Sustainability of a Parental Tobacco Control Intervention in Pediatric Practice

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Parental smoking cessation helps eliminate children' s exposure to tobacco smoke. A child' s visit to the doctor provides a teachable moment for parental smoking cessation. Effective strategies to help parents quit smoking are available for implementation.WHAT THIS STUDY ADDS: Evidence-based outpatient intervention for parents who smoke can be delivered successfully after the initial implementation. Maximizing parental quit rates in the pediatric context will require more complete and sustained systems-level integration. abstract OBJECTIVE: To determine whether an evidence-based pediatric outpatient intervention for parents who smoke persisted after initial implementation. METHODS:A cluster randomized controlled trial of 20 pediatric practices in 16 states that received either Clinical and Community Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care. The intervention provided practices with training to provide evidence-based assistance to parents who smoke. The primary outcome, assessed by the 12-month followup telephone survey with parents, was provision of meaningful tobacco control assistance, defined as discussing various strategies to quit smoking, discussing smoking cessation medication, or recommending the use of the state quitline after initial enrollment visit. We also assessed parental quit rates at 12 months, determined by self-report and biochemical verification.RESULTS: Practices' rates of providing any meaningful tobacco control assistance (55% vs 19%), discussing various strategies to quit smoking (25% vs 10%), discussing cessation medication (41% vs 11%), and recommending the use of the quitline (37% vs 9%) were all significantly higher in the intervention than in the control groups, respectively (P , .0001 for each), during the 12-month postintervention implementation. Receiving any assistance was associated with a cotinine-confirmed quitting adjusted odds ratio of 1.89 (95% confidence interval: 1.13-3.19). After controlling for demographic and behavioral factors, the adjusted odds ratio for cotinine-confirmed quitting in intervention versus control practices was 1.07 (95% confidence interval: 0.64-1.78). CONCLUSIONS:Intervention practices had higher rates of delivering tobacco control assistance than usual care practices over the 1-year follow-up period. Parents who received any assistance were more likely to quit smoking; however, parents' likelihood of quitting smoking was not statistically different between the intervention and control groups. Maximizing parental quit rates will require more complete systems-level integration and adjunctive cessation strategies. Pediatrics 2014;134:933-941

Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care

“…6 Pediatric primary care-based smoking cessation interventions can be effective in helping parents quit, but barriers have prevented further adoption and sustainability of such practices. [8][9][10] Time, recordkeeping challenges, logistical issues, scope of practice concerns, and lack of insurance reimbursement are cited as barriers to providing counseling and prescribing nicotine replacement therapy (NRT). 11,12 To address some of these concerns, professional organizations have adopted policy statements and clinical guidelines that underscore the importance of all clinicians addressing tobacco smoke exposure, including recommendations that pediatricians provide counseling and treatment to adults who expose their children to SHS.…”

Clinical Decision Support Tool for Parental Tobacco Treatment in Hospitalized Children

“…Pediatric-based smoking cessation interventions in a variety of care settings may be effective in helping parents quit, but barriers have prevented further adoption and sustainability of such practices [8][9][10]. Time, logistical issues, record-keeping challenges, scope of practice concerns, and lack of insurance reimbursement are cited as barriers to counseling and prescribing NRT [11].…”

“…Parents who smoke are receptive to receiving smoking cessation interventions when their child is hospitalized [7]. Inpatient pediatric clinicians, however, rarely provide such treatments to parents who smoke [7,8].Pediatric-based smoking cessation interventions in a variety of care settings may be effective in helping parents quit, but barriers have prevented further adoption and sustainability of such practices [8][9][10]. Time, logistical issues, record-keeping challenges, scope of practice concerns, and lack of insurance reimbursement are cited as barriers to counseling and prescribing NRT [11].…”

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

“…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]. 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 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].…”