Georgia pediatric pulmonologist and certified tobacco treatment specialist Varada Divgi, MD, is on a mission. Working in the nation’s largest pediatric pulmonary practice, she is on an active crusade for tobacco prevention. She has been campaigning against secondhand smoke since 1982 to make parents understand the impact they have on their children, especially when it relates to cigarette smoking.
“As pediatric specialists, we are unable to treat the parents, but we are trying to make them more aware of tobacco hazards,” she said. “If we go to parents as child advocates, showing them the effects secondhand smoke has on their kids, they are more open to hearing what we say than they would be if we merely told them to talk to their primary care physicians. We are not doing enough to educate the parents on protecting their children on their own.”
She added, “Nicotine addiction is a pediatric disease because 90% of the smokers start smoking when they are younger than 18 years old. At the earliest, COPD is diagnosed when they are around 40 years old. For each patient diagnosed with COPD, one to two patients are undiagnosed with early symptoms. There is a significant interval for the cumulative effect of smoking that can be intervened upon in order to prevent COPD. I try to make parents understand what they are doing to their children and that COPD is a result of smoking. My goal is to prevent COPD.”
Dr. Divgi sees tobacco-related issues as an iceberg, the tip of which is secondhand smoke, lung cancer, and COPD. She explains that we are all aboard the Titanic that is headed toward this iceberg. There are more issues to address that are just under the surface, such as coordinated health-care efforts; preventive roles of pediatric, primary care, and ob-gyn task forces; policies to make it difficult for young children to initiate tobacco use; and raising the general awareness about smokeless tobacco and non-cigarette tobacco products by health-care providers, as well as a lack of funds.
In fact, Dr. Divgi aims to make the entire state of Georgia smoke free, which is quite a challenge because Georgia is a tobacco-growing state. However, she notes that the neighboring state of North Carolina has managed to make all hospitals tobacco-free, so Georgia can follow suit.
As one step toward her smoke-free goal, Dr. Divgi is very involved in the Asthma Center of Excellence for child health care. She uses the ACCP Tobacco Dependence Treatment Toolkit as a model, talking to colleagues and explaining what else can be done. Smoke-free homes and cars are the primary goal as she identifies and tracks adolescent smokers and children of smokers in her practice. She advises and helps their parents with smoking cessation.
Dr. Divgi said she is aware of the stages involved regarding behavior changes. “If I can move someone from precontemplation to contemplation, getting them away from thinking they are not able to effect change but thinking they can effect change, I consider it a step toward success. This is true of providers as well as patients.”
In her practice, she documents the effects of secondhand smoke in patient electronic health records, including, as she describes, “the stage each individual is at and where the parents are when I speak to [that patient].” She also notes that the main difference between tobacco use and any other addiction is there is no immediate penalty for smoking, such as receiving a ticket or a driving under the influence citation, and there are no immediate aftereffects as when a person takes hard drugs. Instead, tobacco has a cumulative effect.
“You won’t see the effects right away,” she added. “As health-care providers, we need to understand this fact and show the rewards of being smoke free. There is a different way of talking about the topic. When talking to parents, it is beet to tell them to stress the rewards of being tobacco-free to their children, rather than telling the children how smoking is bad for them.”
Dr. Divgi feels strongly that the information in the ACCP Tobacco Dependence Treatment Toolkit should be followed by everyone. She says, “The US public health guidelines tell us what we need to be doing, but this tool kit tells us how we can do it, no matter what we are doing.” However, Dr. Divgi feels that the tobacco-related disparity and smokeless tobacco and non-cigarette tobacco products have been addressed well.
Taking the step to becoming smoke free is an individual choice that requires tremendous support from others. Access the ACCP Tobacco Dependence Treatment ToolKit and take the first step to help your patients become smoke free.