Smoking Among Mothers of Young Children
March 28, 2003 -- Low-income mothers who receive support to stop smoking from their children's doctors and other staff are more likely to quit the habit, according to a recent study at the University of Illinois (Arch Pediatr Adolesc Med 2003 Mar; 157(3): 295-302). The study sample consisted of three hundred and three women who visited Seattle, Washington pediatric clinics with their children. In one group (the "intervention group"), the women were told about the effects of secondhand smoke. The pediatrician spoke to them about their smoking and gave them a printed guide, "Make Yours a Fresh Start Family: A Magazine for Mothers Who Smoke." The booklet included the first-person stories of former smokers, a section on preparing to quit, and details about a 4-step smoking cessation program. A nurse or study participant counseled the women and made at least three follow-up telephone calls within the first three months after enrollment. The control group did not receive counseling or written materials about smoking.
The women filled out an initial survey about their medical and mental health, smoking patterns, social support system, and their children's health. Questions about smoking included the amount smoked, the time to the first cigarette of the day, the number of serious attempts to quit, and the longest prior period of abstinence from smoking. The mothers returned to the clinic to complete a questionnaire at 3 months and 12 months after they had enrolled in the study. At these times, an experienced interviewer asked them questions about whether they had stopped smoking. Some women also took a carbon monoxide breath test, which has a limited capacity to measure whether one has been smoking.
Results of Smoking Study
The percent of women in the intervention group who quit at 12 months was more than twice that in the control group, but the differences at 3 months were not statistically significant. The percent of women who reported a serious attempt to quit was also higher in the intervention group. The researchers concluded that providing anti-smoking education and support in a pediatric office could benefit both mothers and their children. Because young children need frequent medical care visits, parents may see their children's health care providers more often than their own primary care physicians.
The results of the University of Illinois study are in line with other more short-term reports. For example, a pediatric clinic in Portland, Oregon studied the smoking behavior of 2,901 mothers of newborn babies (Pediatrics 1995 Oct; 96(4 Pt 1): 622-8). One group received a hospital packet containing written information about passive smoking and a letter advising them to quit. The other group received the hospital packet plus verbal and written advice at their usual well baby visits, which took place at 2 weeks, 2 months, 4 months, and 6 months after delivery. Once again, the personal touch was most effective. Those who received counseling had higher quit rates (5.9% vs. 2.7%) and lower relapse rates (45% vs 55%) than those who did not. They also had better attitudes and knowledge regarding passive smoke and allowed less smoking in the home.
Pediatricians' Knowledge of Anti-Smoking Techniques
Unfortunately, not all children's doctors and their staff are comfortable with their roles in smoking prevention, according to one survey of 499 urban California doctors (Arch Pediatr Adolesc Med 2001 Jan; 155(1): 25-31). Compared with pediatricians, family physicians were more likely to report referring a parent to a smoking cessation program, giving pamphlets on smoking cessation, asking for a quit date, scheduling a follow-up visit to discuss quitting, and recommending nicotine replacement therapy. Pediatricians were more likely to report in the medical record that a parent's smoking was a problem for the child, but many thought that parents would ignore any anti-smoking advice. When asked about their counseling skills, many pediatricians reported that they felt uncomfortable talking to parents about smoking. Because the effects of secondhand smoke on children can be devastating, an educational program for pediatricians is clearly warranted.
Effects of Secondhand Smoke on Children
In the United States, secondhand smoke is responsible for more than 300,000 annual cases of bronchitis and pneumonia in children under 18 months old, according to the Environmental Protection Agency. It causes and aggravates childhood asthma and has been linked to sudden infant death syndrome (American Academy of Pediatrics, also see Tobacco Free Initiative, Frequently Asked Questions, World Health Organization).
Childhood exposure to tobacco smoke also contributes to heart disease in adulthood and to nervous system problems. Secondhand smoke causes lung cancer, according to the World Health Organization, which labels it a "real and substantial threat to child health, causing death and suffering throughout the world" (International Consultation on Environmental Tobacco Smoke and Child Health). Preventing children's exposure to tobacco smoke can lead to improved health for everyone. Figuring out ways to reach parents who smoke is a step in the right direction.