Contemporary Culture

The Power of Advertisers (Article)

I was perusing my CDC weekly mortality and morbidity report a few weeks ago, and I saw an interesting statistical graph: smoking by occupation in the U.S. As we have talked about many times in this blog, smoking rates have been–and continue to–decline in the United States, thank goodness. Currently 20% of the population smokes, down from 50% during my childhood years. As you can see in the graph, the CDC has further broken down smoking by occupation, and I am happy to report that healthcare and social assistance occupations were the lowest group of smokers by percentage, currently at 16%.

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Just a few decades ago, the picture of the healthcare industry’s relationship with smoking was a very different one. Just take a look at these ads featuring doctors, babies, mothers, and cigarettes. Engaging pictures of distinguished looking doctors, cute babies, and young vital, attractive mothers were used to endorse cigarettes. A careful examination of the message in these ads to me revealed two essential messages:

1.  Loving, kind, respected, attractive people around you want you to smoke.

2.  The advertisers of particular brand of cigarette claiming that their brand is less “irritating” than the other brands.

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In other words, the makers of cigarettes knew, long before the devastating effects of tobacco smoke were fully understood, that some cigarettes were less likely to make smokers sick than others.

Oh, what a difference a few decades can make in behavior and attitude. I think we can conclude from all this information that the anti-smoking campaign, waged in the past 50 years, has been extremely effective. These new statistics once again reveal how effectively advertising can change behavior. Remember the government tobacco settlement with cigarette makers just a few years ago? Tobacco companies were forced to turn over a staggering amount of money to be spent mostly on anti-smoking advertising. I think we have to admit that these ads seemed to have worked. Negative images and messages about tobacco have had a big impact on our behavior, especially the behavior of healthcare workers and children. Isn’t it wonderful that without banning the sale or use of tobacco, a little negative advertising could convince so many millions of Americans not to sicken themselves by using tobacco? America: for our children’s sake, let’s not stop until we are completely tobacco free.

I welcome your comments. Visit today. You’ll be glad you did. Until next time.

Smo Notes:

Children and Pools (Article)

​Summer is a season when parents need to be especially vigilant about their children’s safety. One of the biggest summer risks starts when the pools open for business. What summer vacation signifies for youth is cooling off from the summertime heat by jumping and playing in a pool. For children, the neighborhood pool means freedom, friends, and fun. For parents however, their immediate concern needs to be, “safety first!” As beautiful and harmless as backyard appears, parents must remember it can be dangerous and even lethal for their children. A 2013 report found that children younger than 15 represented 78% of deaths from pool-related injuries. These data certainly cast a dark shadow over the image of fun in the sun. ​Since when did swimming at the pool become dangerous? The report “Pool and Spa Submersions: Estimated Injuries and Reported Fatalities” discusses findings related to this class of injuries. This 2013 report found that the majority of these pool-related fatalities involved children “15 years or younger” at neighborhood pools. Interestingly enough, the report also found interesting demographic information related to these incidents. The Centers for Disease Control and Prevention found African American and Hispanic children at higher risk of drowning. Particularly, African American children, between ages 5 and 19, were “six times more likely to drown in pools [versus] white and Hispanic children.” They also found that 70% and 62% of African American and Hispanic children, respectively, could not swim adequately. The report did not identify the exact origins behind these figures but point out a serious health hazard threatening a large group of children. ​How do we solve the problem of childhood drownings? Should we outlaw community and backyard pools? No, we need to increase our efforts to make sure every child learns to swim and know how to safely be around water. Thanks to organizations like the American Red Cross, the YMCA, and most public swim facilities, families can teach their children how to swim and remain safe during this and all future summer seasons. Proper swimming is a vital life skill that all beachgoers, children and parents should know. It may seem obvious but the solution to childhood drownings is really simple, professionally taught swim lessons along with good adult supervision around water. Smo Notes: Written collaboratively by Norman Spencer an Paul Smolen M.D.

