Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Young adult smokers frequently encounter the health care system as parents coming in for their child' s medical visit. Child health care clinicians, however, do not typically provide smoking cessation assistance to parents. WHAT THIS STUDY ADDS:This national cluster-randomized trial demonstrates that a tobacco dependence intervention for parents can be effectively implemented in routine pediatric outpatient practice.abstract OBJECTIVE: To test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking. METHODS:Cluster RCT of 20 pediatric practices in 16 states that received either CEASE intervention or usual care. The intervention gave practices training and materials to change their care delivery systems to provide evidence-based assistance to parents who smoke. This assistance included motivational messaging; proactive referral to quitlines; and pharmacologic treatment of tobacco dependence. The primary outcome, assessed at an exit interview after an office visit, was provision of meaningful tobacco control assistance, defined as counseling beyond simple advice (discussing various strategies to quit smoking), prescription of medication, or referral to the state quitline, at that office visit.RESULTS: Among 18 607 parents screened after their child' s office visit between June 2009 and March 2011, 3228 were eligible smokers and 1980 enrolled (999 in 10 intervention practices and 981 in 10 control practices). Practices' mean rate of delivering meaningful assistance for parental cigarette smoking was 42.5% (range 34%-66%) in the intervention group and 3.5% (range 0%-8%) in the control group (P , .0001). Rates of enrollment in the quitline (10% vs 0%); provision of smoking cessation medication (12% vs 0%); and counseling for smoking cessation (24% vs 2%) were all higher in the intervention group compared with the control group (P , .0001 for each). CONCLUSIONS:A system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit.

State-of-the-Art Office-Based Interventions to Eliminate Youth Tobacco Use: The Past Decade

“…Pediatric clinic-based programs for parents using decision support tools to ask, assist (including providing prescription for pharmacotherapy), and refer for telephone counseling via the quitline (1-800-QUIT-NOW) have been validated as practical to implement within the workflow of the pediatric office and substantially improve parental report of receipt of tobacco control assistance. 111,112 Telephone counseling for tobacco dependence treatment is beneficial, and text-to-quit programs show great promise as well. 113 …”

The Clinical Effort against Secondhand Smoke Exposure (CEASE) California: Implementing a Pediatric Clinical Intervention to Reduce Secondhand Smoke Exposure

“…They are generally a trusted source of health information [4] and have access to many parents, especially the medically underserved, who may lack a primary care provider and/or see their child's doctor more than their own [5,6] However, only 3.5% of pediatricians report providing smoking cessation assistance to parents. There is a significant missed opportunity to address SHSE in the pediatric setting [7].…”

“…CEASE consists of a three-step approach: ask, assist and connect [8,9]. In this model, pediatric providers are trained to ask each family about SHSE, assist families by providing brief motivational interviewing and offer nicotine replacement therapy (NRT) prescriptions to smokers, and connect the smoker to the state Helpline for additional smoking cessation support.…”

“…In this model, pediatric providers are trained to ask each family about SHSE, assist families by providing brief motivational interviewing and offer nicotine replacement therapy (NRT) prescriptions to smokers, and connect the smoker to the state Helpline for additional smoking cessation support. In one randomized controlled trial, clinics trained to implement CEASE had significantly higher rates of quitline enrollment rates, smoking cessation medication provision, and counseling for smoking cessation, than clinics that were not receiving the CEASE intervention [8]. A follow-up study found that these clinics were able to sustain these effects over time after the official study had ended [10].…”

“…A follow-up study found that these clinics were able to sustain these effects over time after the official study had ended [10]. Although CEASE has been shown to be an effective intervention [8,10] the study included the first 22 practices that responded to the request to participate in the research study and the sample likely included clinics that were more motivated to implement the CEASE intervention. A review of other interventions to address SHS found less promising results [11].…”