Health system failing to keep children from respiratory ills

Ohio health-care providers are missing opportunities to protect children from secondhand smoke, a series of studies by University of Toledo researchers reveals.

In the most recent study, published this week in the American Journal of Health Behavior, Joseph Dake, an assistant professor of health education, found that while 60 percent of pediatricians advise parents not to smoke, they seldom do anything to help the parent quit smoking.

"I'm not knocking pediatricians," Mr. Dake said. In fact, his studies have shown other doctors are just as reluctant to push patients to quit smoking.

"I would say the system we have is one that is not sufficient to protect kids from secondhand smoke," he said.

The risks of secondhand smoke for children are more than just academic, Mr. Dake said. Children exposed to secondhand smoke miss more school than children whose parents don't smoke. Secondhand smoke is associated with increased incidence of asthma, sudden infant death, decreased lung function, and middle ear problems.

Of the 153 pediatricians responding to the survey, few used proven methods to help people stop smoking. Only 24 percent asked parents if they were willing to quit smoking in the next 30 days.

Only 18 percent of pediatricians referred patients to a smoking cessation program. And 16 percent recommended some form of nicotine replacement therapy.

Earlier studies by Mr. Dake and colleagues Timothy Jordan and James Price showed that pediatricians are not alone in their reluctance to launch a frontal attack on smoking. Midwives and obstetrician-gynecologists also are unlikely to do much more than tell a prospective mother, "don't smoke."

Yet a 2005 study revealed maternal smoking is the greatest preventable cause of poor pregnancy outcomes.

In a study awaiting publication, the researchers found that pediatricians also are unlikely to go beyond the "don't smoke" lecture for even the youngsters in their practice who smoke.

But experts say simply lecturing patients not to smoke doesn't work.

"That's not helpful, that's not helpful at all," said Karen Ahijevych, a researcher at Ohio State University. "We need to assess your readiness to quit. We don't just tell people to go home and quit; we give them some strategies."

Earlier this year, The Journal of Community Health Nursing published the results of a study conducted by Ms. Ahijevych in which home-health nurses were trained to provide smoking cessation counseling to mothers of newborns.

While 40 percent of pregnant women quit smoking, within a month of childbirth 60 percent of those women started smoking again. By six months, 70 percent were smoking.

But mothers who received smoking cessation counseling in Ms. Ahijevych's study were 2 1/2 times less likely to start smoking again.

"Even a couple of minutes [of counseling] is going to help if we can provide some strategies," Ms. Ahijevych said.