Clinicians role in intervening with high risk families to reduce secondhand smoke exposure

Secondhand smoke is a major contributor to respiratory disease in children. Exposure has also been linked to behavioral issues and school absenteeism. Despite the fact that secondhand smoke exacerbates or results in disease, physicians do not regularly address it in office visits especially in low income communities. 71% of children under six who are poor or near poor are exposed to secondhand smoke compared to only 19% from families with middle or high incomes.

The American Medical Association secondhand smoke initiative is designed to increase physician counseling on secondhand smoke to reduce children's exposure by developing system changes in clinics that serve high risk patient populations.

National guidelines recommend that clinicians talk to parents about the health risks of secondhand smoke. Studies indicate room for improvement when it comes to physician behavior. One study of 33,820 well child visits found that 1.5% of parents were counseled about smoking; when the child had asthma 4.4% received counseling. Clinicians working with low income families need a prescribed plan to ensure that children's exposure to secondhand smoke is recorded, parents who smoke are offered cessation intervention, and parents that don't smoke are helped to establish smokefree environments.

Creating systems that include tools to educate clinicians and parents will greatly improve physician practice and patient care while improving the respiratory health of children.

Children of low economic status have higher rates of exposure to secondhand smoke and suffer more from the negative health outcomes including low birth weight, asthma and respiratory tract infections.