the USA ETS causes each year the death of about 6.000 children younger than 5. Teenagers whose parents are active smokers are more likely to begin smoking. Children's ETS exposure occurs primarily in the home, wwhere legislative measures against it can not be applied and it is completely up to the parents to minimise it.


Since November of 2004, under the National Action Plan for Environment and Children's Health (Cy-CEHAP), the National Committee on children's Environment and Health carried out a comprehensive anti-smoking campaign in Cyprus, with the aim to reduce children exposure to passive smoking and prevent the related health impacts.

The specific targets are:

a) evaluation of knowledge and attitudes of Cypriot parents in relation to passive smoking and the practices followed in every day life

b) design and implementation of an antti-smoking campaign ptimised according to the results of the initial evaluation

c) evaluation of the effectiveness of the intervention with experimental determination of the exposure of children to ETS by measuring nicotine in the air of children's homes and cotinine in their saliva


The campaign is a joint venture of National Committeeon the Environment and Children's Health, the Medical and Public Health Services, the State General Laboratory and the Cyprus Paediatric Association.


The campaign is desinged to achieve the following two aims:

1. Promote anti-smoking attitude in people of all ages, bur primarily targeting children. Children should understand WHY they should not become active smokers, learn to demand the right to clean air and learn also how to protect themselves from ETS.

2. Promote smoke-free homes and cars by changing the attitudes and practices of parent smokers. Parents should understand why children are valnerable and how their future development depends on parents' behavior with regars to smoking and also how they can protect children, even when are unable to quit smoking.


The knowledge, attitudes and practices of parents' on passive smoking were evaluated in 2005 with the use of questionnaires. This work showed that least one parent was an active smoker in 42% of the households and 72& of smokers smoked in their homes. Parents were not fully aware of the effects of ETS on children and had erroneous perceptions on how to protect them. Based on these results, an intervention program was developed and implemented up to 2008.


Informative leaflets were prepared and distributed to 50.000 elementary school children. The students discussed with their teachers the information provided in the leaflets and were asked to pass the leaflets and discuss them with their parents. Furthermore, a short video on passive smoking and children was produced and distributed to schools and health visitors, related seminars were widely offered to concerned groups and the importance of limiting and even eliminating children's exposure to ETS was stressed extensively in numerous TV and radio programmes.


The effectiveness of the intervention was evaluated in a pilot study (2008-2009) in which nicotine was assessed in indoor air in the homes of preschool children and the exposure of the children to ETS was evaluated from the cotinine level in their saliva.


Nicotine measurements in the air after the intervention (2008) shoed a definite improvement in smokers' practices.  In only 41% of the smokers homes nicotine was detected indicating a non smoking in house practice. However, associated cotinine measurements in children's saliva showed that 97% of children were exposed to ETS, regardless whether their parents smoked or not. No significant difference in the levels of cotinine was found between the two groups and there was no correlation between cotinine levels and the levels of nicotine found in the family home indicating that other predominant might occur outside homes. These results showed that although the intervention led to an improvement in smoking parents' practices at home, children were still substantially exposed to ETS outside the family home.


Based on the above findings, an expanded program, financed by the Cyprus Research Promotion Foundation is currently running (2009-2011), in which:

a) Parents konwledge, attitudes and practices and children's knowledge on ETS are evaluated

b) measurements of nicotine in homes of children with smoker parents and cotinine in children's urine are performed before and after the implementation of a stricter anti-smoking law enterd into force January 2010, which prohibits smoking in indoor public places. following the launce of the new Legislation, the National Committee initiated a complimentary awareness and intervention programme, stressing the need that beyonf public places, homes also must kept tobacco free. The intervention includes informative lectures to all interested parties (children, parents, teachers and public at large), leaflets, videos, TV and radio promotions and programmes and newspaper articles. In addition, an extensive campaign for Tobacco free homes with the message ''when you smoke, I smoke too''  is underway, in which baby bibs carrying the campaign's message are distributed to the families of all newborn babies in the country for the year 2010, together with related information leaflets.





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