Smoke-Free Society
PTs Play Leading Role in Wellness Education
By Jennifer Bresnick, PT, DPT
Monday May 11, 2009
According to the CDC, about one-third of women and half of men in the U.S. smoked cigarettes in 1964. By 2005, those statistics had significantly improved, indicating that only about 24% of men and 18% of women reported being smokers.This decrease in the number of American smokers was accomplished in large part through multifaceted programs educating the public about the dangers of smoking and the effects of environmental tobacco smoke (secondhand smoke). Key features centered on the fact that children are particularly vulnerable to the effects of secondhand smoke.The 2004 Surgeon General’s Report: The Health Consequences of Smoking declared that there is no safe level of secondhand smoke exposure for children, and that even brief exposure can be harmful. According to the report, more than 250 toxic chemicals known to be present in secondhand smoke can lead to SIDS, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children.Smoke and Mirrors
As healthcare providers, pediatric PTs and PTAs are in a unique position to counsel parents on the dangers of secondhand smoke.“PTs have an ethical obligation to discuss health risks that we are aware of within our scope of practice with patients and with those responsible for the care of our patients, for their good as well as the good of society,” says Nancy R. Kirsch, PT, DPT, PhD, professor of the DPT program at the University of Medicine and Dentistry of New Jersey in Newark, owner of Northern Hills Physical Therapy in Flanders, N.J., and a member of APTA’s Ethics and Judicial Committee.Paul T. de Regt, MS, PT, a pediatric outpatient and school therapist for the Ahlbin Rehabilitation Centers in Bridgeport, Conn., says, “This is an issue that deserves greater attention. In an environment where our children are showing increasing rates of obesity and earlier onset of chronic conditions … it is incumbent on PTs and PTAs to recognize that secondhand smoke is an additional risk factor. [Therapists] should be able to discuss the issue briefly and be able to provide follow-up information to patients and families.”Gretchen May-Fendo, MDiv, RRT, AE-C, outpatient pulmonary coordinator at Bridgeport Hospital in Bridgeport, Conn., sees many pediatric patients with asthma who are “‘frequent fliers,’ seeking medical treatment for recurrent asthma episodes.” Secondhand smoke can be an exacerbating factor, she says.But many parents are surprisingly unaware of the harm they may be doing to their children by smoking. According to a recent American Journal of Preventative Medicine study, 41% of tobacco-smoking parents of hospitalized children did not believe their smoking had a negative effect on the child’s health.Blowing Smoke
“As an outpatient and school PT, if I smell cigarette smoke on a child’s clothes, I will mention it. However, the subject of secondhand smoke has rarely arisen unless the child is being seen for a respiratory condition,” de Regt says.Many clinicians find starting the conversation about smoking cessation with a parent to be difficult. May-Fendo has provided smoking cessation counseling to many patients and says increased comfort with the subject “comes with the clinician’s ownership of the problem and knowing that patients and parents are not only open to smoking cessation counseling, but that most want to quit.”She uses a technique developed by a panel of smoking cessation experts that is based on the scientific literature called the 5A’s, which stands for ask, advise, assess, assist, and arrange. May-Fendo explains, “‘Ask’ refers to the most important step, which is screening. Many times clinicians are simply not discussing this issue with their patients. Clinicians should ‘advise’ all patients who smoke to quit. The next step is to ‘assess’ whether the individual wants to quit or not. If the answer is yes, ‘assist’ the patient in setting up a plan to quit. And finally, ‘arrange’ for follow-up contact.”“When setting up a plan to quit, the most important step is to set a quit date,” she says. “The clinician should then help patients get the tools they need, such as counseling, printed materials, and medications.” According to an APTA House of Delegates position statement, “Physical therapists are uniquely qualified to assume leadership positions in efforts to prevent injury and disability, and [the APTA] fully supports the positive roles that physical therapists and physical therapist assistants play in the promotion of healthy lifestyles, wellness, and injury prevention.”Kirsch adds, “Smoking cessation is certainly part of wellness and consistent with our understanding of physiology and cardiopulmonary functioning. We should accept the responsibility to address smoking cessation as long as we have the skills to do so effectively.”Resources
American Lung Association: www.lungusa.org
Helping Smokers Quit, A Guide for Clinicians: www.ahrq.gov/clinic/tobacco/clinhlpsmksqt.htm
PHS Clinical Practice Guideline: Five Major Steps to Intervention (The “5A’s”): www.ahrq.gov/clinic/tobacco/5steps.htm
Jennifer W. Bresnick, PT, DPT, is a medical writer for the Gannett Healthcare Group. To comment, e-mail pteditor@gannetthg.com.
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