Editorial [Hot Topic: Pediatricians' Role in Tobacco Prevention and Control (Guest Editors: Norman Hymowitz, Dana Best and Joseph V. Schwab)]

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Abstract:

Pediatricians play an active role in ensuring that children are born healthy and live free of diseases, including those caused by tobacco use and tobacco smoke exposure. The Surgeon General's reports [1, 2] have shown that tobacco harms nearly every organ in the body and there is no safe level of tobacco smoke exposure. The negative effects of smoking and smoke exposure extend across the life course from the fetuses of smoking mothers to adults whose lives are ended prematurely by a variety of cancers, cardiovascular diseases, and respiratory diseases. Pediatricians have multiple opportunities to interrupt this cycle of smoking by educating pregnant women and caregivers about the health risks of tobacco use, preventing youth from ever using tobacco products, expanding screening and access to effective treatments, and reducing tobacco smoke exposure. The articles in this special issue will educate readers about the epidemiology and health consequences of smoking, and will provide a new way of thinking about nicotine addiction. Readers will learn about training for pediatricians, epidemiology and health effects of tobacco use and smoke exposure, tobacco policies, and prevention and treatment programs.

Physicians are a trusted source of information for parents and their medical advice to quit smoking increases abstinence rates [3] even when advice is delivered briefly. The Preventive Services Guidelines on Treating Tobacco Use and Dependence: 2008 Update [3] recommends that all clinicians should consistently identify and document tobacco use status and treat every adult tobacco user seen in a health care setting. As part of their tobacco counseling, pediatricians can use the five A's (ask, advise, assist, arrange, and anticipate), problem solving, skills training, and social support. Motivational interviewing techniques may be needed for smokers who are not yet ready to make quit attempts or to divulge information about their smoking behavior. Pediatricians have historically missed valuable opportunities to discuss smoking with parents and children during routine well child visits for reasons that include the stigmatizing nature of the topic, respect for privacy, lack of tobacco cessation training during medical school [4], and insufficient time, expertise, and financial incentives. The creation of pediatric residency smoking cessation programs and curricula has led to an improvement in residents' self-efficacy for counseling parents, and will hopefully empower the next generation of practicing pediatricians to take more active roles in anti-smoking counseling and advocacy.

There have been numerous Surgeon General's reports (http://www.surgeongeneral.gov/library/reports/index.html) on tobacco use, smoke exposure, health consequences, and prevention efforts in general and minority populations, women, and children. Links have been established between maternal smoking and increased risks for reduced fertility, stillbirths, premature infants, infants with low birth weight, sudden infant death syndrome, and long-term behavioral problems in infants [1]. Children whose mothers smoked during pregnancy are predisposed to many long-term behavioral and learning problems and are more likely to become dependent on tobacco if they start smoking. Pregnant women have higher quit rates compared to the general population, but relapse is, unfortunately, not uncommon in the months following delivery. However pediatricians interacting with pregnant and postpartum women can encourage them to remain tobacco free by pointing out the negative health effects of smoking on both mother and child.

Parents are important sources of smoke exposure for their children [5] in homes and automobiles, but children are also exposed to smoke in daycare settings and in other environments. As many as 17-18% of children in the United States [6] live in homes where a parent smokes; worldwide about 40% of children are exposed to tobacco smoke [7]. Tobacco smoke exposure affects numerous organ systems, causes genetic changes, influences the developing immune system, and contributes to an estimated 165,000 deaths in children each year [7]. Health effects of smoke exposure in children include atopy, asthma, respiratory illnesses, decreased lung function, increased risk of sudden infant death syndrome (SIDS), an increase in ear infections, and associations with behavioral and sleep problems [1]....



Document Type: Research Article

Publication date: May 1, 2011

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  • Current Pediatric Reviews publishes frontier reviews on all the latest advances in pediatric medicine. The journal's aim is to publish the highest quality review articles dedicated to clinical research in the field. The journal is essential reading for all researchers and clinicians in pediatric medicine.
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