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Mahabee-Gittens EM, Southworth H, Kranich C, Lorenz A, Arnold MW, Gittelman MA. Assessment of the Smoke Free Families Tobacco Screening, Counseling, and Referral Program in Pediatric Primary Care Practices. Acad Pediatr 2024; 24:277-283. [PMID: 37245665 PMCID: PMC10676440 DOI: 10.1016/j.acap.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The Smoke Free Families (SFF) program trained pediatric providers to use an SFF tool during well-child visits (WCVs) of infants ≤12 months to "Ask" caregivers about tobacco use, "Advise" smokers to quit, and "Refer" smokers to cessation services (AAR). The primary objectives were to assess the prevalence and changes in caregiver tobacco use after being screened and counseled by providers using the SFF tool. A secondary objective was to examine providers' AAR behavior facilitated by using the SFF tool. METHODS Pediatric practices participated in 1 of 3 6-9-month SFF program waves. Over the 3 waves, all initial SFF tools completed on caregivers during their infant's WCV were evaluated for the caregiver and household tobacco use and providers' AAR rates. An infant's first and next WCV was matched to determine changes in caregiver tobacco product use. RESULTS In total, the SFF tool was completed at 19,976 WCVs; 2081 (18.8%) infants were exposed to tobacco smoke. A total of 834 (74.1%) caregivers who smoked received counseling: 786 (69.9%) were advised to quit, 700 (62.2%) were given cessation resources, and 198 (17.6%) were referred to the Quitline. In total, 230 (27.6%) of caregivers who smoked had a second visit; 58 (25.2%) self-reported that they quit using tobacco. Among cigarette users (n = 183), 89 (48.6%) reported that they used fewer cigarettes or quit at their infants' second WCV. CONCLUSIONS Systematic use of the SFF AAR tool during infants' WCVs could improve the health of caregivers and children, resulting in decreases in tobacco-related morbidity.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine (EM Mahabee-Gittens and MA Gittelman), Cincinnati Children's Hospital Medical Center, Ohio; University of Cincinnati (EM Mahabee-Gittens and MA Gittelman), College of Medicine, Ohio.
| | - Hayley Southworth
- Ohio Chapter (H Southworth, MW Arnold, and MA Gittelman), American Academy of Pediatrics, Columbus
| | - Christiana Kranich
- Ohio Colleges of Medicine (C Kranich and A Lorenz), Government Resource Center, Columbus
| | - Allison Lorenz
- Ohio Colleges of Medicine (C Kranich and A Lorenz), Government Resource Center, Columbus
| | - Melissa Wervey Arnold
- Ohio Chapter (H Southworth, MW Arnold, and MA Gittelman), American Academy of Pediatrics, Columbus
| | - Michael A Gittelman
- Division of Emergency Medicine (EM Mahabee-Gittens and MA Gittelman), Cincinnati Children's Hospital Medical Center, Ohio; University of Cincinnati (EM Mahabee-Gittens and MA Gittelman), College of Medicine, Ohio; Ohio Chapter (H Southworth, MW Arnold, and MA Gittelman), American Academy of Pediatrics, Columbus
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Counseling Tobacco Smoke Exposure Reduction Measures in Pediatrics: A Quality Improvement Project. Pediatr Qual Saf 2022; 7:e588. [PMID: 36128331 PMCID: PMC9478329 DOI: 10.1097/pq9.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
With over 40% of children in the USA exposed to tobacco smoke, the AAP recommends tobacco smoke exposure (TSE) assessment during clinic visits. We aimed to increase the rates of TSE screening and provider counseling regarding TSE reduction using an evidence-based approach.
