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Health Concerns

Make your home and car smoke-free: A guide to protecting your family from second-hand smoke

Published by authority of the Minister of Health
2008
ISBN: 978-0-662-48085-3
Cat. No.: H128-1/08-524E
HC Pub.: 4278

Table of Contents

A Message to Readers

This guide is intended to help families remove second-hand smoke from 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. Hopefully, it will raise new issues that you may not have thought about, help you talk to your family about smoking and ultimately rid your home and car of second-hand smoke.

Introduction

In Canada, 15% of homes have at least one regular smoker,Footnote 1 and 25% of Canadians are exposed to second-hand smoke in a car or vehicle.1 Even in homes where regular smoking does not take place, 14% still allow smoking inside.Footnote 1

In 2006, over 350,000 (9%) of Canadian children under 12 years oldFootnote 2 and over 600,000 children between 12 and 19 years oldFootnote 3 were exposed to second-hand smoke in their homes from cigarettes, cigars or pipes. Although this number is dropping, it still means that almost one million children under 19 years old continue to be exposed regularly to second-hand smoke. If two parents smoked half a pack each a day in the home, in one year a child may be exposed to the smoke from over 7,000 cigarettes.Footnote 2

The good news is that most Canadian families agree they should avoid exposure to second-hand smoke in their homesFootnote 4 and in their cars.Footnote 5 Although less than half of Canadian homes (42%) place some restriction on smoking,Footnote 1 Canadian families agree they should avoid exposure to second-hand smoke in their homes.Footnote 4 Parents also report that the primary reason they want to cut back on the amount of second-hand smoke in their home is because of their children.Footnote 4

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

The Truth About Second-Hand Smoke

Did you know?

Second-hand smoke has been labelled as a "Class A" cancer-causing substance in the United States. Class A is considered the most dangerous type of cancer agent and there is no known safe level of exposure.Footnote 7

A non-smoker in a smoky room is inhaling the same chemicals as a smoker.Footnote 6

Some of the toxic and cancer causing agents found in second-hand smoke include asbestos, arsenic, and benzene.Footnote 10

Second-hand smoke contains the same 4,000+ chemicals that are inhaled by a smoker. About 50 of these chemicals are associated with, or are known to cause cancer.Footnote 9

Smoking in a closed-in space such as a car greatly increases the concentration of harmful chemicals produced by second-hand smoke.Footnote 8

Second-hand smoke is also known as environmental tobacco smoke (ETS) or passive smoke. Second-hand smoke is made up of:

  • Sidestream smoke that goes directly into the air from the end of a burning cigarette, cigar or pipe.

    PLUS
  • Mainstream smoke that is inhaled by the smoker first, then exhaled into the air.

Second-hand smoke hurts everyone, but it is especially dangerous to little ones.

The Health Effects of Second-hand Smoke

Second-hand smoke affects your family members differently depending on their age and their health. There is no risk-free level of exposure.Footnote 11 Second-hand smoke hurts everyone, but it is especially dangerous to little ones because their lungs are still growing and developing. Because they are smaller, babies and children breathe more quickly and take in more harmful chemicals for their size than adults do. In addition, their immune systems, which protect them from getting sick, are less developed and can't protect them as much from tobacco smoke.Footnote 12

Before a baby is born ...

Second-hand smoke is even 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.Footnote 13
  • Nicotine can affect an unborn baby's heart, lungs, digestive system and even central nervous system.Footnote 14
  • Carbon monoxide contained in cigarette smoke can affect an unborn baby's growth and may lead to low birth weight.Footnote 14

After a baby is born ...

Children don't have as much control over their world as adults do. Babies and toddlers can't complain about smoke. Even older children may not feel comfortable saying anything or trying to get away from the smoke. This is unfortunate because the health effects of second-hand smoke on children are much worse than on adults.

