The Surgeon General’s report also found that secondhand smoke causes disease and death in children and nonsmoking adults. Breathing secondhand smoke can be harmful to children's health and can cause or contribute to asthma, Sudden Infant Death Syndrome (SIDS), bronchitis, pneumonia and ear infections.
The developing lungs of young children are severely affected by exposure to secondhand smoke for several reasons, including that children are still developing physically, have higher breathing rates than adults, and have little control over their indoor environments.
Previous surveys by Collins’ team found that more than 40 percent of postpartum mothers were either currently smoking or reported smoking late in their pregnancies.
“The rates of postpartum smoking we found in North and West Philadelphia are consistent with other lower-income, urban communities across the country…It’s alarming when considering the consequences children bear,” Collins said.
Such data underscores the importance of programs like Philadelphia FRESH – a free health education program from Temple University — that helps parents create a smoke-free home, and why researchers are interested in learning how to enhance pediatricians’ role in the overall process in promoting clean home air environments, Collins said.
For the Journal of Pediatrics article, Collins and his co-authors surveyed physician training needs and attitudes toward improving secondhand smoke reduction efforts at a Philadelphia hospital.
Sixty-six residents across all years of training and 27 preceptors (resident supervisors) responded to the survey. Most pediatricians surveyed believed secondhand smoke exposure was a serious health concern for children, but they also believed they were not equipped to help. Almost all respondents (93 percent) reported that they received less than two hours of smoking cessation training during residency.
Survey participants cited key barriers to addressing patients’ secondhand smoke exposure, including lack of training, time, confidence in their tobacco intervention skills, and knowledge about appropriate tobacco intervention resources.
A recent large-scale analysis from the Cochrane Collaboration showed that brief physician advice provided in primary care, hospital wards and outpatient clinics significantly increased the odds of quitting smoking by approximately 2.5 percent compared to no advice. While the analysis called this a “a small effect on cessation rates,” a 2.5 percent annual improvement in promoting parental smoking cessation would result in the improved health of tens if not hundreds of thousands of children each year, from a public health perspective, Collins said.
Linking brief physician advice and follow-up with more intensive behavioral smoking treatment programs like Philadelphia FRESH would improve the impact of physician advice more dramatically, he added.
As a result of this study, the co-authors have made recommendations for tobacco intervention training for pediatric medical residents. These include classroom lecture, strategies for problem-solving with smoking parents, patient-education materials, and clinical reminders for guideline adherence.
Other authors on this paper are Dr. Kenneth P. Levin from Children’s Community Pediatrics – South Hills Pediatric Associates and Dr. Tyra Bryant-Stephens from the Department of Pediatrics, Children’s Hospital of Philadelphia. This survey was funded by a National Institutes of Health grant that Collins received to test treatments to reduce postpartum smoking and children’s secondhand smoke exposure.
Collins, a clinical psychologist by training, is director of the Health Behavior Research Clinic at Temple University. The clinic currently offers free smoking treatments including Philadelphia FRESH, a program designed to help smoking mothers reduce their children’s exposure to tobacco smoke, and Quit 4 Good, a smoking relapse prevention treatment that includes medication to help smokers quit and stay quit for good. |
