Parent Preferences for Pediatric Clinician Messaging to Promote Smoking Cessation Treatment

Abstract

BACKGROUND AND OBJECTIVES: Insights from behavioral economics suggests that the effectiveness of health messages depends on how a message is framed. Parent preferences for smoking cessation messaging has not been studied in pediatrics, warranting further exploration to maximize benefit. We sought to assess parents' perceptions regarding the relative importance of distinct message framings to promote their smoking cessation.METHODS: We conducted a cross-sectional discrete choice experiment in which parent smokers rated the relative importance of 26 messages designed to encourage them to begin cessation treatment. Messages varied on who was featured (child, parent, or family), whether the message was gain or loss framed, and what outcome was included (general health, cancer, respiratory illnesses, child becoming a smoker, or financial impact). The participants were 180 parent smokers attending primary care visits with their children at 4 diverse pediatric sites. The main outcome was the importance of smoking cessation messages based on who was featured, gain or loss framing, and the outcome emphasized.RESULTS: Parent smokers highly prioritized cessation messages emphasizing the impact of quitting smoking on their child versus parent or family. Messages focusing on respiratory illness, cancer, or general health outcomes consistently ranked highest, whereas messages focused on the financial benefits of quitting ranked lowest. Gain versus loss framing did not meaningfully influence rankings.CONCLUSIONS: Parent smokers identified smoking cessation messages that emphasized the impact on their child, with outcomes focused on respiratory health, cancer, or general health, as most important. The clinical impact of these messages should be tested in future research.WHAT'S KNOWN ON THIS SUBJECT: Insights from behavioral economics suggest that effectiveness of health messages depends on how a message is framed. Parent preferences for smoking cessation messaging has not been studied in pediatrics, warranting further exploration to maximize benefit.WHAT THIS STUDY ADDS: In this discrete choice experiment in which 180 parent smokers rated the relative importance of different messages, parents rated messages that emphasized the impact of smoking on their child as most likely to prompt acceptance of cessation treatment.

Electronic Health Record-Embedded, Behavioral Science-Informed System for Smoking Cessation for the Parents of Pediatric Patients

“…Participant interactions with iterative system prototypes helped identify how to make these key functions acceptable and usable. Parents valued motivational messages, informed by behavioral science, that focused on the benefits of smoking cessation to their child's health 11,12 and simple, easy-to-understand explanations of treatment options. Pediatric clinicians valued automation of parent screening, treatment, and documentation with simple guidance on key conversation prompts that support treatment.…”

“…In pediatric settings, tobacco use treatment messages that emphasize the impact of smoking to parents on their child may increase acceptance of cessation treatment. 11 12 Effective messages and interventions for parental tobacco use treatment can be systematized through electronic health records' (EHRs') clinical decision support (CDS) systems. These systems are effective in improving health care process measures across a wide variety of care settings.…”

Pediatrician intervention impacts parental smoking in cystic fibrosis, diabetes, and bronchiolitis

“…Jenssen et al 11 showed that parent smokers identified the most important smoking cessation message for motivating a smoking cessation attempt to be those that emphasized the impact on their child's health. The fact that parents of children suffering from respiratory disease were more likely to quit smoking may, therefore, be a consequence of their concern for their child's respiratory health.…”

“…Pediatricians can be particularly influential since they intervene at the time when parents are seeking to improve their child's state of health. As recently established by Jenssen et al, 11 the benefit on their child's health is the main motivation for parents to quit smoking.…”

A Clinical Decision Support System for Motivational Messaging and Tobacco Cessation Treatment for Parents: Pilot Evaluation of Use and Acceptance

“…In pediatric settings, tobacco use treatment messages to parents that emphasize the impact of smoking on their child may increase acceptance of cessation treatment. 11,12 Prior research suggests that messages to parents about their smoking should focus on child health rather than, for example, the financial impact of smoking. 11 Incorporating foundational elements of motivational interviewing, framing conversations to address concerns unique to parents, can increase engagement and intrinsic motivation as well as perceived clinician empathy.…”