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SA: Hello and welcome to Master the MRCPCH. In this series, we tap into the expertise here at Great Ormond Street Hospital to give you an overview of a topic on the RCPCH exam curriculum. So whether you're revising for an exam or just brushing up on a need to know topic, hopefully this podcast can give you the information that you need.
I'm Dr. Sarah Ahmed, a paediatric registrar and the current digital learning education fellow here at GOSH.
In today's episode, we are delighted to have back Dr. Rossa Brugha, a consultant in paediatric respiratory medicine at Great Ormond Street Hospital. You may have heard him on a previous episode talking about one of his special interests, cystic fibrosis.
Today, we'll be talking about health promotion. Under the respiratory medicine section of the exam curriculum, there are learning outcomes which state “know the role of health promotion programs in preventing respiratory morbidity” and “understand the risks associated with smoking and passive smoking exposure”. We're going to be taking a very evidence based approach to these topics today. All the numbers we mentioned have been taken from papers and societies such as Action on Smoking and Health.
Rossa, thank you so much for coming on the show today.
RB: Pleasure to be here. Thanks, Sarah.
SA: So before we delve into more detail, I want to start by asking, what would you like people to get out of this podcast?
RB: I mean, there's obviously this curriculum requirements and I have to admit, I was googling Progress Plus before joining online. There is useful skills that people need to have in terms of talking to children, adolescents about risks like smoking, obesity, all those sort of things.
But I would like just to get really, like a bit of a narrative around how we can think about what smoking, what dirty air does to people's lungs and then, you know, how we can advocate for our patients in terms of how we can try to make the air that we breathe cleaner.
SA: Fantastic. I think those are all really worthwhile learning outcomes.
So should we start by talking about smoking?
RB: Yes.
SA: So we know that there's a connection between smoking, so both passive smoking and the active act of smoking and poor lung health. Can you tell us a little bit about that connection that's already known?
RB: Yeah, it's actually one of my personal heroes is the is the guy who worked this out, Sir Richard Doll. I've got to admit I'm a bit of a geek and I bought his biography. He's really interesting and he did various things with the British Expeditionary Force in 1940 in World War Two. He was a doctor out there. And then came back and became an epidemiologist and he was concerned about the epidemic of lung cancer in men and then developing in women in the 50s and 60s, I think in the 50s mainly.
And he did some really cool, really basic stats to work out that smoking was associated with lung cancer. It's a chi squared, it's there, it's in the paper. Is it 1953? Doll and Bradford Hill, I think the names are. Anyway, smoking is bad for you. Like it's really bad for you, like half of smokers die of smoking related diseases, maybe two thirds of smokers die of smoking related diseases. I can't think of anything that's more associated with the risk of killing you beyond the act of just being alive is I think 100 percent associated with death and I think smoking is probably the second most common cause of death after just living. Someone will come up with something that gives you a higher risk of mortality. I think being a World War Two bomber crew was worse for you than smoking, but only just. Why is this World War Two references? Yeah, yeah, only just. Yeah. And like, you wouldn't cross the road if you were given a 50 percent risk of death in your lifetime of road crossings, would you? I don't know. It depends what's on the other side.
So, cigarette smoke is a really interesting mixture of particles and cancicles and gases. I think there's about four thousand different things in it that either you breathe directly into your lungs or you breathe out or your cigarette burns and the, the children and your pets breathe in. Do you see this? So there was there is a study that demonstrates that your dog is more likely to get cancer if you smoke.
SA: Really?
RB: Yeah.
SA: I didn't know that.
RB: Yeah. Yeah. So before we branch out into the Royal Veterinary College stuff. So yeah, so the summary is smoking is bad for you, but then quitting smoking is actively good for you. It's one of the strongest pills we have. So if you quit smoking, I think it's one way around or the other. I think your heart attack risk goes back to that of a non smoker after about five years, and your lung cancer risk goes to that of a non smoker after about 10 years, I think. And your sense of taste and smell, and the smell of your house, and the smell of your clothes gets better within a few days. I'm not sure I should be quoted on that, but those figures are roughly one of those two, so it's definitely good for you at any point in your life to give up, and it's very good for those around you as well to quit.
