The Means Report

New study looks at the role kids play in parents breaking their smoking habit

Augusta, Ga. (WJBF) - Today's edition of The Means Report is going to be especially helpful for parents and for children who want to lead healthier lives. A ground breaking new study has come out over the past few months from our very own Medical College of Georgia about smoking and how to quit and how to make sure kids never start. All about breaking that cycle of tobacco and nicotine addiction, getting rid of second-hand smoke, also what about vaping? We will talk about the health implications of that smoking method.


Brad Means: This smoking study was conducted by a couple of doctors from MCG, the Department of Pediatrics, in particular and I am so grateful that they are here with us today. Dr. Martha Tingen is a Professor of Population Health Sciences and MCG and Dr. Alice Caldwell is an Associate Professor of Pediatrics also at the Medical College of Georgia. Doctors, thank you for being here today.


Dr. Martha Tingen: Thank you.


Brad Means: I really appreciate it. Great study by the the way.


Dr. Alice Little Caldwell: Thank you very much.


Brad Means: I'll start with you, Dr. Caldwell. Why did you do the study? Was it to try to get mom and dad to quit smoking or was it to try to make sure the kids never start? Why'd you do it?


Dr. Alice Little Caldwell: Well, I think the main thing is try to get the parents to stop smoking and of course, along the way, we want children to understand that it's very dangerous to their health and they could be allies in this battle to help their parents quit. You know, they could be supportive of their parents attempts to quit.


Brad Means: Alright so let's talk about the grown-ups in the study first. You took about 400 of 'em, parents of 4th graders?


Dr. Martha Tingen: Parents of 4th graders--


Brad Means: Why that, go ahead, why that group and how'd you come about that study group?


Dr. Martha Tingen: Yeah so what we did is we included children and parents and to be in the study, both the parent and the child needed to agree that they wanted to do this. We had seven rural schools across our regional CSRA, but only in Georgia and we had seven inter-city or urban schools that were all from Richmond County and we had a class at each of those schools if not more than one class. And all of those schools were randomly assigned by school. And this is a really important part of the study because it gives great validity to the study. So the group that was randomized to what we called a typical health intervention study, those kids got the traditional health education program in the school as mandated by the Department of Education. And the parents that were smokers in the study, got handouts about the importance of quitting and they also got put in touch with a toll free quit line for the state of Georgia, which we have that has fantastic trainers on the phone that you can talk with. That was all one group. The other group which was really, we call our intervention, where we really wanted to see could we really get parents to quit smoking at the same time their child is in a classroom and receives a tobacco prevention message. Could a child be a health messenger, a change agent to encourage their parent to quit and at the same time, in their mind be thinkin' about I never wanna take up this habit?


Brad Means: Alright, so were these people who wanted to quit smoking or who just said, yes I'll take part in your study, we'll see what happens?


Dr. Martha Tingen: These were people who wanted to be in the study and they knew it was about quitting smoking for the parents and they knew it was about preventing the onset of smoking with children. And I have to tell ya about the intervention component 'cause it's really critical to the study. So the kids received the traditional required, educational requirements by the State Department of Education on healthy behaviors. But they also received a fantastic program that occurred weekly over a total of 12 weeks, related to tobacco and drug use prevention.


Brad Means: Why did you, Dr. Caldwell, choose children and parents from rural and urban settings? You wanted to make sure that was a part of this. It's the first time it's ever been done, why? Why did that matter to you?


Dr. Alice Little Caldwell: Well, we were just trying to be inclusive. You know, try to, there may be different effects of living in a community and a rural community where there may not be as much education available versus in the city where there may be more mass media that they're exposed to.


Brad Means: I wanted to follow-up on somethin' Dr. Tingen mentioned about children being change agents. Were you able to see pretty quickly in the study that these kids could have an impact on whether mom and dad stopped smoking?


Dr. Alice Little Caldwell: Well, I would say so, yeah because when children learn about something that impacts their parents they're willing to go and talk to them about that and they may be upset when they see their parents continuing to smoke and they say something about it.


Brad Means: What kind of weekly intervention are we talking about? Would you see mom and dad face to face or would it be over the telephone?