  • Babies who breathe in second-hand smoke have a higher risk of dying from sudden infant death syndrome (SIDS) or crib death.Footnote 11
  • Babies and children exposed to second-hand smoke have more frequent lower respiratory tract problems, such as coughs, pneumonia, bronchitis and croup.Footnote 11
  • Children who are exposed to second-hand smoke are more likely to develop asthma, and they will suffer more from it than children of non-smokers who have asthma.Footnote 11
  • Second-hand smoke increases the number of ear infections in children.Footnote 15

Many parents don't realize that second-hand smoke may harm their child's behaviour and ability to think things through (cognition). Children exposed to tobacco smoke score lower on tests than children who were not exposed to tobacco smoke.Footnote 16

Adults are affected, too!

Adult non-smokers who live with smokers also suffer the harmful effects of second-hand smoke.Footnote 11

  • If you are a non-smoker, exposure to second-hand smoke may increase your risk of getting lung cancer, heart disease, or respiratory problems.Footnote 11
  • Second-hand smoke fosters the formation of blood clots that can lead to heart attacks and strokes.Footnote 17
  • Second-hand smoke raises your heart rate and damages your heart muscle.Footnote 17
  • Second-hand smoke lowers the level of protective HDL-cholesterol in your blood.Footnote 18

Second-hand smoke and your pets

Some studies have shown that second-hand smoke can cause leukemia (a type of cancer) in catsFootnote 19 and that dogs in smoking households have a greater risk of cancer.Footnote 20 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 19

The Truth About How Second-hand Smoke Travels in Your Home and Car

Many peoples 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 spreads from one room to another even if the door of the smoking area is closed. In addition, potentially toxic chemicals can cling to rugs, curtains, clothes, food, furniture and other materials and can usually remain in a room long after someone has smoked there.Footnote 21,Footnote 22,Footnote 23

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

The Truth: You may think that by opening a window or turning on a fan you are clearing the smoke from a room or your car, but that is not the case. Unfortunately, extensive studies have shown that there is no level of ventilation that will eliminate the harmful effects of second-hand smoke.Footnote 24,Footnote 25,Footnote 26 In addition, opening a car or room window can result in air flow back into the room or car which may cause the smoke to be blown directly back at non-smokers.Footnote 27

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 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 can remain in contaminated dust and surfaces, even if smoking took place days, weeks or months earlier.Footnote 21,Footnote 22,Footnote 23

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 and do not reduce the harm in
any way. The sad truth is that even air filters (air purifiers) are not enough. Second-hand smoke is composed of both particles and gases. Most air filters are designed to reduce fine smoke particles in the air, but they do not remove the gases. This means that many of the cancer-causing agents in the gases remain.Footnote 26

Work together to make your home and car smokefree.

If You Live in a Multi-Unit Residence

A Health Canada survey found that 36% of people who live in multi-unit housing experience smoke seeping or drifting into their personal living space usually through an open window or door from a neighbour's patio, balcony or outdoor common area.Footnote 28

Find information on making your building smoke-free.

What you can do to protect your family's unit from second-hand smoke.Footnote 29

Your first step will be to identify where the smoke is entering your home. Then, you or your landlord should:

  • Insulate cracks and gaps around pipes and vents.
  • Install special seals for electrical outlets and switch plates at a hardware store. They are easily installed and can prevent smoke travelling from room to room.
  • Install door bottoms and door sweeps to prevent smoke from leaving a room. Insulation on doors and windows can also help prevent smoke from entering or leaving a room.
  • Install window fans to help reduce smoke and increase ventilation.

Note: These actions may limit the flow of fresh air into your unit and should be taken only if you are experiencing extreme problems with second-hand smoke from your neighbours. It is advised that you talk to building management prior to making any modifications to your unit.

There are many reasons why you should keep your home and car smoke-free.

Further Benefits of a Smoke-free Home and Car

Beside 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.Footnote 30
  • You will have a much better chance of quitting smoking successfullyFootnote 31 in a smoke-free home.
  • The air in your home and car will be much fresher, cleaner and will smell better.
  • You will lower the chances of fire in your home.
  • Your cooking will taste better because your ingredients have not absorbed the smell of second-hand smoke.
  • You will save time, money and energy by not having to clean your curtains, walls, windows and mirrors as often.
  • You won't need to paint your walls and ceilings as often.
  • The resale value of your home and car may be greater.
  • You will be less distracted while driving and you will lower the chances of traffic violations and accidents.Footnote 32
  • There won't be any cigarette burn marks on your car upholstery or furniture in your home.
  • Your car will be cleaner and you won't have to empty the ashtray in your car anymore.