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Siddiqi AD, Britton M, Chen TA, Carter BJ, Wang C, Martinez Leal I, Rogova A, Kyburz B, Williams T, Patel M, Reitzel LR. Tobacco Screening Practices and Perceived Barriers to Offering Tobacco Cessation Services among Texas Health Care Centers Providing Behavioral Health Treatment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9647. [PMID: 35955001 PMCID: PMC9367734 DOI: 10.3390/ijerph19159647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 05/11/2023]
Abstract
Tobacco use, and thus tobacco-related morbidity, is elevated amongst patients with behavioral health treatment needs. Consequently, it is important that centers providing health care to this group mandate providers' use of tobacco screenings to inform the need for tobacco use disorder intervention. This study examined the prevalence of mandated tobacco screenings in 80 centers providing health care to Texans with behavioral health needs, examined key factors that could enhance screening conduct, and delineated providers' perceived barriers to tobacco use intervention provision. The results indicated that 80% of surveyed centers mandated tobacco use screenings; those that did were significantly more likely than those that did not to have a hard stop for tobacco use status in health records and were marginally more likely to make training on tobacco screening available to providers. The most widespread barriers to tobacco use disorder care provision were relative perceived importance of competing diagnoses, lack of community resources to refer patients, perceived lack of time, lack of provider knowledge or confidence, and belief that patients do not comply with cessation treatment. Overall, the results suggest that there are opportunities for centers providing care to Texans with behavioral health needs to bolster their tobacco screening and intervention capacity to better address tobacco-related health disparities in this group. Health care centers can support their providers to intervene in tobacco use by mandating screenings, streamlining clinical workflows with hard stops in patient records, and educating providers about the importance of treating tobacco with brief evidence-based intervention strategies while providing accurate information about patients' interest in quitting and providers' potential impacts on a successful quit attempt.
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Affiliation(s)
- Ammar D. Siddiqi
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
| | - Maggie Britton
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Brian J. Carter
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Carol Wang
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Department of Health Disparities Research, MD Anderson Cancer Center, Houston, TX 77230, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Anastasia Rogova
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier St., Austin, TX 78704, USA
| | | | - Mayuri Patel
- Department of State Health Services, Tobacco Prevention and Control Branch, Austin, TX 78714, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA
- Health Research Institute, The University of Houston, 4349 Martin Luther King Blvd, Houston, TX 77204, USA
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Parks J, McLean KE, McCandless L, de Souza RJ, Brook JR, Scott J, Turvey SE, Mandhane PJ, Becker AB, Azad MB, Moraes TJ, Lefebvre DL, Sears MR, Subbarao P, Takaro TK. Assessing secondhand and thirdhand tobacco smoke exposure in Canadian infants using questionnaires, biomarkers, and machine learning. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:112-123. [PMID: 34175887 PMCID: PMC8770125 DOI: 10.1038/s41370-021-00350-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND As smoking prevalence has decreased in Canada, particularly during pregnancy and around children, and technological improvements have lowered detection limits, the use of traditional tobacco smoke biomarkers in infant populations requires re-evaluation. OBJECTIVE We evaluated concentrations of urinary nicotine biomarkers, cotinine and trans-3'-hydroxycotinine (3HC), and questionnaire responses. We used machine learning and prediction modeling to understand sources of tobacco smoke exposure for infants from the CHILD Cohort Study. METHODS Multivariable linear regression models, chosen through a combination of conceptual and data-driven strategies including random forest regression, assessed the ability of questionnaires to predict variation in urinary cotinine and 3HC concentrations of 2017 3-month-old infants. RESULTS Although only 2% of mothers reported smoking prior to and throughout their pregnancy, cotinine and 3HC were detected in 76 and 89% of the infants' urine (n = 2017). Questionnaire-based models explained 31 and 41% of the variance in cotinine and 3HC levels, respectively. Observed concentrations suggest 0.25 and 0.50 ng/mL as cut-points in cotinine and 3HC to characterize SHS exposure. This cut-point suggests that 23.5% of infants had moderate or regular smoke exposure. SIGNIFICANCE Though most people make efforts to reduce exposure to their infants, parents do not appear to consider the pervasiveness and persistence of secondhand and thirdhand smoke. More than half of the variation in urinary cotinine and 3HC in infants could not be predicted with modeling. The pervasiveness of thirdhand smoke, the potential for dermal and oral routes of nicotine exposure, along with changes in public perceptions of smoking exposure and risk warrant further exploration.