Dr. Martha Tingen: Yeah, so what we did for the parents intervention components, so we trained either the school nurse or the health education teacher in each of these schools on the curriculum for the kids. And then we made visits to monitor fidelity to be sure the program for the children was being implemented appropriately. For the parents, the parents were offered what's called evidence based cessation treatment, that is recognized nation wide, which includes two components. It includes behavioral skills counseling where you can either meet in a group or one on one or by telephone to help you develop behaviors that will combat the psychological addiction of nicotine. It also included as a second component that's evidence based a form of co-therapy or medication, which was nicotine replacement therapy and that's a patch.


Brad Means: A patch?


Dr. Martha Tingen: Uh huh, and that is available over-the-counter if you are 18 years of age or older and I am a nurse practitioner and nurse and Dr. Caldwell, of course is a physician, and you do not have to have that prescribed by a provider. You can buy it if you're 18 years of age, over-the-counter. There are some things for reasons that you should not take that medication, but we of course, screened those people carefully for that.


Brad Means: Alright so you had this group that you're focusing on as far as intervention. You have another control group, did you do nothing with them or did you send 'em a pamphlet every now and then?


Dr. Martha Tingen: They got mail-outs, the parents got mail-outs about quitting smoking, the importance for their own health, the importance for their child, and they also received information about the toll free quit line for the state of Georgia.


Brad Means: Alright so this study covered 400 plus people over four years.


Dr. Martha Tingen: Correct.


Brad Means: How quickly or how long did it take before you started to see results, where you started to see people buy-in and say, you know what? It is time to quit.


Dr. Alice Little Caldwell: Will you answer it? Yeah you can.


Dr. Martha Tingen: Okay, so with the first, we did this in what we call cohorts or another fancy word for groups. So we did seven schools first, half of those or three of those were intervention three control and then we did the other seven. Because you can imagine managing this many people at one time with a team, that we have a great team that helps us implement this. But what we did, we did an original analysis after the first year at about a year and a half in and we were already seeing that the intervention effects of parents quitting were much greater than the others.


Brad Means: Wow.


Dr. Martha Tingen: There's a big component of this that's really critical. So when we do research studies, there's all kinds of ways to do it and a lot of what we do is we do self-report. They fill out a survey, they tell us what they think. Their knowledge change, their attitude, their behaviors change. That's all fine and good and we want to trust and believe that what they tell us is the truth. But this study went one step further. We also on every child and every parent that was in the study, we collected their saliva sample and in that saliva we measured something called cotinine. Cotinine is the primary metabolite that nicotine that is exposed to the body or that is inhaled to the body, can be detected.


Brad Means: If you smoke you're gonna have it in your saliva.


Dr. Martha Tingen: You're gonna have it--


Brad Means: You can't run from that. You can't hide from that test.


Dr. Martha Tingen: It can be measured in your saliva, your blood, your urine, your hair shaft, even your toenail clippings. So we use saliva, it's non-invasive. It's like putting a little dental roll in the mouth.


Brad Means: Sure.


Dr. Martha Tingen: And we of course had permission for all this. And then we fought, we did saliva testing for cotinine at baseline, we did it after the first year of intervention, the second year of intervention, and then two years later.


Brad Means: Did it steadily go down?


Dr. Martha Tingen:  Yes.


Brad Means: Incredible. Talk about the role of those kids when it comes to quitting again, I wanna touch on that again. So my question to you is what made parents start to decide that it was time to quit? Because they were worried about their own health or because they were worried that they were being bad role models by smoking?


Dr. Alice Little Caldwell Yes, I think it's both. I think that they know that they'll have health consequences eventually but they also know that they're role models for children so the children see that adults smoke it so they may think that that's what adults do and also, they know that the smoking around the children is also detrimental to the children's health.


Brad Means: What can a child say to a mom and dad to maybe make the parent think, "You know what? "I probably shouldn't do this anymore." What kind of words could you give a kid who might be watching to say to mom and dad or their grandparents?


Dr. Alice Little Caldwell: Well, I would say, I just, telling them that, mom and dad you know, this is dangerous to your health, you're gonna get sick, you could die from lung cancer. You know, just that eventually you know, everyone will have some consequences of this and so, please do this for me as well as for your own health. I don't think children think of it so much is that it's dangerous for themselves, although they maybe have some sense of that but I think that they're concerned about their parents.


