Doctors ill equipped to confront parent smoking

May 2 2007

With the growing concerns of children's exposure to secondhand smoke, it has become more critical than ever to involve health care providers such as pediatricians in educating parents about the potential hazardous health consequences.

Almost 60 percent of U.S. children ages 3 to 11 -- approximately 22 million children --are exposed to secondhand smoke daily, with urban children suffering the highest rates of exposure in a U.S. Surgeon General report from June 2006.

However, minimal formal medical training exists regarding how pediatricians can effectively speak to their patients about secondhand smoke-related issues, according to an article in the May issue of The Journal of Pediatrics.

"Part of the issue is teaching medical residents (physicians in training) to advise smoking parents at every patient visit. Consider every message as a ,dose, of advice that in the long run could promote lasting changes in parental smoking behavior and children's exposure," said Brad Collins, Ph.D, the lead author and assistant professor of public health at Temple University.

The Surgeon General's report also found 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 and 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 over 40 percent of postpartum mothers were either currently smoking or reported smoking late in their pregnancy.

"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 we're 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 towards improving secondhand smoke reduction efforts at a Philadelphia hospital.

Sixty-six residents across all years of training and twenty-seven preceptors (resident supervisors) responded to the survey. Most pediatricians surveyed believed second-hand 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, second-hand 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.