ASH ATTACKED FOR POSTING SMOKING-SIDS LINK NEWS [12/18]

The Washington Times, a newspaper which frequently takes a pro-tobacco position, today ran an article critical of a news item ASH recently posted about the link between smoking and Sudden Infant Death Syndrome (SIDS).

The article, entitled "Infant-death link to smoking hit as 'misleading data,'" quotes a spokesperson for a Baltimore-based SIDS organization and her criticism.

The spokesperson seems to be a lay person rather than a physician or scientist, and neither the article nor the letter written to ASH about the matter cites any scientific or medical authority for the critic's views.

Reprinted below are:

1. ASH's Letter to the Editor responding to the Washington Times article;

2. ASH's letter to the complaining individual; and

3. Citations to some of the many studies/articles linking parental smoking to SIDS.

ASH' LETTER TO THE EDITOR

To the Editor:

In "Infant-death link to smoking hit as 'misleading data,'" you reported about a news item posted on ASH's Web Site, but neither the critic nor the reporter cited any medical support for questioning the smoking-SIDS link.

That particular news item was based upon a Reuters news article entitled "Parents Who Smoke Blamed For Crib Deaths," which reported on a study published in the British Medical Journal.

Reuters said that "British researchers Thursday blamed parents who smoke for more than half of crib deaths . . . More than 60 percent of all crib deaths, also known as sudden infant death syndrome (SIDS), could be prevented if people stopped smoking around their babies and pregnant women."

An article in the Journal of Family Practice similarly concluded: "Tobacco use is also annually responsible for an estimated 1900 to 4800 infant deaths resulting from perinatal disorders, and 1200 to 2200 deaths from sudden infant death syndrome (SIDS)."

A headline in the San Diego Union-Tribune reported "2nd-Hand Smoke Can Kill Babies, Study Says," based upon a report published in the Journal of the American Medical Association. Cites to many more similar medical articles may be found on ASH's Web Site:

Whether parental smoking is termed a "cause" or a "major risk factor" for SIDS, parents should never smoke around infants. As one of the leading researchers in the area recently put it, "At least three times as many infants die of SIDS caused by maternal smoking as are killed as a result of homicide or child abuse."

ASH'S LETTER TO THE COMPLAINANT

This responds to your letter dated December 4, 1996, in which your organization was critical of a news item posted on ASH's Web Site. You apparently are critical both of the headline ASH used, and of at least two of the paragraphs (which were marked "speculation").

However, as shown below, ASH's headline to which you object is very substantially similar to that chosen by the impartial and highly respected Reuters news organization:

ASH HEADLINE: "Smoking Parents Are Killing Their Infants."

REUTERS HEADLINE: "Parents Who Smoke Blamed For Crib Deaths"

Indeed, the Reuters headline goes even further, actually blaming the parents for causing the deaths (i.e., "killing").

Thus while your organization may well disagree with this conclusion, it is hard to claim that ASH's report on this news item was not accurate, or that ASHshould be held to a higher standard than a major national news organization employing specially-trained medical writers and proofreaders.

Moreover, ASH's article immediately below the headline more than adequately explained and described the medical study which was being reported on þ thus correcting any possible uncertainty or confusion which could have been caused by our need to sum up a complex study in a headline of only a few words. Based upon the Reuters article, ASH accurately reported:

"British researchers Thursday blamed parents who smoke for more than half of crib deaths and said babies should not be exposed to tobacco smoke at all."

"More than 60 percent of all crib deaths, also known as sudden infant death syndrome (SIDS), could be prevented if people stopped smoking around their babies and pregnant women, the report in the British Medical Journal said."

""The recent research makes it clear that fathers who smoke are also a problem," Joyce Epstein of the Foundation for the Study of Infant Deaths told a news conference. "If we could remove all smoking from a baby's environment, we estimate that cot deaths would fall by 61 percent," she said, adding the findings were in line with studies underway in the United States, New Zealand and Scandinavia.""

""The risk increases crudely by 100 percent for every hour a day a baby spends in a smoky atmosphere. This is startling," Fleming said. "Please don't allow anybody to smoke in a room where the baby sometimes goes.""

Thus persons who read ASH's report are more than adequately advised of the conclusions of the British researchers, regardless of the particular terms used in the very brief headline ASH used.

The two paragraphs in ASH's report which you labeled "speculation" were taken almost verbatim from the Reuters news article. The Reuters news article is in turn based upon a report in the highly-respected British Medical Journal.

Therefore, although your organization may well disagree with the conclusions of the Journal and/or of Reuters, ASH's words do appear to be an accurate representation of the views of those we quoted and reported on.