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Affiliation(s)
- Jaclyn Parks
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Padmaja Subbarao
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Klein JD, Chamberlin ME, Kress EA, Geraci MW, Rosenblatt S, Boykan R, Jenssen B, Rosenblatt SM, Milberger S, Adams WG, Goldstein AO, Rigotti NA, Hovell MF, Holm AL, Vandivier RW, Croxton TL, Young PL, Blissard L, Jewell K, Richardson L, Ostrow J, Resnick EA. Asking the Right Questions About Secondhand Smoke. Nicotine Tob Res 2021; 23:57-62. [PMID: 31407779 DOI: 10.1093/ntr/ntz125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/25/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Despite knowledge about major health effects of secondhand tobacco smoke (SHS) exposure, systematic incorporation of SHS screening and counseling in clinical settings has not occurred. METHODS A three-round modified Delphi Panel of tobacco control experts was convened to build consensus on the screening questions that should be asked and identify opportunities and barriers to SHS exposure screening and counseling. The panel considered four questions: (1) what questions should be asked about SHS exposure; (2) what are the top priorities to advance the goal of ensuring that these questions are asked; (3) what are the barriers to achieving these goals; and (4) how might these barriers be overcome. Each panel member submitted answers to the questions. Responses were summarized and successive rounds were reviewed by panel members for consolidation and prioritization. RESULTS Panelists agreed that both adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from any tobacco products in their usual environment. The panel found that consistent clinician training, quality measurement or other accountability, and policy and electronic health records interventions were needed to successfully implement consistent screening. CONCLUSIONS The panel successfully generated screening questions and identified priorities to improve SHS exposure screening. Policy interventions and stakeholder engagement are needed to overcome barriers to implementing effective SHS screening. IMPLICATIONS In a modified Delphi panel, tobacco control and clinical prevention experts agreed that all adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from tobacco products. Consistent training, accountability, and policy and electronic health records interventions are needed to implement consistent screening. Increasing SHS screening will have a significant impact on public health and costs.
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Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA
| | | | | | - Mark W Geraci
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Susan Rosenblatt
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Rachel Boykan
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Brian Jenssen
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Sharon Milberger
- Michigan Developmental Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - William G Adams
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Melbourne F Hovell
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | - Amanda L Holm
- Center of Health Promotion and Disease Prevention, Henry Ford Health System, Detroit, MI, USA
| | - Richard W Vandivier
- Department of Medicine, Pulmonary Sciences & Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas L Croxton
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Patricia L Young
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Lani Blissard
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Kate Jewell
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Leisa Richardson
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - John Ostrow
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Elissa A Resnick
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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Meijer E, Chavannes NH. Lacking willpower? A latent class analysis of healthcare providers' perceptions of smokers' responsibility for smoking. PATIENT EDUCATION AND COUNSELING 2021; 104:620-626. [PMID: 32943247 DOI: 10.1016/j.pec.2020.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/29/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Healthcare providers' (HCPs) perceptions of smokers' responsibility for smoking may affect implementation of smoking cessation care (SCC), but are understudied. This study examined Dutch HCPs' perceptions of smokers' responsibility for smoking, and how many and which subgroups exist with regard to these perceptions. METHODS Observational cross-sectional study among physicians and other HCPs (N = 570). Latent class analysis was used to analyse data. RESULTS Results showed two latent classes of HCPs: a majority (77 %) that appeared to hold smokers themselves more accountable for their smoking, and a minority (23 %) that seemed more inclined to believe that people smoked as a consequence of factors such as addiction, and smoking initiation when people were young and could not foresee consequences. The two-class model showed excellent certainty in classification. Class membership was associated with age, working experience, and smoking status. The majority class experienced more barriers to SCC than the minority class and provided SCC tasks to fewer patients. CONCLUSIONS HCPs' perceptions of smokers' responsibility for smoking relate to HCP background characteristics, barriers to SCC and implementation of SCC. PRACTICE IMPLICATIONS New approaches to improving SCC might be needed that take HCP's perceptions of smokers' responsibility into account.
