9.2.3.15: Policies Prohibiting Smoking, Tobacco, Alcohol, Illegal Drugs, and Toxic Substances

Facilities should have written policies addressing the use and possession of tobacco and electronic cigarette (e-cigarette) products, alcohol, illegal drugs, legal drugs (e.g. medicinal/recreational marijuana, prescribed narcotics, etc.) that have side effects that diminish the ability to properly supervise and care for children or safely drive program vehicles, and other potentially toxic substances. Policies should include that all of these substances are prohibited inside the facility, on facility grounds, and in any vehicles that transport children at all times. Policies should specify that smoking and vaping is prohibited at all times and in all areas (indoor and outdoor) of the program. This includes any vehicles that are used to transport children.

Policies must also specify that use and possession of all substances referred to above are prohibited during all times when caregivers/teachers are responsible for the supervision of children, including times when children are transported, when playing in outdoor play areas not attached to the facility, and during field trips and staff breaks.

Child care centers and large family child care homes should provide information to employees about available drug, alcohol, and tobacco counseling and rehabilitation, and any available employee assistance programs.

RATIONALE

The age, defenselessness, and lack of discretion of the child under care make this prohibition an absolute requirement. 

The hazards of second-hand and third-hand smoke exposure warrant the prohibition of smoking in proximity of child care areas at any time (1-10). Third-hand smoke refers to gases and particles clinging to smokers’ hair and clothing, cushions, carpeting and outdoor equipment after visible tobacco smoke has dissipated (9). The residue includes heavy metals, carcinogens, and even radioactive materials that young children can get on their hands and ingest, especially if they’re crawling or playing on the floor. Residual toxins from smoking at times when the children are not using the space can trigger asthma and allergies when the children do use the space (10). 

Safe child care necessitates sober caregivers/teachers. Alcohol and drug use, including the misuse of prescription, over-the-counter (OTC), or recreational drugs, prevent caregivers/teachers from providing appropriate care to infants and children by impairing motor coordination, judgment, and response time. Off-site use prior to or during work, of alcohol and illegal drugs is prohibited. OTC medications or prescription medications that have not been prescribed for the user or that could impair motor coordination, judgment, and response time is prohibited.

The use of alcoholic beverages and legal drugs in family child care homes when children are not in care is not prohibited, but these items should be stored safely at all times.

COMMENTS

The policies related to smoking and use of prohibited substances should be discussed with staff and parents/guardians. Educational material such as handouts could include information on the health risks and dangers of these prohibited substances and referrals to services for counseling or rehabilitation programs.

It is strongly recommended that, whenever possible, all caregivers/teachers should be non-tobacco and non-electronic cigarette (e-cigarette) users. Family child care homes should be kept smoke-free at all times to prevent exposure of the children who are cared for in these spaces.

In states that permit recreational and/or medicinal use of marijuana, special care is needed to store edible marijuana products securely and apart from other foods. State regulations typically required that these products be clearly labeled as containing an intoxicating substance and stored in the original packaging that is tamper-proof and child-proof. Any legal edible marijuana products in a family child care home should be helpy in a locked and child-resistant storage device. 

TYPE OF FACILITY

Center, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home

RELATED STANDARDS

3.4.1.1 Use of Tobacco, Electronic Cigarettes, Alcohol, and Drugs
5.2.9.1 Use and Storage of Toxic Substances
6.5.1.2 Qualifications for Drivers

REFERENCES

1. U.S. Environmental Protection Agency. Secondhand tobacco smoke and smoke-free homes. 2016. https://www.epa.gov/indoor-air-quality-iaq/secondhand-tobacco-smoke-and-smoke-free-homes.
   
2. American Academy of Pediatrics. Healthychildren.org. 2015. The dangers of secondhand smoke. https://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Secondhand-Smoke.aspx. 
   
3. U.S. Department of Health and Human Services. 2007. Children and secondhand smoke exposure. Excerpts from the health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: 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.
   