SA: Yeah, absolutely. I don't think I realized quite how bad it was for you. I think everyone knows it's bad. But hearing you like talk about the numbers like that really puts it all into perspective.
Are there specific things in kids that we know smoking makes worse?
RB: So all the evidence from this, like great things in medicines comes, from taking stuff away and seeing what the effect is. So there's various really well put together epidemiological studies now looking at the effect of smoking bans. So when the proper smoking ban came in the UK in 2007, they saw, I think it was something like a 14 percent decrease in lower respiratory tract infections in children.
SA: Wow.
RB: 10 percent drop in attendances with wheezing to paediatric A& Es. This is going to put me out of a job. Yeah. I'll need fewer people like me if people stop smoking. Yeah, so passive, passive smoking is obviously bad for children because when you get rid of it and the amount of smoking exposure decreased, that was, that was proven. These things that we thought were smoking related in terms of you know, going to A& E with bronchiolitis, wheezing, pneumonia, they all decreased.
SA: Wow. And third hand smoke as well, which is a concept that I wasn't really aware of, but third hand smoke is when all of the chemicals and the nicotine kind of stays on the surface.
And then kids, like, go and put things in their mouth and ingest the chemicals.
RB: Yeah, we can think of cigarette smoke in sort of three things. There's the, there's the volatile gases, chemicals you're breathing in. There's the particulates you're breathing that will then sit in your lungs. And, you know, we can see them in people's macrophages if we do sputum collections. And then there's nicotine itself as the addictive substance in it. Nicotine is a neurotoxin, but in very decent doses. And it's just a clever addictive substance that I think, I think tobacco plants use nicotine to kill insects, I think. Anyway, it's addictive to humans. Yeah.
So secondhand smoking comes from two sources. Either comes from people breathing in the smoke that's coming from the burning end of the cigarette, cigar, pipe, who smokes a pipe? Anyway, pipe. And then there's the, what do they call it? I think the sideline smoke, something like that, where you breathe, where you breathe in the stuff that someone else breathes out.
Now, breathing in the end of someone's cigarette is much worse for you than breathing in something that someone has filtered for you using their own lungs. Yeah, but it's still not good. Third hand smoking is what happens in that sort of milieu of your soft furnishings. Okay, so I I became familiar with the concept of the scatter cushion when at some point in my, in my middle age. And these scatter cushions are designed so that your children can scatter them around the house in places you're not expecting to find them, often under the table. And so your sofa, which when you don't have kids, is for sitting on. Instead, your sofa becomes a bouncy castle, a source for making dens. So when your kids go downstairs in the morning, if you're a smoker, you don't smoke inside. Yes, of course, I believe you. I change my coat when I come inside. Yes, of course, I believe you. But adults breathe out cigarette smoke for about 3 hours after 1 cigarette. That's why you can smell it on their breath. That's why when they come into clinic, I open the window, I go, “Oh, you smoke.” And they say, “How do you know?” And I say, “Because I can smell it.” So they breathe that out, it settles on their scatter cushions and their sofa and then the kids come downstairs in the morning, jump up and down, put on CBeebies, and that cigarette smoke and the particulates re repopulate the air. They, they are, they are re aerosolized essentially, and then the kids breathe that in the next day.
SA: I think I've found some numbers from ASH, which is the Action on Smoking and Health. They were saying, so, smoking – so this is passive smoking, active smoking, third hand smoke – increases your risk of LRTIs by 50%. By “your”, I think this is for kids.
RB: Yeah.
SA: So increases the risk of kids LRTIs by 50%. There's a 30 to 70% increased risk of wheeze. And a 21 to 85% increased risk of a child going on to develop asthma. And those are huge numbers.