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Affiliation(s)
- E Meijer
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands.
| | - N H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Bailey SR, Fankhauser K, Marino M, Schmidt T, Giebultowicz S, Ezekiel-Herrera D, Heintzman J. Smoking Assessment and Current Smoking Status Among Adolescents in Primary Care Settings. Nicotine Tob Res 2021; 22:2098-2103. [PMID: 32556337 DOI: 10.1093/ntr/ntaa106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued use into adulthood. Primary care visits provide opportunities for the assessment and treatment of tobacco use; however, little is known about prevalence and correlates of assessing smoking status and current use among adolescents in these settings. AIMS AND METHODS Using electronic health record data from the OCHIN network, we identified adolescents with greater than or equal to one primary care visit to a study clinic (n = 366 clinics from 15 US states) during January 1, 2016 to December 31, 2017. We estimated odds ratios of smoking assessment and current smoking status by patient covariates. RESULTS Of 140 887 patients, 87.4% were assessed for smoking. Being Latino or Black (adjusted odds ratio = 1.22, 95% confidence interval: 1.13-1.32; adjusted odds ratio = 1.17, 95% confidence interval: 1.07-1.29, respectively, vs. non-Hispanic White), publicly insured, having more visits, and having an asthma diagnosis or other respiratory symptoms were associated with higher odds of assessment. Odds were lower if the patient was male and uninsured. Of those assessed, 1.6% identified as current smokers. Being older, having more visits, an asthma diagnosis, other respiratory symptoms, and lower household income was associated with higher odds of being a current smoker. Latinos and Blacks had lower odds than non-Hispanic Whites. CONCLUSIONS Although some commonly reported tobacco-related disparities were not present, smoking assessment and current smoking status differed significantly by most patient demographics. Implementation of adolescent tobacco assessment protocols and the development of interventions to target subpopulations of adolescents with higher rates of smoking could mitigate disparate rates of assessment and smoking, respectively. IMPLICATIONS Clinical guidelines recommend screening adolescents for tobacco use in primary care settings. We found that most adolescents seen in US safety-net primary care clinics were assessed for smoking. We also found that smoking assessment and current smoking status differed significantly by most patient demographics. Implementing tobacco assessment protocols specific to adolescents could mitigate disparate rates of assessment and ensure accurate documentation of all forms of tobacco use, given the evolution of alternative tobacco products and poly use among adolescents. Interventions to target subpopulations of adolescents with higher smoking rates are needed to prevent the negative health effects of continued smoking.
