Pediatric practices can successfully deliver parental smoking interventions

Pediatric practices can implement a tobacco dependence intervention for parents who smoke as part of routine child health outpatient care, a new study shows. In collaboration with the Pediatric Research in Outpatient Settings (PROS) research network of the American Academy of Pediatrics, investigators recruited 22 pediatric practices in 16 states that included about 2,000 parents who smoke to participate in the randomized, controlled trial, providing half the practices with the intervention. At the conclusion of the study, investigators surveyed participants to compare levels of delivering tobacco control assistance between the practices that received the intervention and those that did not.

Investigators provided the intervention practices with training and materials to enable them to provide evidence-based assistance to parents who smoke. Training was delivered in group and individual sessions and via brief clinical counseling videos that covered likely scenarios that clinicians would encounter. Also provided was an overview of strategies for integrating tobacco cessation screening, assistance, and referrals into visits with parents. Investigators then encouraged intervention practices to supply motivational messages based on parents’ own concerns as well as to exploit potential teachable moments, for example, when cued by a child’s illness; to refer to quitlines; and to recommend pharmacologic treatment of tobacco dependence. Dosing information for nicotine replacement therapy and state-specific quitline referral information were also provided to the intervention practice physicians and staff.

Compared with control practices, intervention practices had a 12-fold higher rate of delivering tobacco control assistance to parents; 42.5% of intervention group participants reported discussion of methods and strategies to quit smoking, being enrolled in a quitline, or being prescribed nicotine replacement medication, compared with only 3.5% of control practice participants (Winickoff JP, et al. Pediatrics. 2013;132[1]:109-117).

COMMENTARY  Previous studies have shown that each component of the smoking cessation intervention is effective. Rather than restudying the interventions, this study aimed at measuring the effectiveness of a program to change the practice behaviors of physicians and their staff, and it worked. After education and removal of barriers, the intervention practices were much more likely to actively take on the problem of parental smoking. The result may improve not only the parents’ physical and financial health but also the litany of conditions worsened by passive smoke exposure in children. -Michael Burke, MD

DR BURKE, section editor for Journal Club, is chairman of the Department of Pediatrics at St. Agnes Hospital, Baltimore, Maryland, He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with or financial interests in any organization that may have an interest in any part of this article.

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