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Counselling and cigarette smoking in pregnancy
- Satyajit Nag (3 September 2000)
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who thanks you for smoking?
- Paul Fenton (29 September 2000)
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Misleading abstract
- Christopher Martin (20 November 2000)
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Satyajit Nag, Specialist Registrar Royal Victoria Infirmary,Queen Victoria Road,Newcastle upon Tyne NE1 4LP
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Sir, The study by Hovell and others demonstrates the effectiveness of maternal counselling in reducing children's exposure to tobacco smoke(1). Such structured counselling should be offered in particular to an often neglected but suseptible group of women-pregnant mothers. The dose-response relationship between cigarette smoking and increased fetal morbidity and mortality is well established.Smoking in pregnancy is associated with spontaneous abortions,prematurity,low birth weight,placental abruption,fetal death and the Sudden Infant Death Syndrome. Epidemiological studies have also linked smoking during pregnancy with congenital malformations like cleft lip/palate(2). Women smokers, who are planning a pregnancy should be counselled and urged to give up smoking in much the same way, as women with diabetes are adviced to improve their glycaemic control pre-conceptually to improve fetal outcome.Pregnant women may be most receptive to advice regarding smoking during the first trimester(3). Perhaps, more graphic public information campaigns are required to educate women on the deleterious effects of tobacco smoke on the unborn child. References: 1.Hovell MF,Zakarian JM,Matt GE,Hofstetter CR,Bernert JT,Pirkle J.Effect of counselling mothers on their children's exposure to environmental tobacco smoke:randomised controlled trial.BMJ 2000;321:337- 42 2.Chung KC,Kowalski CP,Kim HM,Buchman SR.Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip/palate.Plastic and Reconstructive Surgery 2000;105(2):485-91 3.Hutchison KE,Stevens VM,Collins FL Jr.Cigarette smoking and the intention to quit among pregnant smokers.Journal of Behavioral Medicine 1996;19(3):307-16 Competing interests:none |
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Paul Fenton, professor of anaesthesia college of medicine malawi
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WHO THANKS YOU FOR SMOKING? We are constantly fed a diet of lies from politicians, scientists and others in the public domain. Even doctors writing in medical journals. Smoking and tobacco has more than its fair share of misinformation and poor, tobacco exporting countries like Malawi are suffering on this account. The anti-smoking lobby is determined to destroy the export that accounts for over three quarters of the revenue of this country. Yet there is silence from here, as No-Tobacco Doomsday approaches! Don't let me dwell on the iniquitous trading practices (called "auctions") that pay such low prices to the grower for the product, nor the absurdity of importing cigarettes into this country, nor the current belief (espoused in the BMJ, the film "The Insider" and by the World Health Organisation) that the tobacco giants actually put chemicals into cigarettes to make the nicotine more addictive. The truth about this will emerge one day. I am pretty neutral about smoking - used to do it but now find the smell offensive. But I don't see why other people should be prevented from smoking. We have had "passive smoking". That was clearly a trumped up disease - a lie put about by the anti-smokers. Now we know there has been no such thing for 15 years! Both health and economic reasons are given to stop us smoking but the fact is the members of the anti-smoking lobby do not care about my health. No. They just want to have power over other people. They all aspire to be Matrons of a well-nannied Super Nursing Home to which we are all to be forcibly admitted, leaving our Stetsons, guns and packets of Marlboro at the door. Smokers die younger, of course. So they should. They indulge in an unhealthy and distasteful habit. That's why I gave it up. But let anyone chose a hobby that kills him, why not? If the children smoke because the parents smoke, the same argument applies. What about the much vaunted economic arguments against smoking? Notwithstanding their halitosis, smokers should be commended for their heroic sacrifices to supporting the economies of all the countries of the world. They literally lay down their lives that we non-smokers can benefit. They pay vast taxes in Europe, as we all know. I bought a brick of 200 in the plane (a present for my mother) recently for US$7, slightly more than the price of 20 cigarettes in England. Without these taxes, all Development Aid and Balance of Payments support to Malawi would vanish at a stroke. They need heart and lung operations more than other people, which cost money, but these costs are offset by the fact that they work all their lives (often with a nervous energy that the indolent non-smoker cannot match) reach retirement age and then conveniently drop dead before collecting their pensions. There's more. In Europe non-smokers now live so long that their accumulated wealth which would, in former times, be passed on to their children, eager to channel these funds into business and enterprise (or just spend it lavishly) is instead being passed on to offspring who have themselves retired! The money moves from one static, tea drinkers bank account to another, or stays in safe shares and is not spent. Matron is happy but the economy stagnates. Enterprise, invention, business venture - all hallmarks of economic vitality - wither and die. Nice, healthy, non-taxable, non-driving, non-spending people will be seen walking everywhere, not on the wild side. Their sensible opinions will be right all the time so the rest of us will die of boredom. This lifestyle has been noted already in Japan. Even the UN has spotted this and made a report last March. It proposed a solution for Western Europe that Matron may not have anticipated: more immigration. The report recommended bringing in younger people from Eastern Europe, Asia and elsewhere. Immigration from Eastern Europe? Now, lets be reasonable. Sure, no one in their right mind pays much attention to a UN report but some politician or civil servant might read it. You can't be too careful about these things. It was 10 years ago that the Albanian King Zog was seen on TV and in the papers, gun-totting around a lawless country largely inhabited by bandits firing into the air or into each other. Matron remembers him. She thinks it's still the same there and she is right: it has not changed. Here is the chance for Malawi, is it not? Offer Europe King Zog and his Albanian gangs or nice quiet cigarettes and lung cancer? Let them take their pick. Paul Fenton |
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Christopher Martin, GP principal Laindon, Essex
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Sir, This article was selected by our journal club for discussion as appeared to have important results for all primary care team members. On closer scrutiny we were dissappointed with the interpretation of results reported in the abstract. It states that 'Counselling was effective in reducing children's exposure to environmental tobacco smoke.' However, the results suggest that the intervention (counselling women about smoking and smoke exposure of children) had no effect on reducing children's exposure to smoke. What it seemd to show, was that the control intervention (nutritional counselling and brief advice to quit smoking) increased children's exposure to smoke. Either interpretation is possible, but where the objective outcome measures in one group remain unchanged, the simplest explanation is that was no effect. If the other group showed an increase in its objective outcome measure, the simplest interpretation is that there was an effect. Most people will be familiar with the interelationship between diet and smoking, and so there are possible plausible explanations for this finding. The other useful finding of this study was the unreliability of self reported changes in smoking habits. Both intervention and control groups reported marked reductions in smoking and exposure of the children to smoke, yet objective measures demonstrated that there was no significant reduction in maternal smoking or childrens exposure to smoke in either group. The lesson we need to learn from this is that: any study on smoking cessation which relies on self reported changes in smoking behaviour as the outcome measure, needs to be read with caution. Yours sincerely, Chris Martin
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