August 16, 2019
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Smoking intervention at pediatrician’s office helps parents quit

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Pediatricians can help parents quit smoking by routinely screening them for tobacco use and offering them cessation assistance during their child’s appointment, study findings published in JAMA Pediatrics suggest.

Study author Emara Nabi-Burza, MBBS, MS, senior clinical research coordinator at Massachusetts General Hospital for Children in Boston, noted that most parents who smoke want to quit smoking, and that all child health care providers want to protect children from exposure to tobacco smoke.

“However, there remains a systemic gap where parents seen in the context of a pediatric visit are not provided assistance to quit smoking,” Nabi-Burza told Infectious Diseases in Children.

“The Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention proved effective in bridging this gap by creating a simple, innovative and efficient way to screen families for tobacco use before they saw their child’s doctor,” Nabi-Burza explained. “This helped parents wanting to quit receive the assistance they need from their child’s doctor in the form of prescriptions for nicotine patches and gum, enrollment in the state’s free tobacco quit line and the [National Cancer Institute’s] free texting program, SmokefreeTXT.”

Photo of man smoking a cigarette 
Source: Shutterstock

Clinic visits provide pediatricians the opportunity to create a teachable moment to help smoking parents quit smoking and improve the health of their children, Nabi-Burza added.

Nabi-Burza and colleagues conducted a cluster randomized clinical trial to determine the effectiveness of the practice-based intervention CEASE, in which staff distributed a tablet-based household tobacco screening instrument to parents at each visit during check-in or before seeing the health care professional. They conducted the trial from April 2015 to October 2017 at 10 pediatric practices in five states. The practices were randomly assigned to either implement the CEASE protocol or maintain usual care as the control group. In their analysis, the researchers included all parents who screened positive for tobacco use by exit survey at 2 weeks after the intervention implementation and again 2 years later. The data analysis occurred from January 2018 to March 2019, according to the study.

The primary outcome was delivery of “meaningful tobacco treatment,” which the researchers defined as “the prescription of nicotine replacement therapy or quit line enrollment.” They also assessed changes in practice-level smoking prevalence and cotinine-confirmed quit rates over the 2 years of the intervention.

Nabi-Burza and colleagues screened a total of 8,184 parents after their child’s visit 2 weeks after CEASE implementation. Of these, the researchers identified 961 (27.1%) parents enrolled at intervention practices and 1,103 (23.9%) enrolled at control practices as current smokers.

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A total of 822 and 701 eligible parents, respectively, completed the survey in intervention and control practices. Of these, 364 in the intervention practices (44.3%) received meaningful treatment at that visit, vs. one in a control practice (0.1%) (risk difference, 44%; 95% CI, 9.8%-84.8%).

At 2 years, 9,794 parents were screened, of whom 1,261 (24.4%) in intervention practices and 1,149 (25%) in control practices were identified as currently smoking, according to the study. The researchers reported that 804 and 727 eligible parents, respectively, completed the survey in intervention and control practices, of whom 113 in the intervention practices (14.1%) vs. two in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8%; 95% CI, 3.3%-37.8%).

The researchers found that the change in smoking prevalence over the 2 years of CEASE favored the intervention over usual care (–2.7% vs. 1.1%; difference, –3.7%; 95% CI, –6.3% to –1.2%), as did the cotinine-confirmed quit rate (2.4% vs. –3.2%; difference, 5.5%; 95% CI, 1.4%-9.6%).

In a related editorial, Peter F. Belamarich, MD, and Andrew D. Racine, MD, PhD, both from the department of pediatrics at Albert Einstein College of Medicine in Bronx, New York, wrote that although the study achieved modest reductions, they were noteworthy because of the size and quality of the study, the direct involvement of practice staff in CEASE and the use of a biomarker to confirm quit rates.

“Identifying an appropriate target audience for smoking cessation guidance will over time assume its place in the pantheon of well-child visit priorities as different practices assess competing priorities for the limited time available in these visits,” they wrote. – by Joe Gramigna

Disclosures: Belamarich, Nabi-Burza and Racine report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.