Smoke Signals

    Lisa and her husband are both career smokers, each exceeding a pack a day for more than 15 years. One of their daughters has asthma; Lisa’s youngest son, age 7, is battling a soft-tissue tumor called rhabdomyosarcoma. Until a few months back, Lisa didn’t think twice about lighting up in front of her children—at home, in the car, anywhere the need struck. She didn’t realize the dangers of secondhand smoke to her children, especially her son in treatment.

    Smoke screen

    When she saw parents of St. Jude patients smoking in front of their children, Vida Tyc, PhD, of Behavioral Medicine was distressed. Tyc learned that 48 percent of newly diagnosed St. Jude patients live in homes with at least one smoker, a statistic consistent with the national average. She began designing a study to reduce these patients’ exposure to secondhand smoke.

    “No one had thought to conduct a study like this,” Tyc says. “The assumption was that parents who had children with cancer wouldn’t smoke in front of them, or would understand the heightened dangers of exposure to environmental tobacco smoke (ETS), or secondhand smoke.”

    Many studies have been conducted with families of asthmatic children, but this is the nation’s first protocol to focus on parents of cancer patients. Children with cancer are already at risk for developing second cancers because of treatment-induced and genetic predispositions. Continuous exposure to high levels of secondhand smoke may increase their health risks even more.

    Tyc’s five-year study compares two groups for 12 months. The first group receives the information and advice usually given to parents about secondhand smoke. The other group takes part in a new program of education and intervention. The study is open to both smoking and non-smoking parents, as long as at least one adult in the household smokes in the patient’s presence.

    “We want to see if the smoking patterns of parents change throughout their child’s treatment,” Tyc says. To do this, she and her colleagues created questionnaires, counseling sessions and education programs addressing such topics as tobacco knowledge, behavioral changes, social support, perceived risk, relaxation and stress management.

    Cold turkey

    “This is not a smoking cessation study,” emphasizes Diane Brand, RN, of Behavioral Medicine. “It is a study to modify parents’ smoking behaviors in the presence of the child and reduce exposure in the child’s environment. We hope that by addressing exposure issues, we will indirectly affect the parents’ behaviors and perhaps promote some attempts at quitting, but that is not the main goal.”

    Most participants say it is too stressful to concentrate on quitting while dealing with children undergoing cancer treatment. But some parents have done just that.

    “We had a single mother who was very motivated,” says Brand. “Initially, she was reluctant to participate in the study. But once she started filling out the questionnaires and realized how much she was actually smoking in front of her child, she decided to quit altogether. She met her goal two months ahead of schedule. She is one of our success stories.”

    Setting goals

    Researchers are using parental reports to determine the effectiveness of a behavioral intervention as compared with no intervention.

    “Over the months, we develop a rapport with parents and are there to help them set goals—like smoking fewer cigarettes a week, not smoking in the car in the presence of the child or learning how to be firm with relatives about not smoking in front of the child,” says Brand. “So far, we have found that the parents are fairly honest and accurate in their reporting and are increasingly so as they learn more and the trust builds.”

    The accuracy of their reporting is checked against a biological marker. If the parent and child agree, the child’s urine is tested for cotinine, a breakdown product of nicotine. Just being in a room with a smoker will increase the level of cotinine in a person’s urine.

    Another goal of the study is to examine whether a change in tobacco exposure affects short-term health outcomes for the patient.

    “With this intervention to lower ETS exposure, what we are truly addressing are the health benefits for the child who has  cancer,” says Tyc.

    Fresh air

    Before Lisa agreed to participate in the study, she knew that smoking was bad for her children, but she didn’t know how bad it was. Since participating, neither she nor her husband smoke in the house, in the car or in front of the children. Relatives and friends are asked to step outside to smoke.

    “We are learning to do things like suck on candy or get involved in an activity if the kids are around and the need to smoke is there,” says Lisa.

    “The hardest part is knowing you can’t have a smoke when the kids are there. The best part is knowing that not smoking is making them a lot healthier. These are my kids; I should have done this a long time ago.”

    Reprinted from spring 2005 Promise magazine


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