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
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 smoke will be added to the upcoming
4th Edition of the Beginnings Parents Guide.
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
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)