Intervention With Parental Smokers in an Outpatient Pediatric Clinic Using Counseling and Nicotine Replacement

Winickoff, Jonathan P.; Buckley, Valerie J.; Palfrey, Judith S.; Perrin, James M.; Rigotti, Nancy A.

doi:10.1542/peds.112.5.1127

Cited by 79 publications

(80 citation statements)

References 53 publications

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“…Questions used in this study to assess tobacco control service delivery were used previously in our other inpatient or outpatient studies. 16,22 Covariates collected included gender, age, race, education, smoking history, smoking behavior inside the home and car, and attitudes about the dangers of child' s TSE.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Interventionmentioning

confidence: 99%

“…Parents who smoke are often underserved medically, but see their child' s doctor an average of 4 times each year, 12 significantly more than they themselves see a clinician. [13][14][15][16] Even modest cessation rates can have a significant impact on the health of families when applied consistently over time and when the disease burden is high. 11 One of 2 smokers will die of an illness attributable to their smoking.…”

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confidence: 99%

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Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

et al. 2013

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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confidence: 99%

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Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

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“…26 The majority of parents who smoke would accept quitline enrollment in the context of their child's visit to the doctor. 27,28 Previous qualitative work suggested that fathers were not likely to rely on smoking cessation resources to help them quit. 29 High rates of quitline enrollment and counseling in our study suggest that low rates of fathers' previous use of smoking cessation resources may reflect poor access rather than unwillingness to use available resources.…”

Section: Figurementioning

confidence: 99%

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

et al. 2010

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OBJECTIVE: The objective of this study was to test the feasibility and acceptability of introducing an intervention to address mothers' and fathers' smoking during the postpartum hospitalization. METHODS: During a 14-month period (February 2005 to April 2006), we assessed the smoking status of both parents of all newborns who were delivered at a hospital child birth center. Parents who were current smokers (1 cigarette, even a puff, in past 30 days) or recent quitters (smoked since 1 month before conception) were eligible for the study. Parents were assigned to intervention or usual care control condition on the basis of day of study enrollment. Smoking outcomes were assessed at 3 months by telephone survey and cotinine confirmation; quitline use was assessed at 3 months by using quitline database. RESULTS: A total of 101 (64%) of 159 eligible parents enrolled in the study (n = 53 control subject, n = 48 intervention), including 72 (71%) current smokers and 29 (29%) recent quitters. All parents in the intervention group received the in-hospital counseling session, 94% had a fax sent to a provider, and 36 (75%) accepted quitline enrollment. In an intention-to-treat analysis that included both current smokers and recent quitters, self-reported 7-day abstinence decreased from 31% to 25% among intervention parents versus 38% to 23% among control subjects (effect size 9.4%; nonsignificant). Among current smokers at baseline who were reached at follow-up (n = 36), self-reported 24-hour quit attempts were higher in the intervention group versus control group (64% vs 18%; P = .005), whereas the cotinine-confirmed 7-day abstinence rates at follow-up were 9% in the intervention group and 3% in the control group (nonsignificant). CONCLUSIONS: Enrolling mothers and fathers into tobacco treatment services during the immediate postpartum hospital stay is feasible and seems to stimulate quit attempts. The birth of an infant presents a teachable moment to reach both parents and to provide cessation assistance.

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“…77 Also encouraging is the finding that, in another study, more than one half of smoking parents tried to quit after being counseled at their children's clinic and offered nicotine replacement therapy and quit-line referrals. 78 The tobacco industry's disinformation campaign regarding SHS and maternal and child health can be counteracted within clinicians' offices. SHS must be recognized as an established, controllable, risk factor for SIDS, like prone sleep positioning.…”

Section: Discussionmentioning

confidence: 99%

Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry

2005

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ABSTRACT. Background. Prenatal and postnatal exposure to tobacco smoke adversely affects maternal and child health. Secondhand smoke (SHS) has been linked causally with sudden infant death syndrome (SIDS) in major health reports. In 1992, the US Environmental Protection Agency (EPA) first noted an association between SHS and SIDS, and both prenatal exposure and postnatal SHS exposure were listed as independent risk factors for SIDS in a 1997 California EPA report (republished in 1999 by the National Cancer Institute) and a 2004 US Surgeon General report.The tobacco industry has used scientific consultants to attack the evidence that SHS causes disease, most often lung cancer. Little is known about the industry's strategies to contest the evidence on maternal and child health. In 2001, a review was published on SIDS that acknowledged funding from the Philip Morris (PM) tobacco company. Tobacco industry documents related to this review were examined to identify the company's influence on the content and conclusions of this review.Methods. Tobacco industry documents include 40 million pages of internal memos and reports made available to the public as a result of litigation settlements against the tobacco industry in the United States. Between November 2003 and January 2004, we searched tobacco industry document Internet sites from the University of California Legacy Tobacco Documents Library and the Tobacco Documents Online website. Key terms included "SIDS" and names of key persons. Two authors conducted independent searches with similar key terms, reviewed the documents, and agreed on relevancy through consensus. Thirty documents were identified as relevant. Two drafts (an early version and a final version) of an industry-funded review article on SIDS were identified, and 2 authors independently compared these drafts with the final publication. Formal comments by PM executives made in response to the first draft were also reviewed. We used Science Citation Index in July 2004 to determine citation patterns for the referenced SIDS reviews.Results. PM executives feared that SHS and maternal and child health issues would create a powerful and emotional impetus for smoke-free areas in the home, public areas, and the workplace. In response to the 1992 US EPA report on SHS, the Science and Technology Department of PM's Switzerland subsidiary, Fabriques de Tabac Reunies, searched for "independent" consultants to publish articles addressing SHS. The first industry-funded article was a literature review focusing on smoking and SIDS, conducted by consultant Peter Lee and co-author Allison Thornton, which stated that the association between parental smoking and SIDS could have been attributable to the failure to control fully for confounders. That first review has only been cited once, in the subsequent industry-funded review.In 1997, PM commissioned a consultant, Frank Sullivan, to write a review, with coauthor Susan Barlow, of all possible risk factors for SIDS. The first draft concluded that prenatal and postnatal smokin...

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Intervention With Parental Smokers in an Outpatient Pediatric Clinic Using Counseling and Nicotine Replacement

Cited by 79 publications

References 53 publications

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

Implementation of a Parental Tobacco Control Intervention in Pediatric Practice

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

Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry

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