4. Dreyfuss, J.H. Thirdhand smoke identified as potent, enduring carcinogen. CA Cancer J Clin. 2010;60(4):203-204. https://www.ncbi.nlm.nih.gov/pubmed/20530799.
   
5. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Secondhand Smoke What It Means to You. 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. http://www.surgeongeneral.gov/library/reports/secondhand-smoke-consumer.pdf. 
   
6. Hang, B., Sarker, A.H., Havel, C., et al. Thirdhand smoke causes DNA damage in human cells. Mutagenesis. 2013;28(4):381-391. https://www.ncbi.nlm.nih.gov/pubmed/23462851. 
   
7. Winickoff, J. P., J. Friebely, S. E. Tanski, C. Sherrod, G. E. Matt, M. F. Hovell, R. C. McMillen. 2009. Beliefs about the health effects of “thirdhand” smoke and home smoking bans. Pediatrics 123: e74-e79.
   
8. Dale, L. 2014. What is thirdhand smoke, and why is it a concern? http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/third-hand-smoke/faq-20057791.
   
9. Centers for Disease Control and Prevention. 2016. Health effects of secondhand smoke. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/health_effects/. 
   
10. Campaign for Tobacco-Free Kids. Secondhand smoke, kids and cars. 2016. http://www.tobaccofreekids.org/research/factsheets/pdf/0334.pdf.
    
11. ADDITIONAL REFERENCES
     
    U.S. Fire Administration. Electronic cigarette fires and explosions. 2014. https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf.
     
    Campbell. R. Electronic Cigarette Explosions and Fires: The 2015 Experience. 2016. http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/fire-causes/electrical-and-consumer-electronics/electronic-cigarette-explosions-and-fires-the-2015-experience.
     
    National Institute on Drug Abuse. 2016. What is marijuana? https://www.drugabuse.gov/publications/drugfacts/marijuana.
     
    Rapoport, M.J., Lanctôt, K.L., Streiner, D.L., Bédard, M., Vingilis, E., Murray, B., Schaffer, A., Shulman, K.I., Herrmann, N. Benzodiazepine use and driving: A meta-analysis. J Clin Psychiatry. 2009;70(5):663-73. doi:10.4088/JCP.08m04325.
     
    Sansone, R.A., Sansome, L.A. Driving on Antidepressants: Cruising for a crash?. Psychiatry (Edgmont). 2009:6(9): 13–16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766284/.
     
    Volkow, N.D., Baler, R.D., Compton, W.M., R.B. Weiss, S.R.B. Adverse health effects of marijuana use. N Engl J Med 2014:370:2219-2227. DOI: 10.1056/NEJMra1402309.
     
    Lenné MG, Dietze PM, Triggs TJ, Walmsley S, Murphy B, Redman JR. The effects of cannabis and alcohol on simulated arterial driving: Influences of driving experience and task demand. Accid Anal Prev. 2010;42(3):859-866. doi:10.1016/j.aap.2009.04.021.
     
    Hartman RL, Huestis MA. Cannabis effects on driving skills.Clin Chem. 2013;59(3):478-492. doi:10.1373/clinchem.2012.194381.
     
    Verster, J. C., D. S. Veldhuijzen, E. R. Volkerts. 2005. Is it safe to drive a car when treated with anxiolytics? Evidence from on the road driving studies during normal traffic. Current Psychiatry Reviews1:215-25.
     
    Centers for Disease Control and Prevention. 2009. Facts: Preventing residential fire injuries. http://www.cdc.gov/injury/pdfs/Fires2009CDCFactSheet-FINAL-a.pdf. 
     
    American Lung Association. E-cigarettes and Lung Health. 2016. http://www.lung.org/stop-smoking/smoking-facts/e-cigarettes-and-lung-health.html?referrer=https://www.google.com/.
     
    Children’s Hospital Colorado. 2016. Acute marijuana intoxication. https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/acute-marijuana-intoxication/.
    

NOTES

Content in the STANDARD was modified on 1/12/2017.