Pediatric Residency Training on Tobacco

Abstract

ABSTRACT. Objective. Pediatricians have a unique role to play in the antismoking arena. However, few pediatric residency training programs prepare residents to meet the tobacco challenge. This study evaluates the effects of a comprehensive pediatric residency training program on tobacco on resident tobacco intervention behaviors, as well as on changes in the behavior of patients and their parents/guardians.Methods. Pediatric residents were exposed to a comprehensive training program on tobacco. Baseline and follow-up surveys of residents, parents/guardians, and patients were used to assess the effects of the training program. A quasi-experimental design permitted unambiguous evaluation of the program's effects on resident intervention behaviors.Results. The comprehensive training program on tobacco led to marked and significant changes in resident intervention on tobacco. Many of these changes were supported by parents' and patients' reports. In turn, resident intervention on tobacco led to a significant increase in the likelihood that parents would maintain a "smokefree household." Significant changes in the prevalence of parental smoking were not found, although the trend during 3 years of follow-up was in the desired direction. A high proportion of residents reported that they intervened on tobacco in patients at baseline and follow-up, but too few patients were sampled to permit analysis of the impact on changes in smoking.Conclusions. Comprehensive training on tobacco had a positive and powerful effect on the tobacco intervention behavior of pediatric residents. In turn, intervention on tobacco by pediatric residents may have a significant impact on patients and their parents. These findings underscore the efficacy of pediatric residency training on tobacco, and it is hoped that they will serve as an impetus for other pediatric residency programs to introduce training on tobacco. Pediatrics 2001;108(1). URL: http://www. pediatrics.org/cgi/content/full/108/1/e8; tobacco control and prevention, cigarette smoking, environmental tobacco smoke, residency training.

The pediatric residency training on tobacco project: Four-year resident outcome findings

“…Nominal values were used for the Type I and II error rates (i.e., 5% and 20%, respectively; two tailed). Based on 7 residency sites per group and approximately 25 residents per site, an estimated intraclass correlation of .005, and parameter estimates from an earlier study (Hymowitz, et al, 2001b), we were powered to detect a 0.35 difference on the our ordinal rating scales (e.g., beliefs about the effectiveness of pediatric intervention) and a difference of 22 percentage points between groups on dichotomous endpoints (e.g., percent trying to help a patient to quit). Given the relatively low power for cluster models compared to other designs, we also had adequate statistical power for withingroups logistic regression models.…”

“…When pediatricians and residents receive appropriate training, they become more confident in their ability to intervene on tobacco (Zapka, at al., 1999;Cabana, et al, 2004), more skillful in their approach (Lustig, et al, 2001;, and more effective in their impact (Hymowitz, et al, 2001b;Winickoff, et al, 2003b). In view of the need for pediatricians to play a leadership role in the anti-tobacco arena, it is important to develop and evaluate programs for training pediatric residents to address tobacco and to provide resources that may be used by programs throughout the country.…”

Smoking cessation promotion in the pediatric clinic: Increasing pediatricians’ rate of screening for second hand smoke exposure, counseling caregivers to stop smoking and referring caregivers to smoking cessation programs

“…Four studies in this review employed the NCI's "5A's": Ask caregivers if they smoke, Advise that they quit smoking, Assess readiness to quit smoking, Assist with smoking cessation efforts and Arrange for the use of smoking cessation programs (Hymowitz et al, 2008;Hymowitz et al, 2001) (Table 1) Two studies employed CEASE, a module to encourage physicians to take three steps to promote smoking cessation: ask caregivers if their child lives with anyone who smokes, assist with smoking cessation and refer caregivers to smoking cessation programs (Table 1).…”

“…Caregiver exit interviewers were used in five (Hipple et al, 2013;Hymowitz et al, 2008) (Hymowitz et al, 2001; J. D. Klein et al, 1995) while physician self-report surveys were used in four studies (Hymowitz et al, 2001; J. D. Klein et al, 1995) (Scal et al, 2004) (Collins et al, 2005) (Table 1). …”

“…Pediatric residents were the only subjects in 6 studies (Collins, D'Angelo, Stearns, & Campbell, 2005;Houston et al, 2006) (Hymowitz, Pyle, Haddock, & Schwab, 2008;Hymowitz, Schwab, & Eckholdt, 2001; J. D. Klein, Portilla, Goldstein, & Leininger, 1995;Lee et al, 2004;Scal, Hennrikus, Ehrlich, Ireland, & Borowsky, 2004), while pediatricians were the sole subjects in 2 studies (Beaty et al, 2013;Hipple, Nabi-Burza, Hall, Regan, & Winickoff, 2013) (Table 1). The effects of the intervention were investigated in both pediatricians and pediatric residents in 1 study (Sharifi et al, 2014) (Table 1).…”