Tough day in the office. My last patient was a 35 year old woman with asthma exacerbation. Her kids have it too (they saw my partner last week). Ironically, I saw them leaving the office last week in the parking lot. They all enthusiastically said hello to me as the drove away .. and I was struck by the father's cigarette fuming away in the car .. as they all smiled at me.
Dad is the only smoker in the house, and .. as mom says ... "he doesn't agree with how smoking is bad for us." At frist I didn't believe her. So I went out to the (empty) waiting room while she was getting her nebulizer (peak flow went from 200 to 400). I suggested that his smoking may play a role in the health of his family. His father smoked and he doesn't have asthma. He knows that I am wrong because of this.
This episode only briefly preceded dinner at our house .. where we were joined by my father-in-law .. who states medical "facts" at the dinner table so preposterous that I simply cannot respond.
Nor shoudl I. These are his health beliefs, and I have no business "correcting" them simply because I went to medical school.
But how to I educate our wayward smoking father? Don't I have an obligation (to his family) to correct his beliefs? How do I educate him?
Trolling the Internet this evening, I have found some educational materials .. but nothing yet that fits the bill. The resource must be:
- Easy to read. 4th or 5th grade level
- Evidence based. We need facts .. not conclusions. "second-hand smoke causes asthma" won't work. We need a document that will say something like:
- 100 families with smokers in them will have 20 kids with asthma
- 100 nonsmoking families will have 10 kids with asthma.
Alas .. I can't find this (yet) .. but I have found some interesting data:
... the range of new cases of asthma annually attributable to ETS (Environmental Tobacco Smoke) exposure is 13,000 to 60,000. This report concludes that, in addition to inducing new cases of asthma, ETS exposure increases the number and severity of episodes among this country's 2 million to 5 million asthmatic children. This chapter considers exposure to parental smoking to be a major aggravating factor to approximately 10%, or 200,000, asthmatic children. Estimates of the number of asthmatics whose condition is aggravated to some degree by ETS exposure are very approximate but could run well over 1 million.
Parental smoking and respiratory tract infections in children.
Prevalence of bronchial asthma and association with environmental tobacco smoke exposure in adolescent school children in Chandigarh, north India.