Feed, Read, Play and Thrive (Article)

Malnutrition can stunt child development, but what about improper and infrequent social interaction? Could isolation inhibit a child’s psychological growth? Dr. Paul Gertler of the University of California at Berkley thinks it can. Dr. Gertler and his colleagues set out to determine if providing appropriate socialization could help disadvantaged children succeed in the academic and employment worlds. Maybe programs such as “Feeding America” would be more effective if social welfare agencies were able to improve the parent-child interaction. Could proper socialization of young children really make that much of a difference? To answer this question, Dr. Gertler conducted a twenty-year longitudinal study of malnourished Jamaican babies. His results are amazing! On a weekly basis from the ages of one to four, researchers provided structured positive social interaction and nutritional support to the experimental group, solely nutritional supplements to one control group, and no support at all to the final control group. At age twenty, the nutrition-plus-social-interaction group were earning 25% more than the controls, less likely to commit a crime, more physically fit, and more successful in school. The success of the experimental group over the controls led Dr. Gertler to conclude that nutrition is not the only factor controlling a disadvantaged child’s well being—frequent and healthy social interaction can help prepare a child for a productive life. Although many programs provide adequate food to struggling families, offering healthy social interactions to toddlers and young preschoolers may be just as important. Is it surprising that giving young children attention and stimulating their language/cognitive development can have a positive impact on their adult lives? The Head Start Program was designed in the 1960’s to provide social and cognitive stimulation to low income children, ages 3-5 years. Today, a similar kind of assistance is available through The Early Head Start program, reflecting the changing tide in child development research. We now know that by helping a child learn language and social skills from a very young age, we improve their chance of achieving success. With what we have learned recently about the negative effects of stress and deprivation on infants and toddlers combined with this new information that social skills training in very young children can dramatically improve their lives, we can begin improve academic and societal performance and maybe even help win the war on poverty.  Let’s hope so. Your comments are welcome at Until next time.

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Smo Notes: 1. Written collaboratively by Sam Allen and Paul Smolen M.D.

Seatbelt Marks Indicate Trouble (Article)

Recognizing which children involved in an automobile accident have serious internal injuries can be a very difficult task for both physicians and parents. Some recent information, gathered by the Pediatric Academic Societies, seems to have made that recognition a little easier, however. These investigators have found that children with external marks from seatbelt injuries, also called the “seatbelt sign,” had a much higher probability of internal injures after a car accident. When young auto accident patients enter Emergency Departments (EDs), doctors are increasingly recognizing that bruising on the chest or abdomen from seatbelt trauma often means trouble, even if the child has little or no pain.

What is this “seatbelt sign?” Well, this physical sign is an elongated area of redness with possible bruising and tenderness on the skin caused by pressure from the seat belt during a collision. Although seen in adult accident patients as well, this bruising can be far more painful for small children and adolescents. Investigators surveyed 3,740 pediatric patients from multiple EDs after auto accidents. 16% had the seat-belt sign present while 84% did not. One in ten of the children with external seatbelt marks had serious internal injuries, especially intra-abdominal, regardless of whether they had pain.  Researchers concluded that external marks from a seat-belt are an important sign for parents and doctors to recognize after an auto accident.

This new data indicates that it is important for both physicians and parents to pay close attention to any bruises or areas of swelling on children involved in an auto accident, since these marks may indicate underlying serious injuries. This study also indicated that the seatbelt sign is not the only indication of abdominal injury; changes in a child’s breathing, low blood pressure, and abdominal tenderness were some of the other significant associated factors for detecting intra-abdominal injury. Dr. Angela Ellison, an emergency physician with the Children’s Hospital of Philadelphia, reported that children with this seatbelt sign remain at high risk of injury, most notably gastrointestinal injury. Parents and doctors alike need to recognize and act on this important physical sign.

If you found this article interesting, take a moment to leave a comment at my blog, While you are there, feel free to explore the hundreds of pedcasts and articles in the Doc Smo’s vault. Until next time.

Smo Notes:


Written collaboratively by norman Spencer and Paul Smolen M.D.