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Matson PA, Bakhai N, Solomon BS, Flessa S, Ramos J, Hammond CJ, Adger H. Understanding caregiver acceptance of screening for family substance use in pediatric clinics serving economically disadvantaged children. Subst Abus 2022; 43:282-288. [PMID: 34214411 PMCID: PMC9901192 DOI: 10.1080/08897077.2021.1941510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Children of parents with substance use disorders are at greater risk for mental and physical health co-morbidities. Despite guidelines, pediatricians rarely screen for substance use in the family/household, citing fear of offending parents. The objectives of this study were to examine (1) caregiver acceptance of pediatricians screening for family/household substance use during well-child visits, (2) prevalence of family/household substance use, and (3) the association between family/household substance use and trust in their child's pediatrician. Methods: This cross-sectional study surveyed adult caregivers presenting a child for medical care at two urban pediatric outpatient clinics using a brief anonymous computer-based survey. The primary outcome measured the acceptability of pediatrician screening for family/household substance use. Substance use and concerns about use in the family/household were also assessed. Results: Adult caregivers (n = 271) surveyed were mean age 35 years, 73% mothers, 90% African American, and 85% on Medicaid. Over half (51%) of caregivers reported substance use by someone in the family/household, most commonly cigarettes (38%), followed by alcohol (19%) and marijuana (10%). Sixty-one percent of caregivers who reported family substance use expressed concern about the use of this substance. The majority (87%) agreed it is appropriate for pediatricians to ask caregivers about family/household substance use. No differences were found between caregivers who did and did not report substance use in their family/household. Caregivers with concerning substance use in their family/household were less likely to trust their pediatrician [OR = 0.21, 95%CI: 0.05, 0.85] Conclusions: Caregivers endorsed acceptance of universal screening for substance use, including illicit substances, and substance use disorders in the family/household during well-child visits. Pediatricians are trusted professionals with expertise in communicating with parents to maximize the health of their patients; assessing family history of substance use and substance use disorders is a natural extension of their role.
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Affiliation(s)
| | | | | | - Sarah Flessa
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Hoover Adger
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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2
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Scheffers-van Schayck T, Hipple Walters B, Otten R, Kleinjan M. Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study. BMC Health Serv Res 2021; 21:973. [PMID: 34530809 PMCID: PMC8444610 DOI: 10.1186/s12913-021-06969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. Methods Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. Results The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. Conclusions Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands. .,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands.
| | - Bethany Hipple Walters
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Roy Otten
- Clinical Developmental Psychology, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands
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3
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Tobacco Use as a Health Disparity: What Can Pediatric Clinicians Do? CHILDREN-BASEL 2019; 6:children6020031. [PMID: 30791653 PMCID: PMC6406965 DOI: 10.3390/children6020031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 01/12/2023]
Abstract
Tobacco use is a global health crisis, and has a tremendous and negative impact on health and wellbeing. Tobacco use disproportionately affects members of vulnerable populations, and by acting on multiple socioecological levels, serves to perpetuate and reinforce cycles of poverty. Members of the pediatric medical community can play a key role in interrupting cycles of tobacco use. Providers can serve as powerful allies to vulnerable communities by treating tobacco use in caregivers, counseling youth against using tobacco products, protecting children from the impact of secondhand smoke exposure, and advocating for economic, social, and health policies to disrupt intergenerational smoking.
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A Cross-Sectional Study of Smoking Behaviors and Attitudes of Parents in Pediatric Primary Care Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071384. [PMID: 30004403 PMCID: PMC6068974 DOI: 10.3390/ijerph15071384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/17/2018] [Accepted: 06/19/2018] [Indexed: 11/24/2022]
Abstract
Environmental tobacco smoke (ETS) exposure is considered an important public health issue in pediatric population. In this study, we aimed to investigate parents’ knowledge on side effects of passive smoking and counseling for parental smoking among pediatricians and family practitioners. Participants were biological parents of pediatric patients up to the age of 18 years old who attended Pediatric Hospital of Medical University of Warsaw. The questionnaire included 28 questions and queries on environmental tobacco smoke in children’s environment. Medical students identified potential subjects and handed out previously created questionnaires. In total, 506 parents of children aged 0–18 years old were interviewed; 41% (207/506) of parents were smokers, 23% (114/506) were asked about ETS exposure by their pediatricians and 41% (205/506) by family physicians during routine visits. Only a minority of the respondents confirmed having “no smoking” policy in their car 31% (157/506) or in their households 24% (121/506). All parents believed that passive smoking could cause at least one harmful effect: most common were more frequent respiratory infections (43%), asthma (40%), and low birth weight (37%). Among smoking parents, 38% (78/207) has tried to quit smoking for their child’s health sake; 63% (131/207) of smokers have never been asked to quit smoking by their doctor. Parents’ understanding of passive smoking among children differs from current medical knowledge. Rates of screening and counseling for parental smoking in pediatric and family practices are still unsatisfactory.
