In medical school, one of the first lessons we are taught when learning to interview patients is how to be an active listener. We are taught different ways of asking open-ended questions, how to ask sensitive questions in a kind and respectful manner, how to talk to patients facing a difficult diagnosis, and how to broach the topic of quitting with patients addicted to alcohol, drugs or smoking. Throughout years of medical school we are given most of the tools we would need to handle difficult situations with our patients, but like a carpenter starting his first day at work, just knowing what the tools are is no substitute for experience. One situation which still frustrates me, and which no amount of classroom teaching could have prepared me for, is discussing smoking cessation with women who are pregnant.
Cigarette smoking has been a hot topic in the news recently, namely because of the changes the Food and Drug Administration plans to make to the warning labels on cigarette boxes. The new warnings, scheduled to appear on boxes as soon as September 2012, use graphic images of a person with oral cancer, another having a stroke or heart attack and even a person who has passed away from the long term effects of smoking, to help prevent you from buying the boxes of harm. The United Kingdom uses a similar tactic for helping you avoid cigarettes. There, cigarette company labels are dwarfed in size by large warnings, reminding shoppers that "Smoking kills," or that "Smoking when pregnant harms your baby."
The latter message is the one that disappoints me the most when it does not reach consumers: Smoking harms your baby. The baby of a mother who smokes is at risk of being born too early, of being a low birthweight baby and of having certain deformities like cleft lip and palate. Smoking also puts mother and baby at risk of complications in other ways, such as increasing the risk of a placental abruption - where the placenta peels away from the uterine wall before delivery, preventing the baby from getting enough oxygen and also putting the mother at risk for major blood loss - and even increasing the risk of having a stillbirth.
The risk for children born to mothers and families who smoke continues as they grow. The new FDA warning labels show that babies are at an increasing risk of Sudden Infant Death Syndrome. In addition to that, a study recently published in the journal Pediatrics showed that 1/3 of all children in America live in homes with a smoker, and about 56 percent of those children, between the ages of 3 and 11 years old, have detectable levels of the chemical cotinine, a breakdown product of nicotine, in their blood. These children were more likely than their peers who do not live in homes with a smoker to suffer from recurrent ear infections and chest colds. This consequently leads to children missing more days of school and parents taking time off from their own jobs to take care of their children at home.
This brings me back to the issue of sitting in a room with a patient who is pregnant and smoking, or is already a mother who smokes. I do not think parents who smoke understand that the decision to continue smoking is no longer one they are making for themselves - it is a decision they have made for their children as well, children who are too young to even know what a cigarette does. I do not know how effective the new FDA labels will be, but I do know that educating parents about the far
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