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Affiliation(s)
- Steffani R Bailey
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Katie Fankhauser
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | | | | | | | - John Heintzman
- Department of Family Medicine, Oregon Health & Science University, Portland, OR.,OCHIN, Inc., Portland, OR
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Masonbrink AR, Berg K, Harrison A, Rossetti A, Heller K, Darby J, Ngo ML, Dean A, Catley D. Barriers to Tobacco Cessation for Caregivers of Hospitalized Children: Perspectives of Pediatric Hospitalists. Hosp Pediatr 2020; 11:1-7. [PMID: 33262220 DOI: 10.1542/hpeds.2020-0168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Secondhand smoke exposure is associated with adverse health outcomes in children, yet tobacco cessation efforts for caregivers of hospitalized children are lacking. We sought to explore pediatric hospitalists' attitudes and barriers to providing tobacco cessation for caregivers of hospitalized children. METHODS We conducted a cross-sectional survey of pediatric hospitalists and fellows at 7 hospitals from November 1, 2018, to November 30, 2019. A 70-question anonymous survey was used to assess participants' perceptions of current practices, attitudes, and barriers to providing tobacco cessation support for caregivers of hospitalized children. We used descriptive statistics to summarize the data. RESULTS Of 207 eligible participants, 100 responded (48%). A majority (79%) agreed that offering tobacco cessation counseling for caregivers is an important part of their role in caring for hospitalized children, but 79% never received tobacco cessation training. Only half of the participants were comfortable providing brief advice and few were comfortable prescribing nicotine replacement therapy. Identified barriers included lack of time (74%), perceived lack of interest from patients' caregivers (71%), and other medical conditions of the patient taking priority (70%). The majority of participants were interested in further training in tobacco cessation support. CONCLUSIONS In this survey of 100 pediatric hospitalists, we found overall agreement that tobacco cessation support for caregivers of hospitalized children is important. However, most participants did not feel comfortable with provision of evidence-based counseling or pharmacotherapy because of identified barriers. Future work should target actionable barriers to improve provision of tobacco cessation support in this clinical setting.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;
| | - Kathleen Berg
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Austin Harrison
- University of Mississippi Medical Center, Baton Children's Hospital, Jackson, Mississippi
| | - Allison Rossetti
- Wexner Medical Center, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Kayla Heller
- School of Medicine, Saint Louis University and Cardinal Glennon Children's Hospital, St Louis, Missouri
| | - John Darby
- School of Medicine, Wake Forest University and Brenner Children's Hospital, Winston-Salem, North Carolina
| | - My-Linh Ngo
- School of Medicine, Vanderbilt University and Monroe Carrell Jr Children's Hospital, Nashville, Tennessee; and
| | - Andrea Dean
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Delwyn Catley
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Riley C, Ladak N. Reducing pediatric exposure to environmental tobacco smoke: The effects of pediatric exposure to environmental tobacco smoke and the role of pediatric perioperative care. Paediatr Anaesth 2020; 30:1199-1203. [PMID: 32395863 DOI: 10.1111/pan.13907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 12/22/2022]
Abstract
Exposure to environmental tobacco smoke (ETS) has deleterious effects on a child's general health and their perioperative risk; specifically, it doubles a child's perioperative risk of adverse respiratory events, particularly laryngospasm. It increases the risk of sudden infant death syndrome, bacterial meningitis, middle ear infection, asthma, and lower respiratory tract infection. The preoperative assessment of children presenting for procedures under general anesthesia is an opportune moment to screen for exposure to ETS and give information about the risks and cessation support (if applicable). This can be described as a "teachable moment"; there is a documented need for this public health education and it aligns with the NHS Long Term Plan, aiming to embed public health information into every consultation a patient or family has with a healthcare practitioner. The period preceding and following surgery is a time when patients or their families are motivated to make a behavioral change. It has been shown that parents who smoke are more likely to attempt smoking cessation if their child has had recent surgery but not to maintain their abstinence; however, we know that subsequent quit attempts increase the likelihood that a smoker will succeed in permanently abstaining so aiming for a quit attempt rather than permanent abstinence is a valid aim. A suggested screening method would be to firstly ask all parents or carers in the preoperative health screening questionnaire about their child's exposure to ETS, accepting this lacks both the sensitivity and specificity of a valid screening tool. This can be augmented by measuring exhaled carbon monoxide in any child who is able to comply with the test; exhaled carbon monoxide has been shown to be a valid screening tool for exposure to ETS in adolescents but not children under 12 years of age, perhaps because smaller children may not be able to cooperate with the test which requires a vital capacity maneuver to provide an adequate endtidal sample. A suggested model for smoking cessation intervention is called Very Brief Advice and comprises three parts: Ask about a child's exposure to ETS with/without exhaled carbon monoxide measurement Advise about the risks to the child's general and perioperative health and the health of the smoker and wider family plus the benefits of smoking cessation Act on the response by referring to local smoking cessation support. Referral to local smoking cessation services should be along established pathways. Thus, recording a household smoking status and referring to local smoking cessation services targets a public health measure with benefits beyond the individual patient and planned anesthetic. There is no evidence in the literature of the effect of environmental exposure to electronic cigarettes ("vaping") on a child's perioperative health. Further research is needed to establish if preoperative reduction in or removal from exposure to ETS reduces the risk of respiratory adverse events in the child.