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5
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Jenssen BP, Bryant-Stephens T, Leone FT, Grundmeier RW, Fiks AG. Clinical Decision Support Tool for Parental Tobacco Treatment in Primary Care. Pediatrics 2016; 137:peds.2015-4185. [PMID: 27244817 DOI: 10.1542/peds.2015-4185] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We created a clinical decision support (CDS) tool and evaluated its feasibility, acceptability, usability, and clinical impact within the electronic health record to help primary care pediatricians provide smoking cessation treatment to parents/caregivers who smoke. METHODS This prospective study of pediatric clinicians and parents was conducted at 1 urban primary care site. Clinicians received training in smoking cessation counseling, nicotine replacement therapy (NRT) prescribing, referral to an adult treatment program, and use of the CDS tool. The tool prompted clinicians to ask about secondhand smoke exposure, provide an electronic NRT prescription, and refer. Feasibility was measured by using electronic health record utilization data, and acceptability and usability were assessed with the use of clinician surveys. Parents reported clinical impact, including NRT accepted and used. RESULTS From June to August 2015, clinicians used the tool to screen for secondhand smoke exposure at 2286 (76%) of 3023 visits. Parent smokers were identified at 308 visits, and 165 parents (55% of smokers) were interested in and offered treatment. Twenty-four (80%) of 30 eligible pediatric clinicians used the tool. Ninety-four percent of clinicians surveyed (n = 17) were satisfied with the tool, and the average system usability scale score was 83 of 100 (good to excellent range). We reached 69 of 100 parents sampled who received treatment; 44 (64%) received NRT, and 17 (25%) were currently using NRT. CONCLUSIONS A CDS tool to help urban primary care pediatric clinicians provide smoking cessation treatment was feasible, acceptable, usable, and influenced clinical care. A larger scale investigation in varied practice settings is warranted.
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Affiliation(s)
- Brian P Jenssen
- Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - Tyra Bryant-Stephens
- Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Robert W Grundmeier
- Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania School of Medicine, and Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA; and
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Robinson LA, Clawson AH, Weinberg JA, Salgado-Garcia FI, Ali JS. Physician Intervention for Improving Tobacco Control Among Parents Who Use Tobacco. Clin Pediatr (Phila) 2015; 54:1044-50. [PMID: 25609099 DOI: 10.1177/0009922814567304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has demonstrated that parents who smoke are often inadvertent sources of their children's first cigarettes. Teaching parents to restrict their tobacco may give pediatricians another method for helping parents who are not ready to quit smoking. This purpose of this study was to determine the feasibility of a program training pediatricians to discuss tobacco control with smoking parents and to examine changes in parents' tobacco control after the physician intervention. One month after the intervention by pediatricians, parents reported significantly improved tobacco control. They were more likely to count their packs and cigarettes and to keep their tobacco products at work and on their person. Parents reported restricting household control of adult smoking, and children were exposed to significantly less secondhand smoke. These results showed that it is possible to integrate advice about tobacco control into a busy pediatric practice and to improve parents' restrictions of their tobacco products.
