The Pediatric Hospitalist and the Smoking Parent

Shawn Ralston, MD and Mahshid Roohi, RN

Background: The impact of parental smoking on children is enormous. Injury and illness related to parental smoking result in 6200 excess pediatric deaths per year in the US, which places smoking as the leading preventable cause of death in children. Parental smoking doubles the risk of child hospitalization for respiratory illness therefore the pediatric hospitalist has frequent contact with smoking parents. There is a great deal of literature on the "teachable moment" which may occur when an adult smoker is hospitalized, particularly for a smoking related condition. National guidelines recommend intervention to promote smoking cessation when all adult smokers are hospitalized. A single study has previously investigated the effect of child hospitalization on parental smoking cessation.
Method: The smoking primary caregivers of children hospitalized for respiratory illness at the University of New Mexico Health Sciences Center were offered a brief smoking cessation intervention by a pediatric hospitalist with or without nicotine replacement. Participants were followed at three and six months post-hospitalization. Data were analyzed for characteristics of parents willing to discuss smoking cessation at child hospitalization and quit rates.
Summary of results: Two hundred thirteen parents qualifiied for the study and 42 (19.7%) enrolled. The majority of participants were: in the preparation stage of change, had rules against smoking in the home, had 2 or more prior quit attempts, had never asked for professional help in quitting, and smoked 1 pack or less per day. Of particular interest, most did not believe their smoking had any correlation with their child's hospitalization. Thirty-six participants (86%) set a quit date. Four (9.5%) particpants were confirmed quitters though the majority were lost to follow-up.
Statements of conclusions: A significant percentage of smoking parents of children hospitalized for respiratory illness are willing to receive smoking cessation counseling and to set a quit date. Abstinence rates appear similar to other brief officed-based interventions. Given the tremendous negative effect of parental smoking on children, child hospitalization should be viewed as an excellent opportunity to provide parents with smoking cessation services.