Brad Means: Sure, they want 'em to be around.


Dr. Alice Little Caldwell: Yeah.


Dr. Martha Tingen: And they did learn that in the tobacco prevention component for the kids in the school, they learned that when you are around a smoker, it also effects you.


Brad Means: What about the, you know, I guess if you wanted to critique this study you could say, I could quit anything if I had the team at MCG in my face every week. But what about when the study is over--


Dr. Martha Tingen: Yeah.


Brad Means: And these people are left on their own and they don't have these personal trainers, if you will, holding them accountable?


Dr. Martha Tingen: Right.


Brad Means: How well do you think they're gonna do then?


Dr. Martha Tingen: Well, one really great thing is through the cancer center and I serve as the Director of the Tobacco Control Program here, we have a phenomenal cessation clinic so right now there's actually another grant that is in place and anybody in Augusta, Richmond County right now, that wants to quit smoking, there's billboards all over town. And we are offering you to come to see a physician or a nurse practitioner, get the appropriate medication prescribed and meet with our counselor for sessions. We are working with Augusta Public Housing Authority because Housing Urban Development has mandated that by July 31st, that public housing across the entire nation have a tobacco free policy in place.


Brad Means: Who smokes more, blacks, whites, men, women or do you know?


Dr. Martha Tingen: Mostly males but women are catchin' up much more. And this is the deal, African Americans and blacks have lower smoking rates but this is the really negative thing for them. There are major racial disparities related to tobacco effects such that if I have a very dear friend of mine smoke a cigarette, the same brand, the same and I smoke the same brand and I do not smoke but I'm giving you an example of course--


Brad Means: Sure, sure, you better not smoke.


Dr. Martha Tingen: No I don't smoke, I never have smoked and I'm thankful for that but anyway, and we smoke the same cigarette, inhale the same amount, and then you tested our cotinine levels. Her's would be higher.


Brad Means: Why?


Dr. Martha Tingen: We do not, we believe it has something to do with genetics and how they metabolize nicotine in their body.


Brad Means: Interesting.


Dr. Martha Tingen: So it stays in their body longer and the effects are damaging. Can I tell ya one quick blurb--


Brad Means: Sure.


Dr. Martha Tingen: Getting back to what you asked Dr. Caldwell about children, so lots of things happen during the study and I had a parent call me one day. I was sitting in the office that was in a very small, rural school and she said, "I didn't sign up "for your study last week when I had a chance. "But my child is buggin' me so bad about "wantin' to be in that study because his classmates "were tellin' him about it and they're in it." And she said, "Is it too late, can I join it?" And I said, "Absolutely not that would be wonderful." And then I was actually sitting in a hall, takin', gettin' some information from a parent that was in the study that had a four year old in the school next door and she has a three year old that starts havin' an asthma attack and at the time I'm there, she's smokin' a Black and Mild. You know what a Black and Mild is?


Brad Means: Oh yeah, sure, people use it, get rid of the tobacco and make it into a joint.


Dr. Martha Tingen: Yeah, right but anyway, a Black and Mild has a very, very heavy dose of tar and nicotine in it. So, I almost physically get sick but I don't and her child starts havin' an asthma attack and I just look at her and say with all sympathy and sincerity, "Mrs. So and so, do you understand "that you're smoking and that smoke is bringing "on his asthma attack?" And she looks at me, sincere as she can be Mr. Means, and says, "I had no idea my smoking effected "the health of my children."


Brad Means: She didn't even know.


Dr. Martha Tingen: She had no clue.


Brad Means: When we come back on The Means Report we're gonna continue to talk about this new study from MCG on smoking and parents and children and the role that the whole family can play in kicking the habit and what in the world is going on with the growing popularity of vaping and hookahs and other things that I don't care to learn about but I guess I'm about to in the next segment. Those things are everywhere aren't they? Stay with us.


Part 2


Brad Means:  Welcome back to The Means Report. Before we talk about all of the bad things that kids are putting into their body from a tobacco and e-cigarette standpoint, let me go back to what we were talking about the first segment, when it comes to mom and dad smoking and the impact it can have on the entire household. Dr. Caldwell, what have you seen whether it's in a clinical setting, whether it's in the hospital, as far as kids getting sick because they're in a smoke environment?