Indeed, one of the persons ASH quoted is, like you, a representative from an organization devoted primarily to the problem of Sudden Infant Death Syndrome. Thus it is unlikely that such a person would be biased or uninformed regarding this issue þ and it is entirely appropriate for ASH to quote such a person in its news report.

Neither your lengthy letter nor the enclosed brochure cites a single medical article or other authority for the many propositions you propound in your letter. Moreover, at least one of your major arguments appears to be incorrect.

Although "the vast majority of infants born to smoking parents do not die of SIDS," and "many SIDS deaths occur in a smoke-free environment," this does not prove that smoking is not a cause of SIDS. One could as well argue that, since the vast majority of people who smoke in bed don't start fires which kill their children, and many children are killed by fires in homes where parents don't smoke in bed, smoking in bed doesn't cause fires which kill children. That conclusion is, of course, absurd.

You also assert that "we must refrain from making smoke exposure appear to be linked to ALL SIDS deaths. [emphasis in original] But of course ASH did no such thing.

In reporting, based upon the British Medical Journal study, that "more than 60 percent of all . . . SIDS . . . could be prevented if people stopped smoking around their babies and pregnant women," it is very clear even to the casual readers that many þ perhaps almost half or more þ of all SIDS deaths are caused by something other than exposure to smoke.

In summary, I believe that the brief news item which appears on ASH's Web Site, which is based in turn upon a news report by Reuters, is a fair and accurate presentation of the conclusions reached by researchers reporting their findings in the British Medical Journal, and the position of the Foundation for the Study of Infant Deaths quoted therein.

Your organization is, of course, free to dispute or to characterize the findings of the British study in a different manner, or to question the statistical conclusions which they support. But your dispute seems to be with those researchers and the other foundation, and not with ASH for simply reporting those conclusions fairly and in an unbiased manner.

Therefore, any further complaints or comments should be addressed to them and not to me.

SOME ARTICLES/STUDIES LINKING SMOKING AND SIDS

Armstrong BG, McDonald AD, Sloan M. Cigarette, alcohol, and coffee consumption and spontaneous abortion. Am J Public Health 1992; 82:85--7.

Bergman AB, Wiesner LA. Relationship of passive cigarette-smoking to sudden infant death syndrome. Pediatrics 1976; 58:665--8.

Blair PS, Fleming PJ, Bensley D, Smith I, Bacon C, Taylor E, et al. Smoking and the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into still-births and deaths in infancy. BMJ 1996;313:195-8.

Bulterys MG, Greenland S, Kraus JF. Chronic fetal hypoxia and sudden infant death syndrome: interaction between maternal smoking and low hematocrit during pregnancy. Pediatrics 1990; 86:535--40.

DiFranza, Joseph R. ; Lew, Robert A. Effect of maternal cigarette smoking on pregnancy complications and sudden infant death syndrome. J. of Family Practice 1995; 40:385

Engelberts A. Cot death in the Netherlands: an epidemiological study. Amsterdam: VU University Press, 1991. (MD Thesis.)

Ericson A, Kallen B. An epidemiological study of work with video screens and pregnancy outcome: II. A case-control study. Am J Ind Med 1986; 9:459--75.

Gilbert RE, Fleming PJ, Azaz Y, Rudd P. Signs of illness preceding sudden unexpected death in infants. BMJ 1990;300:1237-9.

Haglund B, Cnattingius S. Cigarette smoking as a risk factor for sudden infant death syndrome. Am J Public Health 1990;80:29-32.

Hemminki K, Mutanen P, Saloniemi I. Smoking and the occurrence of congenital malformations and spontaneous abortions: multivariate analysis. Am J Obstet Gynecol 1983; 145:61--6.

Himmelberger D, Brown BW, Cohen EN. Cigarette smoking during pregnancy and the occurrence of spontaneous abortion and congenital abnormality. Am J Epidemiol 1978; 108:470--9.

Hoffman HJ, Hunter JC, Ellish NJ, Janerick DT, Goldberg J. Adverse reproductive factors and the sudden infant death syndrome. In: RM Harper, HJ Hoffman eds. Sudden infant death syndrome: risk factors and basic mechanisms. New York: PMA Publishing, 1988:153-75.

Hoffman HJ, Damus K, Hillman L, Krongrad E. Risk factors for SIDS. Results of the National Institute of Child Health and Human Development SIDS Cooperative Epidemiological Study. NY Acad Sci 1988; 533:13--30.

Kline J, Stein ZA, Susser M, Warburton D. Smoking: a risk factor for spontaneous abortion. N Engl J MEd 1977; 297:793--6.