RB: Yeah, 1 in 11 children has asthma. There's quite scary numbers for sudden infant death, I think.
SA: Yeah, yeah, there are.
RB: Yeah, it's, I mean, it's a very, very effective way of spreading poison through the population. By breathing it inside people's homes, inside people's cars. And of course. We have to also recognize there's a socioeconomic gradient involved in this.
SA: Yeah, of course.
RB: You know, and, and the most powerful reason that people take up smoking is 'cause one of their parents smokes.
SA: Absolutely. Kids are more likely to start smoking if their parent has smoked.
RB: Yeah which I have to admit that we have taken advantage of in the medical setting. So I used to work at a different hospital where we had a carbon monoxide monitor, and we would say to parents, look, you know, you're smoking your child is here with wheezing, we keep seeing them in A& E. And we would get them to use the carbon monoxide breath detector to see how much carbon monoxide they are breathing out, but a long time after they've had a cigarette.
And then if the kid was old enough, yeah. We would get the kid to blow into the monitor too and show the parents that we could measure carbon monoxide from passive smoking in their kid's breath. Yeah. Theory behind that being it's like a teachable moment. There's the biological feedback and show, look, this is a normal number. This is what you're breathing. And this is what your kid's breathing out. I thought that was quite powerful.
SA: So you see a lot of kids who've got kind of chronic long term conditions, so things like cystic fibrosis and asthma, are those kids affected more by being exposed to smoke? Are there certain things that they are at risk of?
RB: Yeah, so cystic fibrosis is much worse if you are also exposed to passive smoking. The numbers of which I don't have at my fingertips but, and there's probably confounders in that literature as well in terms of socioeconomic stuff, but it's certainly bad for you. We know that air pollution is bad for you with cystic fibrosis, so cigarette smoking is certainly, I think, the earlier studies are done on passive smoking.
I mean, we have patients who come to transplant clinic and and they have parents who smoke. Post lung transplant, we have some parents who smoke. Post lung transplant, we also have some teenagers who smoke. That's a different discussion. Yeah, or vape anyway, but I'm sure we'll come on to that.
SA: Oh, we will come on to that.
And we know that there's an effect on unborn children as well. So in mums who smoke
RB: So those babies, those babies are smaller than they could have been. So their lungs are smaller than they should have been. They're more likely to wheeze when they're older. I remember, and I don't know if this is... This isn't very evidence based, but I remember being shown a placenta after delivery by a midwife at the Whittington who said, this mum is a smoker and this placenta is gritty.
And then a colleague of mine at the Royal London a couple of years ago did a really elegant study demonstrating that you can see air pollution particles in the macrophages that you find in the placenta.
SA: Wow.
RB: Yeah, that got onto the Holy Grail of medical literature. That was discussed on the Today program on Radio 4. So it makes sense that you can get a gritty placenta uh, from cigarette smoking. And yeah, we know that is linked to birth weight. And low birth weight is associated with all sorts of Michael Marmot style concerns about life course and health.
SA: Yeah.
RB: and there's an increased risk of stillbirths, of miscarriages, and of SIDS, which we spoke about earlier as well. Yeah, those are not the fun parts of the syllabus.
SA: Yeah. And you, you mentioned this earlier, but kids smoke as well. ASH have estimated that every day in England, 280 children under the age of 16 start smoking.
RB: There are some extraordinary prevalences in those tables. So I think 1 of them had a, I think it was in the 80s or it might have been the 90s, that 4 percent of 11 year olds smoked. Wow. And it was something like a quarter of 15 year olds were smoking in the late 1980s, early 1990s. That's something like 2 percent now. Which is a testament to the public health policies involved in reducing the how easy it is to get hold of cigarettes. There's, there's lots of successful things that means that you and I, in our generation of medics, seeing much less wheezing and nasty chest infections than we would have done in our colleagues, you know, 20, 30 years before us.