Dr. Alice Little Caldwell: Well, I think that definitely in can impact their their rate of asthma attacks, increases the risk for ear infections, it also can lead to... The effects of dental decay even so a lot of these kids that come in with really poor dentition and have to have, you know, extensive dental work, a lot of times their parents have been smoking too.


Brad Means: Do you ever go out into the waiting room and say the reason why your child is sick is because you're smoking and if so what do they say?


Dr. Alice Little Caldwell: Well, you know, you have to kind of reach out to them a little gingerly because you don't want them to be very defensive about it. But one time I had more success even in the newborn nursery because a lot of times we'll ask parents if the mother smoked during her pregnancy and usually women stop, they really do make a hard attempt to stop but a lot of times, there may be a pack of cigarettes that maybe the father has left there--


Brad Means: Sure.


Dr. Alice Little Caldwell: And he goes outside to smoke even when the mother is in the hospital. And so I always ask them about that, how do they feel about that? I always tell them that they should never smoke around the baby, the should not smoke in the car but I always try to implicate them too, like I really care about their welfare.


Brad Means: That's a good approach.


Dr. Alice Little Caldwell: Yes, that I care about their health and it's not just for the baby, although I'm very concerned about the baby and I've had, you know, like fathers just say, okay I'm gonna throw these cigarettes away right now


Brad Means: Oh that's awesome.


Dr. Martha Tingen: That's good.


Dr. Alice Little Caldwell: It's pretty impressive in a newborn nursery.


Dr. Martha Tingen: Yeah.


Brad Means: Dr. Tingen, I you know half jokingly as we went to break said that there were several things that kids are doing these days that I didn't want to learn about and that really was me just sort of joking, saying that if I put my head in the sand maybe it'll go away. Of course, it won't. These e-cigs and these vapes and these hookahs are everywhere, are cigarettes even cool anymore for young kids?


Dr. Martha Tingen: Well, this is the deal with what's happened with the tobacco market. The great news is there is a decline in smoking in our area. The national rates are 15 to 16% of people smoking, that's 18 years and above. In our area of Richmond County, the rates are about 19%, in public housing the rates are as high as 40 to 60%. That's pretty dramatic.


Brad Means: It's extremely dramatic.


Dr. Martha Tingen: Yes and--


Brad Means: Cigarettes only?


Dr. Martha Tingen: Mostly cigarettes. Now what's happened with youth, and I'm gonna talk a little bit about high schoolers, so I'm talkin' about 9th, 10th, 11th, and 12th graders. They have really shifted away from tobacco but if you look across the nation and specific data for the state of Georgia, 25% of high schoolers are using some type of nicotine product and that is typically electronic cigarettes.


Brad Means: But they're safe, right?


Dr. Martha Tingen: No they are not safe So you can order ever how much nicotine dose you want to put in your electronic cigarette. That electronic cigarette also has a lot of chemicals in it that are very unhealthy to inhale. The other thing is there's now over 7 to 10,000 different flavors that come in these very small bottles that are very aromatic and very colorful that young children that are toddlers are very drawn to.


Brad Means: Are those things called Juuls, are those the Juuls you're talkin' about?


Dr. Martha Tingen: I don't know what those little things...


Brad Means: Oh those are little electronic devices.


Dr. Martha Tingen: Those are electronic, okay.


Dr. Alice Little Caldwell: Yes.


Brad Means: And I'm sure y'all are laughin' at me young people.


Dr. Alice Little Caldwell: Yeah, yeah.


Brad Means: This is serious.


Dr. Martha Tingen: But you know, the electronic cigarette comes in every color, every imagination, every formulation, you can get 'em to match whatever outfit you're wearin' that day for the guys, the girls. Everything you can imagine, they're creating. But I'm, this is a major deal. So you can order the amount of nicotine in any flavor you can even dream of and the poison control centers calls related to accessing these refills for nicotine replacement cigarettes, electronic cigarettes, has gone up by over 1100% in the last two years from young children getting into those little bottles.


Brad Means: How do they--


Dr. Martha Tingen: Because--


Brad Means: Go ahead.


Dr. Martha Tingen: One teaspoon, one teaspoon of nicotine is lethal to a small child and when I say lethal I mean deadly.


