Tobacco Cessation Program: Up in Smoke

Carmen Camacho-Mojica had never heard of thirdhand smoke. She thought as long as she smoked exclusively outside, never around her 14-year-old medically fragile son Juan, her smoking wouldn’t negatively impact his health.

Through an innovative smoking cessation program at Children’s Hospital of Philadelphia (CHOP), she learned that thirdhand smoke — the particles of nicotine, metals, carcinogens and 60-some other chemicals that are in cigarette smoke and cling to her hands, hair and clothing — get transferred to Juan when she cares for him. That knowledge, plus the counseling and nicotine replacement therapy provided by CHOP, gave Camacho-Mojica the push she needed.

“I was shocked when I learned that,” she says. “That made me determined to quit because I know now that my smoking was affecting Juan.”

Types of smoke that can impact kids

1. Firsthand smoke: Inhaling directly from a cigarette, e-cigarette, cigar or pipe
2. Secondhand smoke: Breathing in exhaled smoke and smoke that comes off the burning end of a cigarette or cigar
3. Thirdhand smoke: Ingesting trace particles of nicotine and other chemicals from smoke that have settled on skin, hair, clothing, carpets, furniture and other surfaces

Assessing the risk

When Juan, who has a rare genetic disorder, was hospitalized, Camacho-Mojica answered “yes” to a question asked of all families with a child admitted to CHOP: Does anyone in your household smoke?

Why that question? As respiratory therapist and researcher Natalie Napolitano, MPH, RRTNPS, CCTS, explains, children’s health suffers if they are exposed to tobacco smoke. The Centers for Disease Control and Prevention cites more frequent and severe asthma attacks, respiratory and ear infections, and sudden infant death syndrome. Knowing the risk exists is the first step to reducing it.

“Once we find out there’s a smoker in the home, we have to do what we can to help,” says Napolitano, who led the Respiratory Therapy Department’s creation of a smoking cessation program targeted to parents, guardians and patients.

Smokers are asked if they want to quit, or at least abstain while their child is in the Hospital. If they do, they receive counseling from a core group of respiratory therapists also trained as certified tobacco treatment specialists. The program, supported by a grant from CVS, offers free nicotine replacement therapy (a patch, lozenges or gum) to help reduce withdrawal symptoms and cravings. The child’s inpatient stay needs to last at least a week so the therapist can follow up with the parent. Those with shorter Hospital stays receive referrals to outpatient cessation programs close to home.

The one-on-one counseling and education piece is important because the physical and psychological addiction to nicotine is tough to overcome. “I had been trying to quit for a year, but it’s really hard,” Camacho-Mojica says. “When something big would happen, I’d get upset and reach for a cigarette. With CHOP’s help, I’m sticking to it this time.”

After discharge, smokers receive a follow-up call from a CHOP respiratory therapist and are connected to local smoking cessation programs to help them stay tobacco free.

Many parents share Camacho-Mojica’s misperception that smoking when children aren’t present doesn’t harm their child.

“Thirdhand smoke is a real thing,” Napolitano explains. “Urine tests of infants show elevated levels of nicotine even when the parent only smokes outside. All those particles land on surfaces like the smoker’s clothes and the carpet, drapes and tables. If a baby lays her head on the smoker’s shoulder or crawls on the floor, she’s going to ingest those particles.”

Help for primary care families

In Philadelphia, 40 to 50 percent of children have confirmed rates of secondhand smoke exposure, prompted a smoking cessation program now active in three primary care practices in the CHOP Care Network.

Pediatrician Brian Jenssen, MD, led a research study that added a question about household smokers to the questions asked at all appointments. Smokers identified by the screen are then counseled on smoking, given a prescription for nicotine replacement therapy and referred to 1-800-QUIT-NOW. More than 500 parents so far have received treatment.

“We frame quitting as one of the best ways to improve their and their child's health,” says Jenssen. “Quitting also extends the parents’ life expectancy, puts more dollars back in the family budget and can end the family’s cycle of tobacco dependence.”