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Public health campains which aim to increase the awareness of dangers of ETS among all people&#44; should consider the smoking habits of parents&#44; cohabitants and guests and the promotion of home smoking rules&#47;precautions&#46; Indeed&#44; many smokers believe that they are protecting their children from ETS just because they only smoke outdoors or smoke at home when the children are not present&#44; but they do not realize that the harmful products of tobacco smoke are present in their home and can be detected in their children&#46; The studies by Protano et al&#46; who analysed the home exposure to ETS of Italian children through urinary cotinine and benzene metabolites&#44; showed an increasing excretion of these biomarkers with increasing ETS exposure &#40;from the minimum value observed when parents&#47;cohabitants do not smoke&#44; to that observed when they smoke but not inside the home&#44; to that observed when they smoke inside the home only when children are out&#44; to the maximum value observed when they smoke inside the home even when children are in&#41;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>&#46;</p><p class="elsevierStylePara">The study by Vit&#243;ria et al&#46; draws attention not only to the health consequences implied by SHS exposure on children&#44; but also to the behavioural message it delivers<a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#46; Children exposed to SHS are more often affected by pneumonia&#44; bronchiolitis&#44; otitis&#44; asthma attacks&#44; but also are more likely to start smoking in the future&#46; Older members of the family&#44; especially parents&#44; and teachers who smoke can give the impression that cigarette smoking is a normal behaviour and thus they can be seen by the children to be a role model to be imitated&#46;</p><p class="elsevierStylePara">Indeed&#44; when youngsters start to smoke&#44; even if they are aware of the dangers of smoking&#44; they do not realize that cigarette smoking may be the first step on the path to other substance abuse and addiction&#46;</p><p class="elsevierStylePara">Furthermore&#44; very young children may be at increased risk of domestic accidents caused by ingesting tobacco related products&#44; playing with matches or cigarette lighters&#44; or indeed burns from unextinguished cigarettes&#46;</p><p class="elsevierStylePara">The importance of giving positive tobacco-free role models to young people is crucial if we really want to conquer the tobacco epidemic&#46;</p><p class="elsevierStylePara">Indeed&#44; in 2009 the European Community adopted the &#8220;Council Recommendations on smoke-free environments&#8221; and on February 2013&#44; published a report summarising the state of the implementation of those Recommendations&#46;</p><p class="elsevierStylePara">In the U&#46;S&#46;A&#46;&#44; in June 2009&#44; President Obama signed &#8220;The Family Smoking Prevention and Tobacco Control Act&#8221; which explicitly charged the Food and Drug Administration &#40;FDA&#41; with protecting children and adolescents from the danger of tobacco use in order to avoid new generations of tobacco-dependent adults<a href="&#35;bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a>&#46;</p><p class="elsevierStylePara">In February 2014&#44; the European Community approved the &#8220;Revision of the Tobacco Products Directive&#8221; which focuses on the protection of the new generations&#46; Indeed&#44; 70&#37; of smokers start before the age of 18 and 94&#37; before the age of 25&#44; and since tobacco causes dependence&#44; the youngsters who start&#44; continue to smoke for many years or even for the rest of their lives&#46; This is the reason why it is so important to prevent young people from starting to smoke&#46; It is also why the Revision gave great importance to the necessity to avoid misinformation and attactiveness of tobacco products by adopting pictorial warnings and banning additives and flavours &#40;mint&#44; chocolate or fruit&#41; which&#44; improving the taste and reducing the irritating effects&#44; make it easier to inhale the smoke&#44; particularly for young people&#46;</p><p class="elsevierStylePara">Moreover&#44; some countries have planned &#8220;Tobacco Endgame&#8221; strategies to reduce the number of smokers &#40;prevalence &#60;&#160;5&#37;&#41; in the long run &#40;Ireland by 2025&#44; Scotland by 2034&#44; Finland by 2040&#41;&#46;</p><p class="elsevierStylePara">There has also been a proposal&#44; alongside current under-age bans&#44; to introduce laws banning the provision of tobacco to any citizen born in or after a specific year &#40;for example the year 2000 as it is convenient for recall&#41;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>&#46;</p><p class="elsevierStylePara">The concept of &#8220;tobacco-free generations&#8221; that will never legally be able to take up the harmful habit of smoking&#44; at any age is a challenge that might be pursued with a multi-factorial approach&#44; which starts at home from positive tobacco-free role models in the family from early childhood&#46;</p>"
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Tobacco-free homes for tobacco-free generations: establishing positive smoke-free role models for youth
M.S.. Cattaruzzaa
a Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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    "textoCompleto" => "<p class="elsevierStylePara">Nowadays&#44; many European Countries have enforced laws to ban smoking in enclosed public places and in workplaces and thus protection from the effects of passive smoking has improved&#46; However&#44; passive smoking is still present not only in outdoor environments&#44; such as parks&#44; beaches&#44; sport stadiums&#44; hospital and university grounds&#44; outdoor areas of bars and restaurants&#44; but also in homes and private motor vehicles and these are very important sources of exposure&#44; especially for children who are more susceptible than adults to the adverse effects of passive smoking&#46;</p><p class="elsevierStylePara">Passive smoking or Environmental Tobacco Smoke &#40;ETS&#41; is a comprehensive term which include second and third hand smoke&#44; while tobacco-free is an even more inclusive term which implies the exclusion of any kind of tobacco&#46;</p><p class="elsevierStylePara">Second Hand Smoke &#40;SHS&#41; was recognized to be a human carcinogen of group A&#44; meaning that its exposure has no safe limit&#44; in 1992 by the Environmental Protection Agency &#40;EPA&#41; and in 2000 by World Health Organization &#40;WHO&#41;&#46; Nevertheless&#44; a great proportion of the world population and about half of the world&#39;s children &#40;700 millions according to WHO&#41; are still exposed to this preventable cause of morbidity&#44; disability and mortality&#46;</p><p class="elsevierStylePara">The cross-sectional study by Vit&#243;ria et al&#46;&#44; who considered more than 3000 children from the seven main regions of Portugal&#44; not only shows that 63&#37; of Portuguese children are &#40;regularly or occasionally&#41; exposed to SHS at home if they have one or both parents who smoke&#44; but also it highlights that SHS exposure is present in those homes where no parents smoke&#33;<a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a></p><p class="elsevierStylePara">This is a very important finding which should be taken into consideration when promoting health&#46; Public health campains which aim to increase the awareness of dangers of ETS among all people&#44; should consider the smoking habits of parents&#44; cohabitants and guests and the promotion of home smoking rules&#47;precautions&#46; Indeed&#44; many smokers believe that they are protecting their children from ETS just because they only smoke outdoors or smoke at home when the children are not present&#44; but they do not realize that the harmful products of tobacco smoke are present in their home and can be detected in their children&#46; The studies by Protano et al&#46; who analysed the home exposure to ETS of Italian children through urinary cotinine and benzene metabolites&#44; showed an increasing excretion of these biomarkers with increasing ETS exposure &#40;from the minimum value observed when parents&#47;cohabitants do not smoke&#44; to that observed when they smoke but not inside the home&#44; to that observed when they smoke inside the home only when children are out&#44; to the maximum value observed when they smoke inside the home even when children are in&#41;<a href="&#35;bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a>&#46;</p><p class="elsevierStylePara">The study by Vit&#243;ria et al&#46; draws attention not only to the health consequences implied by SHS exposure on children&#44; but also to the behavioural message it delivers<a href="&#35;bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a>&#46; Children exposed to SHS are more often affected by pneumonia&#44; bronchiolitis&#44; otitis&#44; asthma attacks&#44; but also are more likely to start smoking in the future&#46; Older members of the family&#44; especially parents&#44; and teachers who smoke can give the impression that cigarette smoking is a normal behaviour and thus they can be seen by the children to be a role model to be imitated&#46;</p><p class="elsevierStylePara">Indeed&#44; when youngsters start to smoke&#44; even if they are aware of the dangers of smoking&#44; they do not realize that cigarette smoking may be the first step on the path to other substance abuse and addiction&#46;</p><p class="elsevierStylePara">Furthermore&#44; very young children may be at increased risk of domestic accidents caused by ingesting tobacco related products&#44; playing with matches or cigarette lighters&#44; or indeed burns from unextinguished cigarettes&#46;</p><p class="elsevierStylePara">The importance of giving positive tobacco-free role models to young people is crucial if we really want to conquer the tobacco epidemic&#46;</p><p class="elsevierStylePara">Indeed&#44; in 2009 the European Community adopted the &#8220;Council Recommendations on smoke-free environments&#8221; and on February 2013&#44; published a report summarising the state of the implementation of those Recommendations&#46;</p><p class="elsevierStylePara">In the U&#46;S&#46;A&#46;&#44; in June 2009&#44; President Obama signed &#8220;The Family Smoking Prevention and Tobacco Control Act&#8221; which explicitly charged the Food and Drug Administration &#40;FDA&#41; with protecting children and adolescents from the danger of tobacco use in order to avoid new generations of tobacco-dependent adults<a href="&#35;bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a>&#46;</p><p class="elsevierStylePara">In February 2014&#44; the European Community approved the &#8220;Revision of the Tobacco Products Directive&#8221; which focuses on the protection of the new generations&#46; Indeed&#44; 70&#37; of smokers start before the age of 18 and 94&#37; before the age of 25&#44; and since tobacco causes dependence&#44; the youngsters who start&#44; continue to smoke for many years or even for the rest of their lives&#46; This is the reason why it is so important to prevent young people from starting to smoke&#46; It is also why the Revision gave great importance to the necessity to avoid misinformation and attactiveness of tobacco products by adopting pictorial warnings and banning additives and flavours &#40;mint&#44; chocolate or fruit&#41; which&#44; improving the taste and reducing the irritating effects&#44; make it easier to inhale the smoke&#44; particularly for young people&#46;</p><p class="elsevierStylePara">Moreover&#44; some countries have planned &#8220;Tobacco Endgame&#8221; strategies to reduce the number of smokers &#40;prevalence &#60;&#160;5&#37;&#41; in the long run &#40;Ireland by 2025&#44; Scotland by 2034&#44; Finland by 2040&#41;&#46;</p><p class="elsevierStylePara">There has also been a proposal&#44; alongside current under-age bans&#44; to introduce laws banning the provision of tobacco to any citizen born in or after a specific year &#40;for example the year 2000 as it is convenient for recall&#41;<a href="&#35;bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a>&#46;</p><p class="elsevierStylePara">The concept of &#8220;tobacco-free generations&#8221; that will never legally be able to take up the harmful habit of smoking&#44; at any age is a challenge that might be pursued with a multi-factorial approach&#44; which starts at home from positive tobacco-free role models in the family from early childhood&#46;</p>"
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ISSN: 08732159
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Pulmonology

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