Brad Means: Please forgive me for interrupting you. How do we make young people stop doing this? Do your smoking cessation classes or resources address vaping and e-cigarettes, if so how?


Dr. Alice Little Caldwell: Yeah, well I think it's important for kids to realize that they aren't safe. That they're not a safe alternative to combustible cigarettes and that they could be, they are just as addictive and probably kids become more addicted sooner when they use electronic cigarettes because the nicotine can be more concentrated.


Brad Means: Does it give them a buzz? What's the appeal or is it just as kids have been doin' forever, it makes them feel cool, it makes them fit in?


Dr. Martha Tingen: It's a cool thing to do, it's a new device. They can get it in every shape, form they want and it's really of quote, bein' part of the group.


Brad Means: Sure.


Dr. Martha Tingen: I think it's really, really important to think about it from the standpoint of a recent study that was published by a medical student and I talked about the trends and looked at all the details of this. The students that are currently using electronic cigarettes, and we're talkin' about young people. I'm talkin' about 12, 13, 14, 15, 16, 17, and 18 year olds, when those kids are interviewed they all say they enjoy it so much. They're probably gonna take up smokin' traditional cigarettes as well.


Brad Means: They have a plan to do that?


Dr. Alice Little Caldwell: Yes.


Dr. Martha Tingen: They have a plan to do that.


Dr. Alice Little Caldwell: That's sad.


Dr. Martha Tingen: And it's often what kids intend to do, often leads to an actual behavior to do. So there's many theoretical models that have been vetted that show that to be true. So, when you think about electronic cigarettes, tobacco, any form of nicotine you can, from even in utero there are all types of things that happen with babies in utero that live out longer term even after they get to be older.


Brad Means: Let me ask you this, if we find some of these things that you're talking about, these little containers of the liquid or a Juul or a e-cig--


Dr. Martha Tingen: Right.


Brad Means: Do we confront the child? Do we throw it away? What's the approach after you bust 'em?


Dr. Alice Little Caldwell: I would definitely talk to the child about them. And tell them about the health consequences and that it's very addictive and talk about the long-term consequences of cigarette smoking. You know, not just immediately that--


Dr. Martha Tingen: Right.


Dr. Alice Little Caldwell: But, you know, over time the risks of heart disease and cancer and things like that. But yes, I would definitely confront the child and talk to them about it.


Dr. Martha Tingen: You know, all the literature shows something very clearly that parent and child relationship, communication, and bonding is critical for life.


Brad Means: Well, I agree.


Dr. Martha Tingen: And the earlier that starts, the better things progress along typically. A specific example of this is by the time a child turns 12 years old, you know, their peers are becoming really important to them. If a child has a strong and healthy relationship with their parent or parents or caregiver, they are intentionally going to choose friends that their parents would agree with that participate in behaviors their parents agree with. If they do not have that relationship and it is fractured or broken, they intentionally do behaviors and pick friends that participate in behaviors that they know their parents would not support. So I can not emphasize enough, from birth the relationship you have with your child of respecting them, of listening to them, of communicating with them, of having family meetings, letting everybody share how they feel about something, but parents to me are incredibly powerful. Do you know Brad, our day is so busy, people are running here and there, their kids are involved in all different things, parents are working more than they've ever worked, daycares are booming businesses, long-term care facilities for elderly parents are booming businesses. If a parent would just have one meal a day with their child and not be on their phone or their iPad or whatever and have a talk, the National Institute of Drug Abuse says, "70% of all drug use by kids could be prevented."


Brad Means: Just a meal a day--


Dr. Martha Tingen: Prevented.


Brad Means:- Thank you for what you do Dr. Caldwell.


Dr. Alice Little Caldwell: Thank you.


Brad Means: My thanks to you, congratulations on your study.


Dr. Martha Tingen: Thank you.


Brad Means: And I hope that it leads to more success stories from parents everywhere. We appreciate you so much. As we go to break, let me show you some resources that are available, thanks to our friends at the Georgia Cancer Center. You can learn how to quit smoking by taking classes. They start every two weeks, dial the number on your screen for more information there. It is easy to kick the habit.


Get Ready To Quit

Tobacco Cessation Program

Tobacco Cessation Class


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