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7
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Zachek CM, Miller MD, Hsu C, Schiffman JD, Sallan S, Metayer C, Dahl GV. Children's Cancer and Environmental Exposures: Professional Attitudes and Practices. J Pediatr Hematol Oncol 2015; 37:491-7. [PMID: 26334434 PMCID: PMC4571458 DOI: 10.1097/mph.0000000000000416] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 07/23/2015] [Indexed: 12/03/2022]
Abstract
BACKGROUND Epidemiologic studies worldwide have provided substantial evidence of the contributions of environmental exposures to the development of childhood cancer, yet this knowledge has not been integrated into the routine practice of clinicians who care for children with this disease. To identify the basis of this deficit, we sought to assess the environmental history-taking behavior and perceptions of environmental health among pediatric hematologists and oncologists. PROCEDURE A web-based survey was sent from June to October 2012 to 427 pediatric oncologists, fellows, and nurse practitioners from 20 US institutions, with an overall response rate of 45%. RESULTS Survey responses indicated that environmental exposures are of concern to clinicians. The vast majority of respondents (88%) reported receiving questions from families about the relationship between certain environmental exposures and the cancers they regularly treat. However, a lack of comfort with these topics seems to have limited their discussions with families about the role of environmental exposures in childhood cancer pathogenesis. Although 77% of respondents suspected that some of the cases they saw had an environmental origin, their methods of taking environmental histories varied widely. Over 90% of respondents believed that more knowledge of the associations between environmental exposures and childhood cancer would be helpful in addressing these issues with patients. CONCLUSIONS Although limited in size and representativeness of participating institutions, the results of this survey indicate a need for increased training for hematology/oncology clinicians about environmental health exposures related to cancer and prompt translation of emerging research findings in biomedical journals that clinicians read.
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Affiliation(s)
- Christine M. Zachek
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco
| | - Mark D. Miller
- Western States Pediatric Environmental Health Specialty Unit, University of California San Francisco, San Francisco
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
| | | | - Joshua D. Schiffman
- Department of Pediatrics, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - Catherine Metayer
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
| | - Gary V. Dahl
- Center for Integrative Research on Childhood Leukemia and the Environment, University of California Berkeley, Berkeley
- Stanford University School of Medicine, Stanford, CA
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Roberts JR, Basco WT, Hulsey TC, Ebeling MD, O’Brien E, Alberg AJ. Prevalence of Parental Smoking and Predictors of Cessation: A Study in the South Carolina Pediatric Practice Research Network. Clin Pediatr (Phila) 2015; 54:847-52. [PMID: 25520365 PMCID: PMC4469622 DOI: 10.1177/0009922814563270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secondhand smoke exposure harms children. The objectives of the study were to determine the prevalence of secondhand smoke exposure in children ≤2 years and determine the predictors of smoking and smoking cessation in parents. METHODS We surveyed parents of children ≤2 years of age, asking about parental smoking patterns, interest in quitting and children's respiratory symptoms. Data were analyzed with chi-square and multiple logistic regression. RESULTS Thirteen percent were current smokers and 18% had quit. The most common reason for quitting was being pregnant (42%). Children's respiratory symptoms did not predict quitting. Parents on Medicaid were more likely to smoke than those on private insurance (OR = 5.7, 95% CI = 2.0-16.5) and less likely to quit (OR = 0.2, 95% CI = 0.1-0.9). CONCLUSION Having a new baby may be a motivator for parents to quit. We must address socioeconomic factors to develop a successful intervention in pediatric practices.
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9
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Omoloja A, Tyc VL. Tobacco and the pediatric chronic kidney disease population. Pediatr Nephrol 2015; 30:235-43. [PMID: 24890336 DOI: 10.1007/s00467-014-2804-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/27/2014] [Accepted: 02/28/2014] [Indexed: 01/18/2023]
Abstract
Tobacco use and exposure are preventable causes of morbidity and mortality. Whereas the impact of this public health issue is well described in adults with kidney disease, its role in the pediatric chronic kidney disease (CKD) population is largely unknown. This review discusses the prevalence of tobacco use and exposure in children with CKD, updates the reader on how tobacco affects the kidney, and presents intervention strategies relevant to this patient population.
