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, too. 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. Epilogue 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. References 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) |
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CategoriesHealth LiteracyMaternal Child Health Test |
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