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Affiliation(s)
| | - Nadia Ladak
- Sheffield Children's Hospital NHS Trust, Sheffield, UK
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10
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LeLaurin JH, Theis RP, Thompson LA, Tan ASL, Young-Wolff KC, Carter-Harris L, Shenkman EA, Salloum RG. Tobacco-Related Counseling and Documentation in Adolescent Primary Care Practice: Challenges and Opportunities. Nicotine Tob Res 2020; 22:1023-1029. [PMID: 31074792 DOI: 10.1093/ntr/ntz076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/09/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Primary care visits present an opportunity to reduce tobacco use and tobacco smoke exposure (TSE) among adolescents. To date, few studies have examined tobacco-related electronic health record (EHR) documentation in adolescent visits. The purpose of this study was to (1) describe tobacco-related EHR documentation practices in adolescent care clinics, including whether alternative tobacco products, parental use, and TSE were addressed; and (2) identify aspects of adolescent tobacco use that may inform EHR updates and counseling and documentation practices. METHODS Following a convergent mixed-methods design, we conducted an EHR review of 508 adolescent well-child visits, performed focus groups with pediatric providers and staff, and conducted in-depth interviews with adolescent patients. Record review data and interview transcripts were analyzed and interpreted concurrently. RESULTS In the EHR review, cigarette screening was documented in 92.3% of visits, smokeless tobacco screening in 51.4%, parental tobacco use in 23.2%, and home TSE in 33.1% of visits. Smoking status options were not mutually exclusive and did not include noncigarette products. No records documented assessment of e-cigarette use, despite nearly half of adolescent interview respondents citing these as the most popular products among adolescents. In interviews, adolescents discussed their experiences with alternative tobacco/nicotine products more than cigarettes. CONCLUSIONS Tobacco use status prompts should be revised for clarity and include noncigarette tobacco products and TSE. Provider education on noncigarette products and TSE assessment is needed. Improvements in EHR systems, resources, and tools can lead to better tobacco screening, prevention, and treatment practices among primary care providers. IMPLICATIONS Clinical guidelines call for pediatricians to assess and treat adolescent and parental tobacco use during primary care visits. The use of electronic health records (EHRs) can improve screening and counseling practices; however, few studies have examined tobacco-related EHR documentation practices in adolescent care settings. This mixed-methods study found low rates of EHR documentation related to noncigarette nicotine/tobacco products, parental tobacco use, and tobacco smoke exposure. These results demonstrate the need for increased provider training and EHR modifications to facilitate comprehensive tobacco control efforts in the adolescent population.