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Affiliation(s)
- Abiodun Omoloja
- Department of Pediatrics, One Children's Plaza, Wright State University, Dayton, OH, 45404, USA,
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Hutchinson SG, Kuijlaars JS, Mesters I, Muris JWM, van Schayck CP, Dompeling E, Feron FJM. Addressing passive smoking in children. PLoS One 2014; 9:e93220. [PMID: 24809443 PMCID: PMC4014468 DOI: 10.1371/journal.pone.0093220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/04/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A significant number of parents are unaware or unconvinced of the health consequences of passive smoking (PS) in children. Physicians could increase parental awareness by giving personal advice. AIM To evaluate the current practices of three Dutch health professions (paediatricians, youth health care physicians, and family physicians) regarding parental counselling for passive smoking (PS) in children. METHODS All physicians (n = 720) representing the three health professions in Limburg, The Netherlands, received an invitation to complete a self-administered electronic questionnaire including questions on their: sex, work experience, personal smoking habits, counselling practices and education regarding PS in children. RESULTS The response rate was 34%. One tenth (11%) of the responding physicians always addressed PS in children, 32% often, 54% occasionally and 4% reported to never attend to it. The three health professions appeared comparable regarding their frequency of parental counselling for PS in children. Addressing PS was more likely when children had respiratory problems. Lack of time was the most frequently mentioned barrier, being very and somewhat applicable for respectively 14% and 43% of the physicians. One fourth of the responders had received postgraduate education about PS. Additionally, 49% of the responders who did not have any education about PS were interested in receiving it. CONCLUSIONS Physicians working in the paediatric field in Limburg, The Netherlands, could more frequently address PS in children with parents. Lack of time appeared to be the most mentioned barrier and physicians were more likely to counsel parents for PS in children with respiratory complaints/diseases. Finally, a need for more education on parental counselling for PS was expressed.
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Affiliation(s)
- Sasha G. Hutchinson
- Department of Paediatric Pulmonology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
- * E-mail:
| | - Jennifer S. Kuijlaars
- Department of Paediatric Pulmonology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Ilse Mesters
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jean W. M. Muris
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Constant P. van Schayck
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Edward Dompeling
- Department of Paediatric Pulmonology, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Frans J. M. Feron
- Department of Social Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands
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Bunik M, Cavanaugh KL, Herrick D, Mehner L, Venugopalakrishnan J, Crane LA, Puma J. The ONE step initiative: quality improvement in a pediatric clinic for secondhand smoke reduction. Pediatrics 2013; 132:e502-11. [PMID: 23858424 DOI: 10.1542/peds.2011-1271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Although comprehensive smoking counseling to limit secondhand smoke (SHS) is widely endorsed, it is often not done. Published evaluations of brief and practical systems that improve screening and counseling to reduce SHS are limited. Our objective was to determine if a quality improvement activity around smoking counseling leads to changes in (1) medical assistant and pediatric provider assessment of smoking history and (2) smoking or other behaviors affecting children's SHS exposure. METHODS In a large urban teaching clinic we assessed the ONE Step intervention, which included the following: (1) "Ask" (medical assistant asking whether caregivers smoke); (2) "Advise" (providers advising smoking outside and quitting if ready); (3) "Refer" (providers referring to the Colorado telephone QuitLine); and (4) electronic medical record prompts and required documentation regarding smoking. Medical assistant and provider assessments of smoking were evaluated with a chart review by using a pre-/posttest design. Caregiver behavior change was evaluated with a time-series survey that included assessment at baseline and follow-up via telephone at 6 and 12 months from study entry. RESULTS ONE Step was associated with a statistically significant increase in Ask, Advise, and Refer documentation. Caregiver surveys showed that 97% found discussions of SHS with providers acceptable. Six- and 12-month follow-ups, respectively, showed that 14% and 13% of smokers reported quitting and that 63% and 70% of current smokers reported reduced SHS exposure. CONCLUSIONS ONE Step was feasible to deliver in a busy outpatient setting, acceptable to families, and appears to have resulted in decreased exposure to SHS in our pediatric population.
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA.
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Carlsson N, Johansson A, Hermansson G, Andersson-Gäre B. Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care. J Child Health Care 2011; 15:272-86. [PMID: 21078698 DOI: 10.1177/1367493510382243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to describe parents' attitudes to smoking and their experience of the tobacco preventive work in antenatal care and in Child Health Care (CHC) in Sweden. A population based survey in which 62 percent of 3000 randomly selected parents with 1- and 3-year-old children answered a questionnaire. Fifty-six percent stated that smoking was registered in the health record of the child yet no further discussion regarding passive smoking took place. The parents' educational level and smoking status was related to the attitudes and experiences of the tobacco preventive work. The results indicated that the dialogue with parents regarding children and environmental tobacco smoke (ETS) exposure has to be redesigned and intensified in order to meet the needs of parents with different backgrounds.
