Betty, a parent educator presented a challenging case in
reflective supervision. She reported that the 19-year old
mother and her seven month-old daughter live with her
mother. And Grandma smokes like a chimney. Mom smokes,
too. She’s begun making efforts to smoke outside. But
Grandma says to Mom, “I smoked all through my pregnancy
and your childhood; you didn’t die, and neither will this
child”. She bristles at any request to stop smoking or take
steps to protect the baby.
I have a lot of respect for grandmothers and their wisdom
(I am one!). But this time, this grandmother is just plain
wrong. Her smoking probably will not kill the child this
year, and hasn’t killed the mother yet, but it might kill
them both before their time.
Second-hand smoke is as harmful as first hand smoke,
and more so for an infant with small size and still-developing
lungs. Exposure to second hand smoke has been linked to
increased risk of SIDS, ear infections, and respiratory disease
in children. Annually, 150,000 to 300,000 cases of bronchitis
or pneumonia in children under 18 months of age are attributed
to second hand smoke. And new research reported by the
journal Respirology this week shows that a child’s reduced
lung function from exposure to second-hand smoke nearly
doubles the risk of lung disease in adulthood.
Mom smoking outside does begin to reduce harm to the
baby by reducing the second hand smoke in the air that
Baby breathes. Betty, the home visitor rightly praises
this effort and continues to encourage Mom to take the
next step. Mom is in a bind because she needs a safe
place to live. And, for now, living with her mother is her
best option. She has set a goal to get a job so she
can get her own place. She is taking courses for a college
degree. It’s a long path to her goal. Meanwhile, Betty
reports, she takes the baby to the doctor “all the time”
for recurring colds and ear infections.
Third-hand smoke is as harmful as first hand smoke,
What makes Grandma’s house hazardous to Baby’s health,
in addition to smoke in the air from her current cigarette,
is the accumulation of smoke in the furniture, curtains,
carpet, bedding, dust; in her hair and clothes, and in her
car. This is third-hand smoke. It toxins remain toxic. Baby
has her face in it all the time. Information on third-hand
Rating Moms and Grandma’s Health Literacy
Betty has made certain that both Mom and Grandma have
plenty of information about smoking and resources to
support quitting. Both understand the information. Grandma
rejects it outright. She warrants a low score of 1 (dysfunctional)
on the “Use of Information” item in the Life Skills Progression
Maternal Health Literacy Scale. She has low health literacy,
not because she can’t read, but because she does not
use information and resources for health.
Mom’s health literacy is increasing. With Betty’s support
she has come to recognize the risk to her child, if not to
herself. She has established a medical home for the child
and seeks care appropriately. She has begun to take action
to change her living situation in order to improve her health
and that of her child. In this case, the barrier to health
literacy promotion is not the mother’s reading skill, it is
the grandmother’s beliefs.
Promoting Health Literacy
Betty planned to keep bringing information on smoking
to each visit with this family, as she has for a year now,
and continue to do whatever she can to “get them to
stop smoking”. When we reviewed the mother’s goals
and motivations - she aims to complete her schooling
so she can get a job so she can move to a more healthful
environment - a different approach emerged that is likely
to be more effective and less frustrating for all parties.
Betty has been trying to fix the family and rescue Baby
by getting Mom and Grandma to stop smoking. If she
could shift from pushing for her own goal to supporting
what Mom wants for herself and the baby, she could
build on Mom’s motivation to graduate and get a job,
celebrate smoking outside and going to school as steps
in the right direction, and support Mom’s step-by-step
progress toward independent living and a smoke-free
environment for her and Baby.
At the end of the case presentation, we learned the baby
had just been taken to the local ER with seizures and
airlifted to the regional medical center. We cannot say that
second- and third-hand smoke caused the seizures, but the
evidence is clear that smoke in an infant’s environment
weakens lung function and increases other health risks.
Mom is right. Time to move.
Winickoff JP, Friebely J, Tanski SE, et al. (2009). Beliefs
about the health effects of “third hand smoke and
home smoking bans. Pediatrics 123: e740e79.
Chan S.& Lam TH. (2003). Preventing exposure to second-hand smoke.
Seminars in Oncology Nursing 19 (4): 284-290
MedlinePlus Secondhand Smoke in Childhood Linked to Lung
Disease Years Later
(available until 6/17/2012)