1. A 12-fold higher rate of delivering tobacco cessation programs to parents in child healthcare settings was seen in the intervention group.
2. Intervention group physicians were five times more likely to deliver assistance to parents.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Parental smoking cessation is essential in the prevention of childhood tobacco smoke exposure and its sequelae. While young adults who smoke are often not seen by their primary care physician, parents visit their child’s pediatrician several times each year. Researchers in the current study investigated the effectiveness of implementing an evidence-based smoking cessation strategy for parents, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention, during pediatric outpatient visits. This randomized trial demonstrated that physicians in the intervention group were more likely to provide smoking cessation information to parents who were smokers. Parents attending these intervention practices were significantly more likely to receive information regarding nicotine replacement therapy, alternative strategies to smoking cessation, and recommendations to contact a telephone quitline than those who did not go to practices using the intervention. The CEASE program can be effectively implemented in the pediatric outpatient setting, and may be successful in reducing childhood tobacco smoke exposure.
Study Author, Dr. Jonathan P. Winickoff, MD, MPH, talks to 2 Minute Medicine: Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital for Children.
“Protection of children from the dangers of household tobacco smoke exposure includes helping parents quit smoking. Parents who quit smoking decrease the chances that their own children will grow up to be smokers, so interventions to reduce the number of parents who smoke can decrease the number of future smokers. This cluster randomized controlled effectiveness trial demonstrated that the CEASE intervention program could be successfully implemented in the child healthcare setting. Practices in the intervention group had a 12-fold higher rate of delivering tobacco control assistance to parents compared to practices in the control group, without the use of research staff to deliver the clinical intervention. Furthermore, this outcome is attributable to most physicians in the intervention practices delivering assistance to parents who smoke, supporting the conclusion that the change was truly at the system level and not simply a few physicians in each practice accounting for the demonstrated change.”
In-Depth [cluster randomized controlled study]: A total of 22 pediatric practices from the American Academy of Pediatrics practice-based research network, Pediatric Research in Office Settings (PROS), were randomized into intervention and control groups. Intervention group physicians were individually trained to implement the three-step CEASE program, which includes 1) routine screening for parental tobacco use, 2) motivational encouragement, and 3) recommendation or provision of nicotine replacement therapy, along with information or enrollment in the free, state tobacco quitline. All participating parents completed a 14-item survey on provision of tobacco control services during the office visit. Outcomes were compared between 981 smoking parents in the control group and 999 in the intervention group. The mean for parental smokers receiving any tobacco control assistance was 42.5% in the intervention group vs. 3.5% in the control group. The intervention practices had a significantly higher rate of providing counseling beyond simple advice by discussing various methods and strategies to quit smoking, prescribing nicotine replacement medication, and enrolling parents in the quitline (all outcomes p ≤ .001). Approximately 77% of physicians in intervention practices offered assistance compared to only 14% of physicians in the control practices.
By Brandon Childs and Leah H. Carr
Reviewed by William V. Raszka, MD
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