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 not to allow the smoking of cigarettes, cigars or pipes in your residence or car. It's that simple . . . and it's also that complicated. Getting through the process will be much easier if you make it a family project. Once you have made the decision to make your home and car smoke-free, you 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 and ever-changing. Making your home and car smoke-free will be an ongoing project. If you are going to reach your smoke-free 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 when you least expect them.

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

1. Step One: Hold a family meeting

The first step toward protecting your family from the dangers of second-hand smoke is to call a family meeting to discuss making your home and car smoke-free. This meeting 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 going smoke-free. This may help reduce their anxiety and will give you a chance to 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. If this upsets anyone, comfort them by telling them you are doing everything you can to stay healthy for them.

Try to set a time for your meeting when everyone is available. During the meeting, make sure that you reduce the number of distractions.

Make it very clear that the purpose of the meeting is to discuss going smoke-free at home and in your car. If there are other issues to discuss, ask that they be put aside until later in the meeting. During the meeting, get everyone's input, even those who may not agree with the decision.

2. Step Two: 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 about 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 will 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 will increase their chances of successfully quitting.31 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.

3. Step Three: Be prepared for challenges!

In this step, 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:

a. You have young children who need your supervision.

It's important not to leave small children alone when you go outside to smoke. You may want to consider making an arrangement 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 or nicotine gum. Or take your children with you when you go outside to smoke. Try to make outdoor activity a regular part of your daily routine. Set a time to be outdoors and take your children for a walk or to play in the park.

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 33

b. Guests arrive to stay for the weekend. They smoke.

Some people are uncomfortable asking friends or family to smoke outside because they feel it's impolite. Remember, these days, most people expect a smoke-free environment. As a result, most smokers are used to curbing their smoking when they are with other people. You may want to 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. Remember, your family's health depends on this.

c. 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. If you are a smoker, one of the reasons you smoke may be to relax--the more stressful your situation is, the more you may want to smoke.

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 he will probably get better faster if you are not smoking inside the house.

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

This is a tough one. If a family member insists on smoking indoors, you will need to have an open and honest discussion about the problem. You may want to recruit the support of other family members and/or a neutral third party to help you. Explain how important it is that the whole family is protected from the harmful effects of second-hand smoke. Ask the smoker to try their best and reassure them that the whole family is there to help.

If it appears the smoker is not going to budge, as an absolute last resort, and perhaps as a temporary compromise, you should demand that the smoker restricts smoking to one room away from the children. If you live in an apartment with a balcony, ask the smoker to smoke there. Keep in mind that this will not eliminate your family's exposure to second-hand smoke.

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. Find more information on quitting smoking.

Ask the smoker to try their best and reassure them that the whole family is there to help.

e. Your child becomes angry with you when you were found smoking a cigarette in the kitchen.

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 at 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 that your child is simply asserting that right. By the same token, your child will also need to understand your perspective. Take some time to explain just how powerful your addiction to tobacco is. Be honest about your own worries and stresses. Use this as an opportunity to tell your child how much you hope they won't start smoking.

f. 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.

This one is even more difficult because, like most Canadians, your workplace is probably smokefree. Your commute to and from work may be one of the last places you can light up indoors. Your car is a direct extension of your home environment so you should follow the same rules that you use in your home. Remind yourself that due to the small interior space of the car, an increased concentration of smoke can be produced quickly and will cling to the upholstery and your clothing.

Instead of smoking in your car, try to leave home a few minutes earlier than usual 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.

4. Step Four: Set a date and make a family smoke-free pledge

An effective way to get everyone on board is to develop a family smoke-free pledge, which you can write down. Everyone should have a chance for input, including smokers and non-smokers, parents and children. Your pledge might say something like this:

Our family believes that everyone has a right to clean and fresh air. We pledge to do everything we can to make our home and car smoke-free.

