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AAP News Vol. 18 No. 4
April 2001, p. 158
AAP statement helps snuff out smoking in patientsTom NugentCorrespondent
An AAP Committee on Substance Abuse (COSA) Policy Statement, Tobacco’s Toll: Implications for the Pediatrician (
Pediatrics. 2001; 107:794-798 Focus on quitting The Academy now recommends that pediatricians focus on smoking cessation in addition to prevention and anticipatory guidance.
"This is a big deal for us. Pediatricians are very big on prevention and anticipatory guidance, but when it comes to the health risks associated with tobacco, that’s not enough. "We should be asking about this problem during every office visit, and we have to be prepared to work with families where parents and caregivers smoke. We also have to be prepared to offer cessation help to our adolescent patients," he said. "There is now a great deal of research to show that many smoking cessation techniques do work. In the past there’s been a sense of hopelessness about this problem, but now we have incontrovertible evidence that such methods as nicotine replacement therapy are often quite effective."
Describing such therapies, the statement concludes: "Those who smoke 10 or more cigarettes per day may benefit from systemic nicotine replacement therapy supplied by patches, gum, spray or inhaler." Dr. Heyman conceded that there are significant barriers to rendering this tobacco cessation care, but insisted that pediatricians can have an effect on parents and children who smoke by asking the right questions and addressing the issue candidly during office visits. "There’s no doubt that we’re facing increased time pressure, and that the insurance companies don’t want to pay for this service," he said. "But the research shows clearly that even a brief, 60-second discussion can be effective with many patients and parents." Other substance abuse
Dr. Jacobs also said it is important that funds from the 1999 national $2.5 billion tobacco injury settlement be used for care and treatment of tobacco-related health problems, rather than being "shunted away on other projects" that won’t help smokers. Smoking parent, sick child Pointing out that nearly half of the nation’s infants and toddlers are routinely exposed to ETS, Dr. Heyman said pediatricians should alert parents to the dangers of allowing children to breathe second-hand smoke. According to the statement, the consequences of smoking or breathing ETS can include increased incidence of upper respiratory infection, cough, asthma, sinusitis, cardiovascular disease, cancer, impaired fertility, premature aging and death. Dr. Heyman said pediatricians should "never miss a chance" to warn patients and parents about such consequences. "We should not be brushing these issues under the rug, just because they’re difficult," he said. "I think we’re all afraid to ask about these problems at times, because of the constraints that managed care puts on us. But the skilled interviewer knows how to open Pandora’s Box, discover the problems, and then address them." Dr. Heyman said he recently treated a 9-month-old infant who had struggled through a series of upper respiratory infections in a home where both parents smoked. "He’d had three respiratory infections this past winter — including a bout with bronchiolitis — and I had been talking to the parents about their smoking for months. "Well, the child came in today, and he was looking great! And both parents informed me that they quit smoking several weeks ago." Pediatricians need training
"I think it’s a good idea to flag the front of the [medical] chart with a special sticker that shows how smoking is a problem for this particular family," said Dr. Kulig. "Knowing how to ask the questions is crucial," said Deborah Simkin, M.D., liaison to COSA from the American Academy of Child and Adolescent Psychiatry. "The kid you’re talking to needs to hear you saying: ‘If you need me, I’m here, and I’m never going to judge you.’" The Policy Statement supports a recent congressional bill, now being debated, that would give the U.S. Food and Drug Administration authority to regulate tobacco sales. A similar bill failed last year.
May 31 is the World Health Organization’s World No-Tobacco Day. Patients and parents can be made aware of the harm of tobacco use with AAP brochures: Smokeless Tobacco; Smoking: Straight Talk for Teens; and The Risk of Tobacco Use: A Message to Parents and Teens. To view all of the brochures available from the Academy, visit the AAP Bookstore online at www.aap.org.
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