Protecting children from shs exposure
This presentation is the property of its rightful owner.
Sponsored Links
1 / 19

Protecting Children from SHS Exposure PowerPoint PPT Presentation


  • 73 Views
  • Uploaded on
  • Presentation posted in: General

Protecting Children from SHS Exposure. Dana Best, MD, MPH, FAAP Jonathan Winickoff, MD, MPH, FAAP The AAP Julius B. Richmond Center of Excellence http://www.aap.org/richmondcenter/. Section A. Cycles of Tobacco Use. Learner Outcomes. To train pediatricians in the following:

Download Presentation

Protecting Children from SHS Exposure

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Protecting children from shs exposure

Protecting Children from SHS Exposure

Dana Best, MD, MPH, FAAP

Jonathan Winickoff, MD, MPH, FAAP

The AAP Julius B. Richmond Center of Excellence

http://www.aap.org/richmondcenter/


Section a

Section A

Cycles of Tobacco Use


Learner outcomes

Learner Outcomes

  • To train pediatricians in the following:

    • Brief, effective ways to assist families to quit using tobacco and make their homes and cars tobacco free

  • To redefine success when addressing tobacco use in the pediatric setting

    • Success is helping a . . .

      • Family move towards a tobacco free home and car

      • Tobacco user learn more about what works when quitting


The health effects of tobacco use

The Health Effects of Tobacco Use

Source: Aligne, C.A., Stodal, J.J.. Tobacco and children: An economic evaluation of the medical effects of parental smoking. Arch Pediatr Adolesc Med. 1997;151:652


The social cycle of tobacco use

The Social Cycle of Tobacco Use

Source: U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. (2004).


The economic cycle of tobacco use

The Economic Cycle of Tobacco Use

Source: Sloan, F., Ostermann, J., Conover, C., Picone, G. (2004). The price of smoking. MIT Press.


Principles of tobacco dependence treatment

Principles of Tobacco Dependence Treatment

  • Tobacco dependence is a chronic, relapsing condition

    • Nicotine is addictive

    • Effective treatments exist

    • Every person who uses tobacco should be offered treatment

Source: Fiore, M., Jaen, C., Baker, T., et al. (2008). Treating Tobacco Use And Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.


Tobacco users want to quit

Tobacco Users Want to Quit

  • 70% of tobacco users report wanting to quit

  • Most have made at least one quit attempt

  • Users say expert advice is important to their decision to quit

    • The expert can be a physician, clinician, health care worker—any member of your practice!

Source: Fiore, M., Jaen, C., Baker, T., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.


Basic counseling

Basic Counseling

  • Patients and families expect you to discuss tobacco use

  • If counseling is delivered in a non-judgmental manner, it is usually well-received

  • Even small “doses” are effective

    • And cumulative!

Source: Frankowski, B.L., Weaver, S.O., Secker-Walker, R.H. (2008). Advising parents to stop smoking: Pediatricians' and parents' attitudes. Pediatrics. 1993; 91(2): 296-300; and Fiore.


Counseling is effective

Counseling IS Effective

  • As little as three minutes of counseling doubles quit attempts and successes

  • Intensive counseling is more effective

    • Dose-response relationship

  • Most effective is as follows:

    • Problem-solving skills

    • Support from clinician

    • Social support outside of treatment

Source: Fiore, M., Jaen, C., Baker, T., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.


The 5 as

The 5 As

Source: Fiore, M., Jaen, C., Baker, T., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.


The 5 as1

The 5 As


Ask the concept

Ask: The Concept

  • Ask about tobacco use and SHS exposure at every visit

    • Include current tobacco use, SHS exposure

    • If appropriate, ask about tobacco use prior to and during pregnancy

  • Make asking routine both consistent and systematic

  • Document as a “vital sign”

    • Use standardized documentation

  • Just asking can double quit attempts

Source: Fiore, M., Jaen, C., Baker, T., et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.


We can learn better ways to ask

We Can Learn Better Ways to Ask

  • “. . . if someone comes at you with an accusatory tone [you’re] going to be defensive.”

  • “. . . putting me down about it doesn't help. If they talk down to me, making me feel small, it makes it so I don't want to quit. It . . . makes me feel bad.”

Source: Tanski, S., Gaffney, C. Unpublished data.


When we don t ask in the right way

When We Don’t Ask in the Right Way . . .

  • We elicit social desirability bias

  • Parents may modify tobacco use reporting to avoid lectures

    • Not divulge “slips”

    • Underreport tobacco use

    • Modify where and when smoking occurs


Ask how

Ask: How

  • Say, “Does your child live with anyone who uses tobacco?”

  • Don’t judge—check your body language, tone of voice, the phrasing of the question

  • Don’t lead with “you don’t smoke, do you?”

  • Depersonalize the question


Ask if no one uses tobacco

Ask: If No One Uses Tobacco

  • Explore

    • “You say no one smokes around your son. What does that mean?”

  • Congratulate and document


Ask if someone uses tobacco

Ask: If Someone Uses Tobacco

  • “Who is it?”

  • “How do they use tobacco?”

  • “Where do they smoke?”

  • “Is that inside the house?”


Assist the concept

Assist: The Concept

  • Ask for permission to make suggestions and offer help

    • “May I make a suggestion . . . ?”

    • Offer help—not “rules”

  • Elicit ideas from the parent

  • Offer alternatives or preparatory steps, such as making the home and car tobacco free

  • Help the parent to set their own goals for behavior change

Source: Miller, W., Rollnick, S., Conforti, K. (2002). Motivational Interviewing, Second Edition: Preparing People for Change. 2nd ed. New York, NY: Guilford Press.


  • Login