Clinical Effort Against Secondhand Smoke Exposure: Development of Framework and Intervention

Abstract

Objective To describe a novel process and present results of formative research to develop a pediatric office intervention that uses available systems of care for addressing parental smoking. Methodology The scientific development of the intervention occurred in three stages. In stage one, we designed an office system for parental tobacco control in the pediatric outpatient setting based on complementary conceptual frameworks of preventive services delivery, conceptualized for the child healthcare setting through a process of key interviews with leaders in the field of implementing practice change; existing Public Health Service guidelines that had been shown effective in adult practices; and adaptation of an evidenced-based adult office system for tobacco control. This was an iterative process that yielded a theoretically framed intervention prototype. In stage two, we performed focus group testing in pediatric practices with pediatricians, nurses, clinical assistants, and key office staff. Using qualitative methods, we adapted the intervention prototype based on this feedback to include five key implementation steps for the child healthcare setting. In stage three, we presented the intervention to breakout groups at two national meetings of pediatric practitioners for further refinements. Results The main result was a theoretically grounded intervention that was responsive to the barriers and suggestions raised in the focus groups and at the national meetings. The CEASE intervention is designed to be flexible and adaptable to the particular practices' staffing, resources, and physical configuration. Practices can choose materials relevant to their own particular systems of care (www.ceasetobacco.org). Conclusions Conceptually-grounded and focus group tested strategies for parental tobacco control are now available for implementation in the pediatric outpatient setting. The tobacco control intervention development process might have particular relevance for other chronic pediatric conditions that have a strong evidence base and have available treatments or resources that are underused.

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

“…The CEASE intervention is adaptable to the particular practice' s staffing, resources, and physical configuration, 29 and practices choose materials relevant to their own particular systems of care. Prior research describes these conceptually grounded and focus groups tested strategies for parental tobacco control now available for implementation in the pediatric outpatient setting, including the Ask, Assist, Refer clinical action framework.…”

“…11,16,21,22,[29][30][31][32] The intervention includes (1) routine screening for parental tobacco use using a CEASE Action Sheet, which helped the office staff identify each smoking family member and document smoking status in the child' s medical record; (2) motivational messaging that is based on the parents' own concerns as well as potential teachable moments that may be cued by the child' s illness; and (3) recommendation and possible provision of nicotine patch and gum by the clinician, and enrollment in the free state quitline. The intervention is designed to function within existing systems of care; research staff deliver none of the clinical tobacco dependence treatment.…”

Using the Postpartum Hospital Stay to Address Mothers' and Fathers' Smoking: The NEWS Study

“…Parents who were assigned to the intervention condition received the following: (1) one 15-minute in-person counseling session delivered by trained study staff working from adapted materials and messages specifically tailored for parental smokers (www.ceasetobacco.org) 18,19 ; (2) offer of enrollment in a proactive state-of-the-art telephone counseling intervention (QuitWorks, the Massachusetts statewide quitline, which did not offer nicotine replacement therapy [NRT] at the time of the study); and (3) letters faxed to the newborn's pediatrician, parents' primary care provider, and mother's obstetrician indicating the parent's tobacco use status and readiness to quit and recommending useful strategies to facilitate parental cessation, the need for ongoing support, and medication prescription when appropriate. The overall strategy is based on the evidence-based 5A model and tailored to the circumstances of the parental smoker in the hospital setting when their child is hospitalized.…”

“…The overall strategy is based on the evidence-based 5A model and tailored to the circumstances of the parental smoker in the hospital setting when their child is hospitalized. 7,19,20 Parents who accepted quitline referral completed a QuitWorks enrollment form, which was faxed to the state quitline. Quitline staff then made up to a total of 5 attempts to reach the parent by telephone.…”

Parents Smoking in Their Cars With Children Present

“…28 The pediatric health care setting provides a unique teachable moment to motivate and help parents quit smoking. [29][30][31][32][33] American Academy of Pediatrics (AAP) guidelines also recommend that pediatricians assist families with tobacco-use prevention and treatment. 34 Although some researchers have examined smoking in cars, [35][36][37] no previous studies have examined rates of counseling for smoke-free cars in the immediate context of a pediatric visit, and few have studied the correlates of parental smoking in cars.…”