Pediatricians can move attitudes, and practices, about smoking

Pediatricians should get more active in pressing for smoke-free facilities and activities in their communities. That is the take-home message from Robert McMillen, MD, of the Social Science Research Center at Mississippi State University, who spoke yesterday at the Pediatric Academic Societies Annual Meeting in San Francisco.

"Pediatricians can and should serve as advocates," McMillen said. "When it comes to children's health, that is who parents and community leaders listen to. Expanding smoke-free environments is much easier when it is science and health talking, and not lobbyists."

Dr. McMillen presented the results of an annual cross-sectional telephone survey of households between 2000 and 2005. What he found is that, although nearly all adults recognize the dangers of second-hand smoke from parental smoking, public policy and private practice lag behind.

Over the five-year survey period, support for a smoking ban in shopping malls increased from 71% to 80%. Support for a smoking ban in fast-food eateries grew from 77% to 82% and, in restaurants, from 61% to 71%. Smoking should be banned in outdoor parks, according to 39% of respondents in 2005, up from 25% in 2000, and 82% now believe that smoking should be banned at indoor sporting events, up from 78% in 2000.

Actual practice varies widely. In 2000, 75% of US communities banned smoking in shopping malls; in 2005, 83% of communities banned the practice, leading public opinion. At the other end of the scale, only 8% of communities banned smoking in public parks in 2000, and 15% in 2005.

Restaurant smoking bans also lag behind public opinion, Dr. McMillen noted. In the fast-food category, 2000 saw a smoking ban in 52% of eateries, rising to 72% in 2005. Among restaurants, 25% banned smoking in 2000 and 45% in 2005.

One of the biggest disparities is in what people practice in private. Although 92% of adults recognize the dangers of second-hand smoke to children, only 89.6% of parents in 2005 made it a policy to not smoke when children are present. That is an increase from 78.6% in 2000. Only 76.7% of 2005 households were smoke-free, up from 69.1% in 2000.

"There is a clear difference between public opinion and public and private practice on the issue of second-hand smoke," Dr. McMillen said. "There is still a substantial population of homes and cars that are settings for second-hand smoke exposure, as well as public areas. Pediatricians can be the thought and action leaders to bring practice in line with public opinion."