Setting a date is also important. Don't put it off too long after your meeting. One week from your meeting date should give everyone time to get organized and to prepare to make your home and car smoke-free.

5. Step Five: Take Action!

All the talking and planning in the world won't take the place of action. You need to show your family that you are serious and that you are following through on your decision to make your home and car smoke-free. Once your family has considered the challenges, written its pledge and set a date, it's time to decide as a family what you are going to do to make your home smoke-free.

Here are some specific actions your family can take:

In Your Home:

  • Set up an area outside for smokers to use. Agree to sit outside or go for a walk with smokers to show that you are not rejecting them, just the smoke.
  • Post a smoke-free home magnet on your fridge and in your car to let people know that you do not allow smoking (see last page of booklet).
  • Remove all ashtrays from inside your home, even decorative ones.
  • Ask your children's caregivers, including babysitters, not to smoke around your children.
  • Ask anyone who is doing work in your home not to smoke indoors.
  • Leave a copy of this guide in a place where your family and friends will see it.
  • Post your smoke-free pledge on your fridge or bulletin board.
  • Buy some fresh flowers or bring them in from the garden.
  • Tell your non-smoking friends about your decision and invite them to visit.

In Your Car:

  • Let all passengers know that your car is smoke-free.
  • Clean out your car's ashtray and fill it with sugar-free candies, change or potpourri.
  • Wash your car and give it a good cleaning, including a thorough vacuuming.
  • Post a smoke-free decal in your car window to let everyone know that you do not allow smoking.

6. Step Six: Celebrate!

You've done it! You've gone smoke-free! Now it's time to celebrate! Treat this like a special occasion. Think about things you do during these occasions and choose something everyone really enjoys. Here are some ideas for things you can do to reward your family for going smoke-free:

  • Have a party! Invite all your friends and family to celebrate with you.
  • Plan a special family celebratory dinner.
  • Go out to eat in a smoke-free restaurant together.
  • Plan a fun outing to go tobogganing or play in the park.
  • Watch a special television show or movie together as a family.
  • Declare a special family board game or puzzle night where everyone participates.

Don't forget to pay special attention to those family members who may have had a tougher time going smoke-free ... the smokers. They deserve a special reward!

7. Step Seven: Dealing with setbacks

Making your home smoke-free and keeping it that way will not be easy. It's a good idea to have a follow-up meeting after you have gone smoke-free to discuss how you are doing and whether or not any changes are needed.

If you need some help to stay on track, your Public Health Department should be able to provide support and assistance, and also 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 doctor for help. You could also ask your family doctor to talk to members of the family about health concerns with second-hand smoke.

We're ready to take the pledge.

Our Pledge for a Smoke-free Home and Car

The Date We Will Go Smoke-free:

Our top 5 reasons for going smoke-free:

  1.  
  2.  
  3.  
  4.  
  5.  

Challenges and how we will face them:

  1.  
  2.  
  3.  
  4.  
  5.  

Post this on the fridge or bulletin board for everyone to see.

Youth Zone

You are probably reading this because you are concerned that someone in your home smokes. You know that smoking is bad for your health and you may be worried that your parents might be harmed by their smoking.

The first thing to understand is that smoking is more than just a habit. It's a powerful addiction. Basically, that means it's really hard to quit. Your parents probably want to quit, but they are having a tough time with that. One thing you can be sure of though, your parents don't want you to get sick. They want to protect you from second-hand smoke. The good news is that there are things you can do to help and that by doing them, you may be able to provide just the support they need to eventually quit.

What should I say? Will my parents get upset? I just wish they would stop smoking. Why do they have to smoke around me?

Talking to your family about second-hand smoke won't be easy, but it will pay off in the end. Here are some tips that might help:

  • Be honest and open with your family about how important it is to you that your home and car is smoke-free.
  • Try not to nag or bring it up in a way that will turn them off. Instead, you may want to say something like: "I love you. I want everyone to live a long and healthy life."
  • Tell your family how second-hand smoke makes you feel, inside and out.

