Addressing passive smoking in children.

BACKGROUND: A significant number of parents are unaware or unconvinced of the health consequences of passive smoking (PS) in children. Physicians could increase parental awareness by giving personal advice. AIM: To evaluate the current practices of three Dutch health professions (paediatricians, youth health care physicians, and family physicians) regarding parental counselling for passive smoking (PS) in children. METHODS: All physicians (n = 720) representing the three health professions in Limburg, The Netherlands, received an invitation to complete a self-administered electronic questionnaire including questions on their: sex, work experience, personal smoking habits, counselling practices and education regarding PS in children. RESULTS: The response rate was 34%. One tenth (11%) of the responding physicians always addressed PS in children, 32% often, 54% occasionally and 4% reported to never attend to it. The three health professions appeared comparable regarding their frequency of parental counselling for PS in children. Addressing PS was more likely when children had respiratory problems. Lack of time was the most frequently mentioned barrier, being very and somewhat applicable for respectively 14% and 43% of the physicians. One fourth of the responders had received postgraduate education about PS. Additionally, 49% of the responders who did not have any education about PS were interested in receiving it. CONCLUSIONS: Physicians working in the paediatric field in Limburg, The Netherlands, could more frequently address PS in children with parents. Lack of time appeared to be the most mentioned barrier and physicians were more likely to counsel parents for PS in children with respiratory complaints/diseases. Finally, a need for more education on parental counselling for PS was expressed

Facilitators.

<p>F1) A patient that you know for a longer time. F2) A patient that you see with a higher frequency of visits. F3) A child with known increased risk of respiratory diseases. F4) A child that presents for consultation with asthmatic complaints. F5) A family with a history of sudden infant death syndrome. F6) A child that presents for consultation with otitis media with effusion. F7) The smell of tobacco around the child and/or parents. F8) Parents with visible presence of smoking accessories. (P  =  paediatricians; YHCPs  =  youth health care physicians; FPs  =  family physicians; Tot  =  total). *Significant group differences for F1 (F(2,230) = 6.812 <i>p</i> = 0.001), F2 (F(2,230) = 9.673 <i>p</i><0.001), F5 (F(2,230) = 7.978 <i>p</i><0.001) and F6 (F(2,230) = 11.050 <i>p</i><0.001).</p

Frequency of addressing passive smoke exposure in children.

<p>The percentages of all the physicians (P  =  Paediatricians; YHCPs  =  youth health care physicians; FPs  =  family physicians) per frequency category are noted in the last columns. There were no significant differences between the three health professions (F(2,1) = 1.59, p = 0.206).</p

Number of reported facilitators and their association with addressing passive smoke (PS) exposure.

#<p>Numbers do not add up to 245 due to the exclusion of 11 physicians who never address PS exposure in children. OR  =  Odds Ratios; 95% CI  =  95% confidence interval; *<i>p</i><0.05.</p

Characteristics.

<p>Missing values: N = 4 did not provide their specialty. Other missing values are presented as unknown in the table. PS  =  passive smoke.</p><p>* = p<0.05.</p

Number of reported barriers and their association with addressing passive smoke (PS) exposure.

#<p>Numbers do not add up to 245 due to the exclusion of 27 physicians who always address PS exposure in children, and 7 physicians who did not complete the survey. OR  =  Odds Ratios; 95% CI  =  95% confidence interval.</p

Barriers.

<p>B1) By talking about this topic I am invading the parents' privacy. B2) I expect that talking about this topic will damage the doctor-patient relationship. B3) I have none/little time to bring up this topic during consultation. B4) I do not find this topic important enough to discuss during consultation. B5) It has no effect to address this topic during consultation as there will be no change for the child anyways. B6) I do not see it as my responsibility to talk about this topic during consultation. B7) I do not have enough knowledge about this topic to bring it up during consultation. B8) I do not have enough communications skills to address this topic during consultation. (P  =  paediatricians; YHCPs  =  youth health care physicians; FPs  =  family physicians; Tot  =  total). *Significant group differences for B3 (F(2,207) = 8.551 <i>p</i><0.001).</p

Relationship between each facilitator and providing advice.

<p>OR  =  odds ratio; 95% CI  =  95% confidence interval; * p<0.05; Adjusted for: sex, specialism, education on PS counselling, current smoking; “-” logistic regression analysis not possible due to small sample size.</p