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Affiliation(s)
- Jennifer H LeLaurin
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Ryan P Theis
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Lindsay A Thompson
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL.,Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL
| | - Andy S L Tan
- Department of Social and Behavioral Health, Harvard TH Chan School of Public Health, Boston, MA
| | - Kelly C Young-Wolff
- Dana-Farber Cancer Institute, Boston, MA.,Kaiser Permanente Division of Research, Oakland, CA
| | - Lisa Carter-Harris
- Department of Psychology and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elizabeth A Shenkman
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL.,Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, FL
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Meijer E, van der Kleij R, Segaar D, Chavannes N. Determinants of providing smoking cessation care in five groups of healthcare professionals: A cross-sectional comparison. PATIENT EDUCATION AND COUNSELING 2019; 102:1140-1149. [PMID: 30718091 DOI: 10.1016/j.pec.2019.01.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
Objective To investigate implementation of a tobacco dependence treatment guideline among five groups of healthcare professionals. Methods Data collected in The Netherlands (2016-2017) were compared among gynaecologists (N = 49), midwives (N = 68), respiratory nurses (N = 72), practice nurses (N = 84) and paediatricians (N = 38). Intentions to use the guideline, satisfaction with own implementation, and dosage delivered of quit-advice and assisting in quitting were predicted using linear regression analyses and regression tree analyses. Results Implementation of smoking cessation care (SCC) and barriers differed between the groups, with nurses reporting better implementation and fewer barriers. Main barriers were lacking training (gynecologists, pediatricians) and time (midwives). Regression tree analyses showed that self-efficacy and training interacted; participants with weaker self-efficacy provided more quit advice if they had participated in SCC training. Training was positively related to intentions to use the guideline, satisfaction, providing quit-advice, and assisting smokers in quitting. Conclusion Implementation of SCC is suboptimal, such that patients who smoke do not receive the highest quality of care. Profession and training in SCC are important determinants of implementation of SCC. Practice implications Efforts to improve implementation should be targeted at profession. Training is indicated, and may focus on skills for nurses, and knowledge for gynecologists, midwives and pediatricians.
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Affiliation(s)
- Eline Meijer
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rianne van der Kleij
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Dewi Segaar
- Dutch Alliance for a Smokefree Society, Utrecht, the Netherlands
| | - Niels Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Meijer E, Chavannes N, Segaar D, Parlevliet J, Van Der Kleij R. Optimizing smoking cessation guideline implementation using text-messages and summary-sheets: A mixed-method evaluation. CLINICAL EHEALTH 2019. [DOI: 10.1016/j.ceh.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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13
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McMillen R, O'Connor KG, Groner J, Tanski S, Park ER, Klein JD. Changes and Factors Associated With Tobacco Counseling: Results From the AAP Periodic Survey. Acad Pediatr 2017; 17:504-514. [PMID: 28104489 DOI: 10.1016/j.acap.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/04/2017] [Accepted: 01/08/2017] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The American Academy of Pediatrics (AAP) advises pediatricians to counsel parents and patients who use tobacco to quit. This study assesses changes in counseling between 2004 and 2010, and factors associated with counseling in 2010. METHODS In 2004 and 2010, the Periodic Survey, a national survey of AAP members, inquired about tobacco counseling. Chi-square tests were performed to compare responses by survey year. Bivariate and multivariable analyses examined factors associated with counseling. RESULTS Similar proportions of pediatricians in both years (N2004 = 535 and N2010 = 549) advised adolescents who smoke to quit (85% vs 81%), discussed quitting techniques (34% vs 32%), and recommended nicotine replacement medications (17% vs 18%). More pediatricians in 2010 reported helping patients assess reasons for and against continuing to smoke (56% vs 48%), providing quitting materials (20% vs 15%), and referring patients to cessation programs (18% vs 13%). More pediatricians in 2010 reported providing quitting materials to parents who smoke (14% vs 10%) and referring to smoking cessation programs (16% vs 11%) (all P < .05). Pediatricians' confidence in their ability to counsel, with more tobacco prevention training, and routine documentation of patients' tobacco smoke exposure were associated with counseling about cessation. CONCLUSIONS Most pediatricians advised patients and parents who smoke to quit, and these percentages did not change from 2004 to 2010. Although percentages for assisting with cessation did increase for several activities, most pediatricians still do not do so. Opportunities exist to improve clinicians' protection of children from tobacco and tobacco smoke through quit-line referrals, motivational interviewing, and offering medications.
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Affiliation(s)
| | - Karen G O'Connor
- AAP Department of Research, American Academy of Pediatrics, Elk Grove Village, Ill
| | - Judith Groner
- Nationwide Childrens Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | | | | | - Jonathan D Klein
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Ill
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