SA: Yeah. Yeah. It is worth saying that the number of kids that smoke is going down year on year, but it is just still crazy to me that every day 280 children start smoking. I think that leads us on really well to vaping. The number of kids who've tried vaping has jumped from 15 percent in 2022 to 20 percent this year. And since 2021, the proportion of children vaping is greater than that of children smoking. And vapes are everywhere. I see them absolutely everywhere.
RB: I'm a paranoid parent now, so I see them even more than you do.
SA: Yeah. Do we know anything about the effect that vaping can have on lung health?
RB: So there are a few extreme cases which are probably quite a useful way of anchoring this conversation, mainly in the states where people were smoking tetrahydrocannabinoids through vapes, and they had additional vitamin E in it, and they got an incredible lung condition, which is now called EVALI, which is “e cigarette and vape associated lung injury” where basically they just completely trashed their lungs and 96 percent were hospitalized and some of them died.
So we don't really know anything about what the cigarettes vapes do to people's lungs, but we are living through a gigantic natural experiment and just trying, trying really hard, letting people to find out for themselves.
I don't think that's the greatest approach to lung health. And it certainly could end up being very interesting. I mean when people. Let's think about this in a sensible way. So we worked out that cigarettes caused lung cancer by enough people getting lung cancer. And then the follow up study didn't work so well because what Richard Doll did was he used the GMC register of doctors to match that to death certificates to look at the incidence and prevalence of things. And then when the first report about smoking caused lung cancer came out lots and lots and lots of doctors stopped smoking. So his follow up study didn't work so well. We tried to do it in a sort of a validation group. So with e cigarettes how long do we have to wait before we work out they're bad for you?
I mean, yeah, the rare and crazy EVALI thing is probably not that useful for policymaking, but... You are heating up rather than using fire. You're using a small battery to heat up a nicotine and other stuff containing liquid that then you breathe in. It's not really what our lungs are evolved to do. We're pretty good with nitrogen, oxygen, water, vapor. We're okay with things like wood smoke. We're quite good at dealing with bacteria, viruses and fungus. But heating up things to then use the internal surface area of our body to get them directly into our bloodstream quickly is not what we were designed to do, apart from doing it with oxygen. Whatever you're breathing in, I think there's various mixtures of various stuff, various entirely, as I can tell, unregulated strengths of both nicotine and other things in it. Yeah. And it could turn out to be a giant mess. I don't think that as a pediatrician, I'm going to see a lot of this stuff, but I would not be surprised if there's a longer term, if you do this for 15 or 20 years. You could do all sorts of interesting things to your lungs. I wouldn't want to be in the forefront of that experiment, but lots of people are choosing to be.
SA: Yeah, I suppose we'll see in 10 to 15 years what happens.
RB: No, let's not. Let's ban them or make them prescription only. Let's do something sensible like the Australians.
SA: Well, that leads us on really nicely to what can we do as paediatricians? What can we do?
RB: So, while it would be nice to have an evidence base to say to people that these are actively bad for you, I think we can probably act using biological plausibility in advance of an evidence base to say, look, there's no way this is helpful to your long term life.
Right? What is the perceived benefit? In either A, getting addicted to nicotine. I can't see how that's helpful. And then B, exposing your lungs to all the other stuff that's in these things. But it's a little bit like telling people to eat healthy food, you know? Yeah. I mean, food that is actively bad for you does taste nice. And telling people what you'll get bowel cancer when you're 55 if you eat, I don't know, some ultra processed thing. Every day that's a bit of a remote thing to be worried about because it is cheap and available. Yeah. Yeah. So let's make things less cheap and less available and then still see just how much people would like it.
And I think it's Australia, they've made them, they've made vapes prescription only with the idea that you use them as an adjunct to quitting smoking. But what we seem to have done in the UK is we've. Made them a product for non smokers to have a crack at trying nicotine and see if they like it. Which is an odd thing to do.