Klonoff-Cohen HS, Edelstein SL, Schneider E, Srinivasan IP, Kaegi D, Chang JC, et al. The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. JAMA 1995;273:795-8.

Knowelden J, Keeling J, Nicholl JP. A multicentre study of post-neonatal mortality. London: Her Majesty's Stationery Office, 1985.

Kraus JF, Greenland S, Bulterys M. Risk factors for sudden infant death syndrome in the US Collaborative Perinatal Project. Int J Epidemiol 1989; 18:113--20.

Kullander S, Kallen B. A prospective study of smoking and pregnancy. Acta Obstet Gynecol Scand 1971; 50:83--94.

Lewak N, van den Berg BJ, Beckwith JB. Sudden infant death syndrome risk factors. Clin Pediatr 1979; 18:404--11.

Li D-K, Dalang JR. Maternal smoking, low birth weight and ethnicity in relation to sudden infant syndrome. Am J Epidemiol 1991;134:958-64.

Malloy MH, Kleinman JC, Land GH, Schramm WF. The association of maternal smoking with age and cause of infant death. Am J Epidemiol 1988; 128:46--55.

McGlashan ND. Sudden infant death in Tasmania 1980-1986: a seven year prospective study. Soc Sci Med 1989;29:1015-26.

Mitchell EA, Taylor BJ, Ford RPK, Stewart AW, Becroft DM, Thompson JM, et al. Four modifiable and other major risk factors for cot death: the New Zealand study. J Paediar Child Health 1992;28(suppl):S3-8.

Mitchell EA, Ford RPK, Stewart AW, Taylor BJ, Becroft DM, Thompson JM, et al. Smoking and the sudden infant death syndrome. Pediatrics 1993;91:893-6.

Mitchell EA, Scragg R, Stewart AW, et al. Results from the first year of the New Zealand cot death study. N Z Med J 1991; 104:71--6.

Mitchell EA. Smoking: the next major and modifiable risk factor. In: Rognum TO, ed. Sudden infant death syndrome: new trends in the nineties. Oslo: Scandinavian University Press, 1995:114-8.

Murphy JF, Mulcahy R. The effects of cigarette smoking, maternal age and parity on the outcome of pregnancy. J Ir Med Assoc 1974; 67:309--13.

Naeye RL, Ladis B, Drage JS. Sudden infant death syndrome, a prospective study. Am J Dis Child 1976; 130:1207--10.

Nicholl JP, O'Cathain A. Antenatal smoking, postnatal passive smoking, and sudden infant death syndrome. In: Poswillo D, Alberman E, eds. Effects of smoking on the fetus, neonate and child. Oxford: Oxford Medical Publications, 1992.

Nicholl JP, O'Cathain A. Epidemiology of babies dying at different ages from the sudden infant death syndrome. J Epidemiol Community Health 1989; 43:133--9.

O'Lane JM. Some fetal effects of maternal cigaret smoking. Obstet Gynecol 1963; 22:181--4.

Sandahl B. Smoking habits and spontaneous abortion. Eur J Obstet Gynecol Reprod Biol 1989; 31:23--31.

Schoendorf KC, Kiely JL. Relationship of sudden infant death syndrome to maternal smoking during and after pregnancy. Pediatrics 1992;90:905-8.

Schrauzer GN, Rhead WJ, Saltzstein SL. Sudden infant death syndrome: plasma vitamin E levels and dietary factors. Ann Clin Lab Sci 1975; 5:31--7.

Selevan SG, Lindbohm ML, Hornung RW, Hemminki K. A study of occupational exposure to antineoplastic drugs and fetal loss in nurses. N Engl J Med 1985; 313:1173--8.

Steele R, Langworth JT. The relationship of antenatal and postnatal factors to sudden unexpected death in infancy. Can Med Assoc J 1966; 94:1165--71.

Stein Z, Kline J, Levin B, Susser M, Warburton D. Epidemiologic studies of environmental exposures in human reproduction. In: Berg GG, Maillie HD, eds. Measurement of risks. New York, NY: Plenum Press, 1981:163--83.

VandenBerg M. Smoking during pregnancy and post-neonatal death. N Z Med J 1985; 98:1075--8.

Windham GC, Swan SH, Fenster L. Parental cigarette smoking and the risk of spontaneous abortion. Am J Epidemiol 1992; 135:1394--403.

Zabriski JR. Effect of cigaret smoking during pregnancy. Study of 2000 cases. Obstet Gynecol 1963; 21:405--11.

ASH - ACTION ON SMOKING AND HEALTH 2013 H Street, NW / Washington, DC 20006 / (202) 659-4310