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Affiliation(s)
- Noomi Carlsson
- Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Calabro KS, Costello TC, Prokhorov AV. Denormalization of Tobacco Use and the Role of the Pediatric Health-Care Provider. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2010. [DOI: 10.1089/ped.2010.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karen S. Calabro
- Division of Cancer Prevention and Population Studies, Department of Behavioral Science, M.D. Anderson Cancer Center, Houston, Texas
| | - Tamara C. Costello
- Department of Behavioral Science, M.D. Anderson Cancer Center, Houston, Texas
| | - Alexander V. Prokhorov
- Tobacco Outreach Education Program, Department of Behavioral Science, The UT M.D. Anderson Cancer Center, Houston, Texas
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14
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Best D. From the American Academy of Pediatrics: Technical report--Secondhand and prenatal tobacco smoke exposure. Pediatrics 2009; 124:e1017-44. [PMID: 19841110 DOI: 10.1542/peds.2009-2120] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Secondhand tobacco smoke (SHS) exposure of children and their families causes significant morbidity and mortality. In their personal and professional roles, pediatricians have many opportunities to advocate for elimination of SHS exposure of children, to counsel tobacco users to quit, and to counsel children never to start. This report discusses the harms of tobacco use and SHS exposure, the extent and costs of tobacco use and SHS exposure, and the evidence that supports counseling and other clinical interventions in the cycle of tobacco use. Recommendations for future research, policy, and clinical practice change are discussed. To improve understanding and provide support for these activities, the harms of SHS exposure are discussed, effective ways to eliminate or reduce SHS exposure are presented, and policies that support a smoke-free environment are outlined.
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Lucero CA, Moss DR, Davies ED, Colborn K, Barnhart WC, Bogen DL. An examination of attitudes, knowledge, and clinical practices among Pennsylvania pediatricians regarding breastfeeding and smoking. Breastfeed Med 2009; 4:83-9. [PMID: 19210131 PMCID: PMC2981379 DOI: 10.1089/bfm.2008.0119] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE The most recent American Academy of Pediatrics policy statement clearly supports breastfeeding for smoking mothers. The impact of this recommendation on pediatricians' counseling and prescribing practices is unclear. This study describes Pennsylvania pediatricians' attitudes, knowledge, and practices regarding breastfeeding, maternal smoking, and smoking cessation. METHODS A descriptive study was conducted using a web-based, anonymous survey. The survey consisted of three clinical vignettes followed by knowledge and attitude questions. RESULTS Among 296 respondents, more than half reported one or more conversations about breastfeeding and smoking in the past year. Most were comfortable counseling on breastfeeding, but few were comfortable counseling about smoking and breastfeeding. Respondents scored poorly on five knowledge items; 27% answered zero items correctly, and only 21% answered four or five items correctly. Less than half reported breastfeeding was safe for smoking mothers. Compared to pediatricians with high knowledge scores, those with a low score were less likely to tell a smoking mother that breastfeeding is safe (38% vs. 69%, p < 0.01) and more likely to recommend formula feeding (19% vs. 3%, p < 0.01). Most pediatricians were uncertain about the safety of nicotine replacement therapy and bupropion (Zyban, GalxoSmithKline, Research Triangle Park, NC) with breastfeeding. CONCLUSIONS Pennsylvania pediatricians lack knowledge and comfort related to the topic of breastfeeding and maternal smoking. Additional efforts to inform and educate pediatricians on the subjects of breastfeeding, maternal tobacco use, and smoking cessation products are needed.