The best thing you can do is to work together with your family to ban all smoking in your home and family car. This guide can help your family set some rules about smoking. It also has tips on actions your family can take to limit smoking in the home and car, and keep it that way. Write a family pledge to go smoke-free and make sure you add your own reasons to the Top Five List.

Above all, remember that going smoke-free won't happen overnight. There will be challenging situations and probably a few setbacks. Sometimes, your parents might get angry and frustrated. If they do, be patient and respect that this is a difficult time for them. Talk to an adult, such as an aunt or uncle or teacher, and ask for help if you need to. Remember that you are a family and you all must work together to keep everyone healthy and happy.

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.

Organize a smoke-free policy where you liveFootnote 34

If you live in a multi-unit housing complex, you may want to work with neighbours and the building owner to advocate for a smoke-free policy. These policies can govern a variety of spaces, including common areas, outdoor child play areas, apartments, and blocks or floors of units. Phase-in policies where units occupied by smokers are converted to smoke-free areas when they leave are also an option.

Steps to do this may involve:

  • Speaking to neighbours and the building owner and telling them about second-hand smoke and smoke-free areas.
  • Raising awareness through campaigns, health fairs and by talking to your neighbours.
  • Developing policies and presenting them to decision makers.

Quit Smoking!

Although this guide was not written with the intention of convincing you to quit smoking, now that your home and car are smoke-free, you may decide that this might 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 will be much easier than it has been in the past.Footnote 31

Talk to your doctor about options that can make it easier, such as the nicotine patch. Or call 1-800 O-Canada for a copy of On the Road to Quitting, Health Canada's guide to quitting smoking. In On the Road to Quitting, you'll find a list of the toll-free quit lines which are available in the provinces and territories to support you as you quit smoking.

For more information about second-hand smoke and quitting smoking, check out Health Canada's website: www.gosmokefree.gc.ca

Make Your Home and Car Smoke-free

Children, especially younger ones, rely on their parent(s) or guardian(s) to provide a safe and healthy home and car environment. By making your home and car smoke-free, you can protect your children from harmful second-hand smoke.

A smoke-free home and car means that NO smoking is allowed inside the home or car. This applies to all family members and visitors.

In order to help you create a healthy home environment, Health Canada has provided you with a few items that can be displayed in your home and car.

Note: If you're reading this guide online, you can order a paper copy to receive your magnet and decal.

Place this double-sided cling sticker on your car window or on a window in your home to let everyone know that your space is smoke-free. The material used in the cling sticker allows it to attach to a window without leaving a residue behind. You can attach and remove the sticker easily, and it's double-sided to ensure that those entering your home or car know that your space is smoke-free.

The attached fridge magnet turns into a magnetic picture frame once the inner piece is removed. You can insert a wallet size photo in the frame to create a personal reminder of why your home is smoke-free. Use the inner piece, which has useful information, as a separate magnet.

BONUS: check out page 29 of this booklet. You will find a smoke-free home and car pledge form that your family can fill in, cut out and post on a bulletin board or on your fridge.

PROTECT YOUR CHILDREN
MAKE YOUR HOME AND CAR SMOKE-FREE

DON'T LET YOUR CHILDREN BE A TARGET.
MAKE YOUR HOME AND CAR SMOKE-FREE.
WWW.GOSMOKEFREE.GC.CA

Notes

Footnotes

Footnote 1

Health Canada Website. Canadian Tobacco Use Monitoring Survey, Summary of Annual Results for 2006. Accessed December 13, 2007.

Return to footnote 1 referrer

Footnote 2

Health Canada Website, Canadian Tobacco Use Monitoring Survey Supplementary Tables. Table 9. Exposure of Children at home to Environmental Tobacco Smoke (ETS) by province and age group, Canada 2006. Accessed December 13, 2007.

Return to footnote 2 referrer

Footnote 3

Statistics Canada, Canadian Community Health Survey (CCHS 3.1), 2005. Exposure to second-hand smoke at home, by age group and sex, household population aged 12 and over, Canada, 2005. Accessed December 13, 2007.