SA: Lots of people say, oh, I'm vaping. This is anecdotal. I'm vaping because it is helping me stop smoking, but it comes with its own host of risk factors that we just haven't, we don't know about, which we discussed.
RB: Yeah, so if those numbers are right, and 20 percent of children are saying that they're using it and people are saying they're using it to stop smoking, then 16 percent of people at least are lying.
Right? It's a difficult policy debate and the English have got themselves into a bit of a pickle about this because they've gone in quite a different way from the World Health Organization advice as to whether you should vape or not. And the UK, I think, has been pragmatic and said, we don't think they're as bad as smoking and therefore, although they're not harmless, they are less harmful. So if you want to replace cigarette smokes with vapes as a way to get off nicotine addiction altogether, that's fine by us. That's, that's a sensible policy.
SA: You mentioned policy. I think we should maybe talk a little bit about policy. So we're recording this in October 2023. And there's just been the conservative conference and Rishi Sunak said they were gonna…Well, why don't you tell us a little bit about what he said.
RB: Yeah, so in New Zealand, there's a very interesting policy to decrease cigarette smoking by increasing the age at which it's illegal to smoke cigarettes by 1 year every year. So you take a year of people who are born in whatever year and say, you can smoke nobody younger than you can with the idea that then if you've got to be 25, you've got to be 28 and you might be 31 in a few years time to be able to buy cigarettes legally at all, you will decrease consumption.
And that is argued by various people that, oh, well, it won't help because you'll just create a black market in cigarettes and you probably will create a little bit of a black market in cigarettes. But I, I think the evidence shows that if you decrease access to these products, fewer people will take it up in the first place.
So I, you know, I think we should. I am glad that the policy has been announced and let's see that through as, you know, the green paper, white paper, and hope it becomes legislation very soon because that, that will, that will decrease the number of people in my clinic.
SA: Absolutely. Should we move on to talk about air pollution?
RB: Let's.
SA: Can you tell us a little bit about what the evidence says about how air pollution can affect lung health, children's lung health?
RB: Yeah, so the earliest work on this is from the USA in the 1990s, where they had a phenomenally dirty air and industrial areas around Los Angeles and different species of air pollutants in different bits.
There's lots of ozone in the states because they have sunshine. And if you. have ozone hitting nitrogen dioxide at sea level, you can split up into various nasty free radicals and affect people's lungs and basically make them inflamed. So they showed that children's lung growth during their adolescence was less if you were exposed to more air pollution.
So your FEV1, your forced expiratory volume in one second, which is quite a good marker of mortality, was lower, you didn't grow as much lung in your teenage years. If you have grown up either in dirtier air by measuring air pollution, or just by looking at stuff like how far you live from a, what the Americans call a freeway, and we would call a busy road.
So we know that air pollution is associated with poorer lung growth, your maximum lung growth. does play quite a big part in determining how long you're going to live. And so if you don't grow lungs that are big enough by the time you've got to the end of your adolescence, you probably keep growing new lung till you're at 21 or 24, I think.
And then it drops by about 1 percent per year, your lung function, which is why humans don't tend to live more than 100 years beyond 20, because you've only got 100 percent of lung function to play with. So if you don't get to 100%, let's say you only got to 95 percent and you're taking some time off your life, or you're having a less healthy later middle age.
And that's expensive because you, I think, I'm going to quote something, I'm pretty sure it's true. I think something like a third or two thirds of your health spending in your entire life happens in the last year of your life. So, if we make people sicker when they're older, then they're going to get more expensive.
Plus, you know, the health, the demographics of our country are very much, there's going to be a lot of older people soon so let's make them as healthy as possible. So air pollution, you don't really have a choice about, whereas if I guess to the extreme, you can just about get away from a passive smoking parent as much as you can.
And although the, if the effect on the individual is lower because it's spread across much larger numbers in the population.
