As we have seen, tobacco misuse is an epidemic amongst Aboriginal people. The rates are even higher for women. The Heart and Stroke Foundation has reported that 60 per cent of Aboriginal women aged 15 or older are regular smokers. In the Northwest Territories, up to 80 per cent of Inuit women are smokers, compared to fewer than 40 per cent of non-Inuit women. Aboriginal women have been found to be more than twice as likely as non-Aboriginal women to smoke during their pregnancies. Findings have shown that 53 per centof Aboriginal mothers smoked while pregnant compared to just 26 per cent of non-Aboriginal mothers.

TOBACCO & SIDS

Exposure to tobacco during pregnancy and motherhood is extremely dangerous and can cause several health problems to the mother, the fetus and the child. Such dangers are a primary motivation for tobacco cessation strategies. One of the most severe health problems that may exist is Sudden Infant Death Syndrome (SIDS).
SIDS is the “sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.” Most researchers now believe that babies who die of SIDS are born with one or more conditions that make them especially vulnerable to stresses that occur in the normal life of an infant, including both internal and external influences. A death is diagnosed as SIDS only after all other alternatives have been eliminated: SIDS is a diagnosis of exclusion.

WHAT CAUSES SIDS?

The exact cause or causes of SIDS is not known but can be a combination of developmental, psychological, environmental, and circumstantial factors. Evidence suggests that some SIDS babies are born with brain abnormalities that make them vulnerable to sudden death during infancy. The brain abnormalities are thought to be in a portion of the brain that is likely to be involved in controlling breathing and waking during sleep. Scientists believe that the abnormalities that are present at birth may not be sufficient to cause death, however they may make the child vulnerable. Quite possibly, other important events that occur after birth may affect the vulnerable child and induce SIDS.
A triple-risk model is used to describe three different ways in which an infant is believed to be vulnerable to SIDS. If these three elements come together, SIDS can result.

1) A vulnerable infant - despite an appearance of health, the vulnerable infant has an underlying defect - probably in the brainstem, which is responsible for heart rate, respiratory control and overall body regulatory mechanisms. There is no way to currently identify or treat this vulnerable infant.

2) A critical development period - in the first six months of life, rapid changes occur in sleep and waking patterns, breathing, heart rate, blood pressure, and temperature.

3) Outside stressors - factors which may tip a delicate balance include lack of oxygen, excessive carbon dioxide intake, exposure to second-hand smoke, overheating or a respiratory infection.

WHAT MIGHT HELP LOWER THE RISK OF SIDS?

Good prenatal care: proper nutrition, no smoking or
drug/substance abuse, frequent medical check-ups
Good postpartum medical care: regular check-ups and routine immunizations for the child
A smoke- and drug-free environment
Sleep position: placing the infant to sleep on his/her back, NOT on his/her stomach
Dressing the baby for sleep: keeping the baby warm but not hot
Bedding: not allowing the infant to sleep on a soft mattress, pillow, duvet/quilt or waterbed
Bed-sharing: adults not sharing a bed with their infant if they are smokers or if there is a history of alcohol or drug use
Feeding the baby - breastfeeding the infant

A SMOKE-FREE ENVIRONMENT AND SIDS

SIDS is the leading cause of death for infants one month to one year old. The risk of SIDS triples if the mother has smoked during pregnancy and doubles if the child is exposed to cigarette smoke only after pregnancy. It is very important that parents create a tobacco-free environment for themselves and their children. The best thing for an infant is not to be exposed to tobacco smoke. The next best thing is to try to reduce the infant’s exposure to smoke by cutting back as much as possible.
Environmental tobacco smoke (ETS) or second-hand smoke is being found to be a major contributor to the poor health of children and a major contributor to the number of SIDS cases.
There are some 4,000 chemicals in ETS and a child with developing (and sensitive lungs) breathes about 40 times per minute (compared to 18 times per minute for a developed adult). If that child is vulnerable, the damage is imminent.
A recent study at Toronto’s Hospital for Sick Children and the University of Maryland supports the suggestion that ETS is linked to SIDS. The lab study found significantly higher levels of nicotine in the lung tissue of babies who died from SIDS than in non-SIDS babies.
The researchers suggest this may be due to the way in which infants process nicotine in their lungs. It is as if the child (or fetus) acts as a reservoir for nicotine and nicotine is known to alter the central nervous system neurotransmission and cardiovascular regulation – which may play a role in the deaths of these infants. This study does not suggest that smoking causes SIDS nor does it describe the mechanism by which death occurs. It does, however, highlight the risks of second-hand smoke for infants who are vulnerable.

SIDS AND ABORIGINAL COMMUNITIES

In the Aboriginal community, the connection between tobacco and SIDS is magnified. Statistics reveal that Aboriginal infants are at a higher risk for SIDS than non-Aboriginal infants. In British Columbia, in 1996, 29 per cent of the deaths due to SIDS occurred in Aboriginal infants, even though these children accounted for only 7 per cent of all births in the province. A study from the British Columbia Ministry of Health found that the mortality rate due to SIDS in Aboriginal infants in British Columbia is almost five times the rate for other BC infants. A University of Calgary study has found that Aboriginal infants in Alberta are 10 times more likely to die from Sudden Infant Death Syndrome than other infants in the province. In Saskatchewan, the SIDS rate between 1982 and 1994 was 5.5 per cent higher among Native than non-Native infants.
Contrary to the general population, where the SIDS rates are decreasing, the proportion of Aboriginal SIDS cases in many areas of Canada has been increasing over the years. This issue must be addressed.