A Smoking Cessation Intervention for Low-Income Smokers in the ED

Abstract

Background There is a high prevalence of smoking among caregivers who bring their children to the pediatric emergency department (PED), and even higher rates of tobacco smoke exposure (TSE) and related morbidity among their children. The PED visit presents an opportunity to intervene with caregivers, but it is unknown whether they are more likely to quit if their child has a TSE-related illness. We sought to examine a PED-based smoking cessation intervention, and compare outcomes based on children’s TSE-related illness. Methods A single-arm, prospective trial, with baseline, 3 and 6 month assessments. Caregivers whose child had either a TSE-related (n=100) or non TSE-related illness (n=100) were given a brief intervention consisting of counseling, referral to the Quitline, and free NRT. Results Participants were: 91.5% female; 50.5% African American; 100% Medicaid recipients; 30.8 years old; child age mean 5.5; 90% highly nicotine dependent; 60.3% and 75.8% allowed smoking in the home and car, respectively. At follow-up (65% retention): 80% reported quit attempts at 3 months, and 89% between 3 and 6 months. There were significant decreases in number of cigarettes smoked, time to first cigarette, and smoking in the home and car. Quit rates were 12.2% at 3 months, 14.6% at 6 months, and 7.3% at both time points (50% biochemically confirmed). There were no significant differences in outcomes based on children’s illness. Conclusions A brief PED-based smoking cessation intervention resulted in quit attempts and successful quits. However, the presence of a TSE-related illness did not result in different cessation outcomes.

Secondhand Smoke Exposure and Pediatric Healthcare Visits and Hospitalizations

“…Prior research has revealed that smoking-cessation efforts targeting caregivers in the ED are accepted by both pediatric ED staff and caregivers, 35 and increase caregiver quit attempts. 35,36 However, a significant proportion of children with SHSe are not being identified in the ED as screening rates are low and counseling rates are even lower. 37,38 Promising research suggests that the use of clinical decision support systems within the electronic health record may help to facilitate the systematic screening and counseling of all caregivers who smoke by healthcare providers in the ED and other settings.…”

“…32,38 These efforts may increase quit attempts, reduce smoking among caregivers, and decrease potentially preventable and costly ED visits and hospitalizations. 36,48 Future research should assess illness severity and healthcare costs related to these visits. Assessing the cost–benefits of providing cessation interventions to caregivers of SHS-exposed children may help to drive the implementation of standardized SHSe screening and counseling in all pediatric settings.…”

The Effect of a Pilot Pediatric In-Patient Department-Based Smoking Cessation Intervention on Parental Smoking and Children’s Secondhand Smoke (SHS) Exposure in Guangxi, China

“…However, our findings differ from another study in the US that reported that the rates of ever achieving 24 h smoking cessation at twelve months were 57% in the intervention group and 60% in the control group. However, the rates of smoking cessation at three and twelve months were twice as great in the intervention group as in the control group (7.7% vs. 3.4% and 13.5% vs. 6.9%, respectively), and the difference was statistically significant at the twelve-month follow-up but not significant at the three-month follow-up [30]. The quitting rates achieved in our study were consistent with findings from other studies evaluating smoking cessation interventions with young women in community health centers [28], pediatric clinics [30], prenatal clinics [31], Planned Parenthood establishments [32], and pediatric settings [33].…”

“…However, the rates of smoking cessation at three and twelve months were twice as great in the intervention group as in the control group (7.7% vs. 3.4% and 13.5% vs. 6.9%, respectively), and the difference was statistically significant at the twelve-month follow-up but not significant at the three-month follow-up [30]. The quitting rates achieved in our study were consistent with findings from other studies evaluating smoking cessation interventions with young women in community health centers [28], pediatric clinics [30], prenatal clinics [31], Planned Parenthood establishments [32], and pediatric settings [33]. It is suggested that the intervention components helped participants succeed in stopping smoking for 24 h at least once, and we should follow up for a longer time (i.e., six months or twelve months) to assess the effects of smoking cessation intervention in the future.…”

Development of a Tobacco Cessation Clinical Decision Support System for Pediatric Emergency Nurses

“…1 Among children who visit the PED, up 48% of the caregivers smoke and children of these caregivers have high levels of tobacco smoke exposure (TSE). 2,3 These caregivers are motivated to quit and are eager to receive cessation counseling in the PED. 1,4–7 A recent Cochrane review showed the benefits and effectiveness of cessation advice given by registered nurses (RNs).…”