Return to footnote 3 referrer

Footnote 4

EKOS, Phoenix Strategic Perspectives Inc. Baseline Survey of Parents on Second-hand Smoke in the Car and at Home. Report to Health Canada, March 2004, p. ii. Accessed December 18, 2007.

Return to footnote 4 referrer

Footnote 5

Ontario Tobacco Research Unit. The Smoke-free Ontario Act: Extend Protection to Children in Vehicles. OTRU Update, August 2006. Accessed December 13, 2007.

Return to footnote 5 referrer

Footnote 6

United States Environmental Protection Agency. (1992). Respiratory health effects of passive smoking: lung cancer and other disorders (p 3-2). Washington, DC: Indoor Air Division, Office of Atmospheric and Indoor Air Programs, Office of Air and Radiation.

Return to footnote 6 referrer

Footnote 7

U.S. Department of Health, Education and Welfare. (1979). Smoking and Health: A Report of the Surgeon General. Rockville, Md.: U.S. Department of Health, Education and Welfare, Public Health Service, Office of the Assistant Secretary for Health, Office on Smoking and Health.

Return to footnote 7 referrer

Footnote 8

Rees VW, Connoly GN. Next link will take you to another Web site Measuring air quality to protect children from second-hand smoke in cars. American Journal of Preventive Medicine 2006;31:363-68. Accessed December 18, 2007.

Return to footnote 8 referrer

Footnote 9

U.S. Department of Health and Human Services. (1984). The Health Consequences of Smoking: Chronic Obstructive Lung Disease. A Report of the Surgeon General. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Office on Smoking and Health.

Return to footnote 9 referrer

Footnote 10

California Environmental Protection Agency. Next link will take you to another Web site Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Sacramen to, CA: California Environmental Protection Agency, Air Resources Board and Office of Environmental Health Hazard Assessment, 2006. Part A: Exposure Assessment; Part B - Health effects; Part C - Public comments and ARB/OEHHA staff responses. Accessed December 18, 2007.

Return to footnote 10 referrer

Footnote 11

U.S. Dept. of Health and Human Services. Next link will take you to another Web site The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. Accessed December 18, 2007.

Return to footnote 11 referrer

Footnote 12

World Health Organization. Tobacco Free Initiative. International Consultation on Environmental Tobacco Smoke (ETS) and Child Health: Consultation Report. Geneva, Switzerland, 11-14 January, 1999. Accessed December 18, 2007.

Return to footnote 12 referrer

Footnote 13

Eliopoulos C, Klein K, Phan MK, Knie B, Greenwald M, Chitayat D, Koren G. Hair concentrations of nicotine and cotinine in women and their newborn infants. Journal of the American Medical Association, 1994;271:8.

Return to footnote 13 referrer

Footnote 14
  1. Visscher AA, Feder M, Burns AM. The impact of smoking and other substance use by urban women on the birth weight of their infants. Substance Use and Misuse 2003;38:1063-1093.
  2. Martin TR, Bracken MB Association of low birth weight with passive smoke exposure in pregnancy. American Journal of Epidemiology, 1986;124:633-642.
  3. Rubin DH, Krasilnikoff PA, Leventhal JM. Effect of passive smoking on birth-weight. Lancet,1986;2: 415-417.

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Footnote 15
  1. Ey JL, Holberg CJ, Aldous MB. Passive smoke exposure and otitis media in the first year of life. Group Health Medical Associates. Pediatrics,1995; 95: 670-677.
  2. Kitchens GG. Relationship of environmental tobacco smoke to otitis media in young children. Laryngoscope, 1995;105(Pt.2 Suppl 69):1-13.
  3. Adair-Bischoff CE, Sauve RS. Environmental tobacco smoke and middle ear disease in preschool-age children. Archives of Pediatric and Adolescent Medicine, 1998;152:127-133.
  4. Strachan DB, Cook DG. Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax 1998;53:50-56.

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Footnote 16

Yolton K, Dietrich K, Auinger P, Lanphear BP, Hornung R. Exposure to environmental tobacco smoke and cognitive abilities among U.S. children and adolescents. Environmental Health Perspectives, 2005;113:98-103.