So kids, so the lungs don't grow as well. Children are exposed to more air pollution. If they've already got a chronic lung disease, like cystic fibrosis, they get more chest infections?
There is a signal that respiratory infection is more common in children. If they've got higher levels of air pollution, it triggers asthma, certainly in adults. And therefore probably in kids as well. When you get like a, an ozone or an nitrogen dioxide burst, which we tend to get in the spring and autumn.
Whenever you go outside, if you notice there's that fine kind of pinky red dust on your bins. We've imported a load of air from North Africa. But what we've also done with that is imported a lot of industrial air from continental Europe rather than getting nice clean air that's blown in over the Atlantic.
So, you know, the air pollution is going to be bad if there's sand in the air. Yeah. Yeah. Brexit does not mean that you also do not get continental air flows.
SA: And do you see an impact on the kids that you see in clinic?
RB: Probably not. No, that's taking things a little bit far. This is a small individual effect when spread across millions of people is quite a large effect on the population.
So people will ask me lots of things about air pollution at work. You know, families will say, look, should we move out of London and move to the countryside? The air pollution can be very high from rural sources like ammonia and fertilizers that are spread on fields. So, there is no simple answer.
SA: It kind of links into the socioeconomic differences as well, doesn't it? Like, it seems unrealistic that anyone is going to move because of air pollution, but it is certainly easier for some people than others.
RB: Yeah, and I mean, I will admit that when my wife and I were choosing where we were going to buy our family home. I mean, I was doing a PhD in air pollution at the time and was a geek and looked at the air pollution maps. But I think people do think about that and think about how they travel to and from school and work in terms of trying to avoid air pollution.
But if you live near a busy road. We know that your air pollution exposure is much higher and that tends to be more dense housing and people with less economic means to not live in those houses end up there. Yeah. And there's not enough houses anyway. So where are you going to move to?
SA: Is there a geographical difference that we know of?
RB: Well, if you're within 500 metres of a busy road, then you've got lower lung function. So that's as geographical as we can be, yeah. Yeah. But for example, your micro environment exposures to air pollution are quite individual. What I mean by that is that I used to give air pollution monitors to kids in East London, and you would see in the day where their exposures to air pollution were, which would be the walk to and from school when they're outside in the playground, so they can have a postcode overall air pollution exposure that is quite low.
But as an individual, depending on what you behave, you can drive very high exposures,
SA: I asked this about smoking and I'm going to ask it again about air pollution, but is there anything that we can do as paediatricians?
RB: Yeah, so... again, we can be advocates for, you know, healthy living and all its various means. So if people have got a child with a wheezing disorder in clinic and, you know, they say to me, is it worth me selling my diesel car and getting a cleaner engine? Yes, it probably is because, you know, we will all breathe in air from our engines. If you can drive less and not sit behind someone else's tailpipe exhaust, as they say in the States, in the papers, then then you will be less exposed to the sort of triggers that can be bad for you. So if you can walk or cycle to school then you should, that is healthier for you because you're in a much larger air mass where stuff moves around rather than sitting in a box where you trap all the air.
But there's not really a great evidence base for that. It's just sensible. Yeah.
SA: Yeah. I mean, how do you research something like that? You can't do a randomized control trial.
RB: So you can. You can do it, but your outcomes aren't going to be health measurements. So you're not going to say that your FEV1 will get better in 10 weeks if you do this. You would have to measure it by their environmental exposures. So people have done that. People have used green walls, they've planted hedges around schools and then looked at the people's air pollution exposure before and after that. The easiest way to measure air pollution exposure inside your house is just to wipe the tissue across the screen of your television because it's electrostatic and it'll pick up the gunk. So you see how dirty your house is. And then get loads of plants and see if they catch the stuff in the air, you know.
But as a health measure, when you're doing population health stuff with these small effects on lungs, you're not going to, there's not going to be a pill for it. I don't think, and it's very difficult to measure that in individuals. So you just give what appears to be sensible advice. And then, you know, doctors have a voice in society and, you know, the Royal College is quite good on advocating for children's lung health and particularly air pollution at the moment.
