In response to my previous post about preterms smoking I was directed to a recent publication about the issue, Notley C, et al. Development of a Smoke-Free Home Intervention for Families of Babies Admitted to Neonatal Intensive Care. Int J Environ Res Public Health. 2022;19(6). Although the title of this post refers to preterm babies, because I linked my previous concerns to the potential deterioration of lung health in former preterm born adults, the publication deals with all babies in the NICU. As the authors of this study note, maternal smoking during pregnancy increases the chances that their infants will be admitted to the NICU. And even though smoking has become much less frequent over the last couple of decades, there are still between 10 and 18% of adults who smoke in Quebec depending on age group (2020 data from Stats Canada). Probably, therefore, around 20% or more of NICU parents smoke here, and improving the respiratory health of all our NICU graduates will be very dependent on protecting them from environmental smoke.
The smoke-free intervention that was evaluated was as evidence-based as possible, following a systematic review (Brown TJ, et al. Systematic Review of Behaviour Change Techniques within Interventions to Reduce Environmental Tobacco Smoke Exposure for Children. 2020;17(21):7731). Most stopping smoking interventions are disappointing in terms of efficacy, so any intervention should be as evidence-based as possible, to select those features for an intervention which might work. Nicotine is incredibly addictive, with most smokers having great difficulties in quitting. Brief advice, group support or individual “buddy” support, nicotine replacement therapy and a couple of medications have been shown to have some effect. Increasing cigarette prices is one of the most effective, but not something we can have much impact on! Interestingly, it seems that brief advice (less than 30 seconds) is at almost as effective as longer lectures… Probably a more widespread lesson there.
At a minimum, we should ensure that all parents taking home a baby from the NICU have been questioned about their smoking status, have brief advice to inform them that it is a risk factor for themselves and for their baby, and are given access to smoking cessation resources. In the paper which I reference at the beginning of this post, they held interviews and focus groups with parents and health professionals; “Findings demonstrated that both parents and healthcare professionals supported the need for intervention. They felt it should be positioned around the promotion of smoke-free homes, but to achieve that end goal might incorporate direct cessation support during the NICU stay, support to stay smoke free (relapse prevention), and support and guidance for discussing smoking with family and household visitors.” In general, parents will likely be open to being questioned about smoking, and will appreciate a more global approach to the health of their family after discharge.
Perhaps smoking cessation advice and interventions in the NICU would help some parents, this would improve the long term outcomes of children (and their lungs)