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Footnote 17

De Groh M, & Morrison H. Next link will take you to another Web site Environmental Tobacco Smoke and Deaths from Coronary Disease in Canada. Chronic Diseases in Canada, 2002;23:13-16. Accessed December 18, 2007.

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Footnote 18

Moffatt RJ, Chelland SA, Pecott DL, Stamford BA. Acute exposure to environmental tobacco smoke reduces HDL-C and HDL2-C. Preventive Medicine, 2004;38:637-41.

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Footnote 19

Bertone ER, Snyder LA, Moore AS. Environmental tobacco smoke and risk of malignant lymphoma in pet cats. American Journal of Epidemiology, 2002;156:268-273.

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Footnote 20

Reif JS, Bruns C, Lower KS. Cancer of the nasal cavity and paranasal sinuses and exposure to environmental tobacco smoke in pet dogs. American Journal of Epidemiology, 1998;14: 488-492.

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Footnote 21

Singer BC, Guevarra KS, Hawley EL Nazaroff WW. Gas-Phase Organics in Environmental Tobacco Smoke. 1. Effects of Smoking Rate, Ventilation, and Furnishing Level on Emission Factors. Environmental Science & Technology, 2002;36:846-853.

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Footnote 22

Singer BC, Hodgson AT, Nazaroff WW. Gas-phase organics in environmental tobacco smoke: 2. Exposure-relevant emission factors and indirect exposures from habitual smoking. Atmospheric Environment, 2003;37:5551-5561.

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Footnote 23

Daisey JM, Mahanama KR, Hodgson AT. Toxic volatile organic compounds in simulated environmental tobacco smoke: Emission factors for exposure assessment. Journal of Exposure Analysis and Environmental Epidemiology, 1998;8:313-334.

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Footnote 24

Collishaw N, Meldrum H. Protection from second-hand smoke in Canada: Applying health science to occupational health and safety law. Ottawa: Physicians for a Smoke-Free Canada. 2003.

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Footnote 25

Repace J, Kawachi I, Glantz S. Fact sheet on secondhand smoke. 2nd European Conference on Tobacco or Health, 1st Iberoamerican Conference on Tobacco or Health. 1999.

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Footnote 26

Repace J. Risk management of passive Smoking. Saint Louis University Public Law Review, 1994;13:2.

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Footnote 27

United States Environmental Protection Agency. (1992). Respiratory health effects of passive smoking: lung cancer and other disorders (p 3-18). Washington, D.C: Indoor Air Division, Office of Atmospheric and Indoor Air Programs, Office of Air and Radiation.

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Footnote 28

Decima Research Report. Next link will take you to another Web site Second Hand Smoke in Multiple Unit Residential Buildings. Prepared for Health Canada, March 2007. Accessed December 17, 2007.

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Footnote 29

Smoke-Free Housing Website. "Next link will take you to another Web site What tenants need to know". Accessed December 19, 2007.

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Footnote 30

Clark PI, Schooley MW, Pierce B, Schulman J, Schmitt CL Hartman AM. Impact of Home Smoking Rules on Smoking Patterns Among Adolescents and Young Adults. Prev Chronic Dis. 2006 April; 3(2): A41. Accessed December 17, 2007.

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Footnote 31

Borland R, Yong H-H, Cummings KM, Hyland A, Anderson S, Fong GT. Next link will take you to another Web site Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control 2006;15(suppl 3):iii42--iii50. Accessed December 17, 2007.

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Footnote 32

Young K, Regan M, Hammer M. Next link will take you to another Web site Driver distraction: a review of the literature. Monash University Accident Research Centre. Report #206. 2003. Accessed December 13, 2007.

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Footnote 33

Canada Safety Council website. "Preparation and Communication the Key for Children Home Alone." Accessed December 19, 2007.

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Footnote 34

Beck P, Tilson M. When Neighbours Smoke: Exposure to Drifting Second-hand Smoke in Multi Unit Dwellings. Background Document: Nonsmokers' Rights Association, November 2006. Accessed December 18, 2007.

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