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Affiliation(s)
- Cynthia A Lucero
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Ewing LJ, Cluss P, Goldstrohm S, Ulrich R, Colborn K, Cipriani L, Wald ER. Translating an evidence-based intervention for pediatric overweight to a primary care setting. Clin Pediatr (Phila) 2009; 48:397-403. [PMID: 19164134 DOI: 10.1177/0009922808330109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to train pediatric providers to address weight, body mass index (BMI), diet, and physical activity with parents. Children aged 8 to 12 years with BMI of >or=85th percentile were eligible if accompanied by a parent. The intervention was a family-based, 11-session behavioral program focusing on healthy eating and physical activity. Outcome measures were weight and BMI. Seventy-three child-parent dyads enrolled. Children who attended at least 6 of 8 intervention sessions and 1 of 3 follow-up sessions (completers) lost an average of 2.84 lb; change in BMI z scores was statistically significant at 5 months (P < .001). Primary care providers can acquire skills to increase their confidence in approaching children and parents regarding weight and BMI. Parents and children will attend an intervention targeting healthy weight in the pediatric practice. Professional office staff can be trained to provide an evidence-informed intervention that promotes healthy weight.
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Affiliation(s)
- Linda J Ewing
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15317, USA.
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Moss DR, Cluss PA, Watt-Morse M, Pike F. Targeting pregnant and parental smokers: Long-term outcomes of a practice-based intervention. Nicotine Tob Res 2009; 11:278-85. [DOI: 10.1093/ntr/ntn035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Winickoff JP, Park ER, Hipple BJ, Berkowitz A, Vieira C, Friebely J, Healey EA, Rigotti NA. Clinical effort against secondhand smoke exposure: development of framework and intervention. Pediatrics 2008; 122:e363-75. [PMID: 18676523 PMCID: PMC2774730 DOI: 10.1542/peds.2008-0478] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to describe a novel process and present results of formative research to develop a pediatric office intervention that uses available systems of care for addressing parental smoking. METHODS The scientific development of the intervention occurred in 3 stages. In stage 1, we designed an office system for parental tobacco control in the pediatric outpatient setting on the basis of complementary conceptual frameworks of preventive services delivery, conceptualized for the child health care setting through a process of key interviews with leaders in the field of implementing practice change; existing Public Health Service guidelines that had been shown effective in adult practices; and adaptation of an evidence-based adult office system for tobacco control. This was an iterative process that yielded a theoretically framed intervention prototype. In stage 2, we performed focus-group testing in pediatric practices with pediatricians, nurses, clinical assistants, and key office staff. Using qualitative methods, we adapted the intervention prototype on the basis of this feedback to include 5 key implementation steps for the child health care setting. In stage 3, we presented the intervention to breakout groups at 2 national meetings of pediatric practitioners for additional refinements. RESULTS The main result was a theoretically grounded intervention that was responsive to the barriers and suggestions raised in the focus groups and at the national meetings. The Clinical Effort Against Secondhand Smoke Exposure intervention was designed to be flexible and adaptable to the particular practices' staffing, resources, and physical configuration. Practice staff can choose materials relevant to their own particular systems of care (www.ceasetobacco.org). CONCLUSIONS Conceptually grounded and focus-group-tested strategies for parental tobacco control are now available for implementation in the pediatric outpatient setting. The tobacco-control intervention-development process might have particular relevance for other chronic pediatric conditions that have a strong evidence base and have available treatments or resources that are underused.
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Affiliation(s)
- Jonathan P. Winickoff
- MGH Center for Child and Adolescent Health Policy, Boston, MA,MGH Tobacco Research and Treatment Center, Boston, MA
| | - Elyse R. Park
- MGH Tobacco Research and Treatment Center, Boston, MA
| | - Bethany J. Hipple
- MGH Center for Child and Adolescent Health Policy, Boston, MA,MGH Tobacco Research and Treatment Center, Boston, MA
| | - Anna Berkowitz
- MGH Center for Child and Adolescent Health Policy, Boston, MA
| | - Cecilia Vieira
- MGH Center for Child and Adolescent Health Policy, Boston, MA,MGH Tobacco Research and Treatment Center, Boston, MA
| | - Joan Friebely
- MGH Center for Child and Adolescent Health Policy, Boston, MA,MGH Tobacco Research and Treatment Center, Boston, MA
| | - Erica A. Healey
- MGH Center for Child and Adolescent Health Policy, Boston, MA,MGH Tobacco Research and Treatment Center, Boston, MA
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