It sounds old fashioned, but if you write to your MP, someone writes back. There might be an AI chat bot now, but someone's getting back to you. And, you know. This is going to stray into policy, but things that decrease traffic flows through where children are growing up and going to school make them breathe cleaner air. So low traffic neighbourhoods, low emission zones, streets that are traffic free outside schools. These are all small things, but if they add up, they will help.
SA: Absolutely. I'm going to end the way we end all of these podcasts by asking you a couple of quickfire questions.
RB: Go for it. I might get them wrong.
SA: That's okay. Are there any classic exam questions that could pop up around this? And I'm talking about not just the theory exam, but the clinical exam.
RB: Yeah, definitely. So I think quite a, if I was to be an exam writer, which I'm not, would be, you know, sit down in front of an adolescent who has developed asthma in quotation marks when they're 14. And the test there is to say, you know, have you kick out the parents and say, have you started smoking and go through the heads assessment? But then also that's not just enough to go. Oh, you're smoking. Oh, and wave your finger. I think quite strongly. Maybe not all pediatricians, but people who see children with lung disorders should have the ability to then talk with some usefulness to parents about how to quit smoking, which is not just willpower. You need to get counselling, and you need to get help with the nicotine cravings and pretty sure it's on e-learning for health, but I did a module somewhere at some point in my distant past where I learned about all the stuff that smoking cessation counselling involves and what's successful and what isn't so that when I see people in parents and clinic and I go, you know, de smoke and like put their head under their arm. Oh, gosh. Yeah. Sorry. I do doctor. Okay. Look, well, let's use this as a moment to go through what it is you can do to sort that out. This is a very long answer and your quickfire questions are getting shorter. But yeah, but people can go and see their GP and be referred basically instantaneously for smoking cessation counselling, which is a mixture of cognitive behavioural approaches and help with physical cravings. Yeah and that's good.
SA: And it's worth mentioning that nicotine replacement therapy is licensed for anyone age 12 and over. So if you have a child who's smoking, they can do the same thing. They can go to their GP.
RB: Yeah, GP practice nurse should be able to prescribe it for you. You don't have to wait to see a doctor.
SA: Great. So second question. Are there any useful resources that you would recommend? And it's worth mentioning all of the things that we've discussed in this are going to be in the description.
RB: Get your thumb out, scroll down, find the links.
And so, yeah, I'm pretty sure there's an NHS e learning for health module on smoking cessation therapy. And all of the hyperlinks that come through the Royal College website and the curriculum about heads assessments and talking to adolescents, because we haven't really covered how you're supposed to talk to a teenager, but I am the worst guy to talk to a teenager.
I need a professional who's good at that. I'm just a nerd. Those, yeah, those are kind of, those resources are, you know, being constantly updated as, you know, we learn more about how to do this right and not just wave our fingers at people and come across as being all patriarchal and didactic.
SA: And we have a podcast on talking to adolescents. You can find it wherever you find your podcasts.
RB: Yeah, I will listen to that.
SA: And finally, what are your three takeaway learning points?
RB: My three takeaway points would be: any interaction that you have with someone who has the ability to smoke, you may as well check. Because if it's no, that's fine. It's also quite good practice to get good at throwing parents out of the room and have conversations with teenagers. Because that's more of a mental stumbling block, I think, for paediatricians than it is for the teenagers, and the teenagers probably quite like it. So do ask about smoking. God, that's a boring point to take away, isn't it? Do you be good at what you will do if someone says they are smoking? That is a useful learning point.
And my third learning point is that we can be advocates nationally for children's lung health. Write to your MP and say, what on earth is the benefits to our country of people getting vapes? Can we stop this as soon as possible?
SA: Amazing. Rossa, thank you, much.
RB: Pleasure. It's a stream of consciousness. Hopefully some of it is educational.
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