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Schuler BR, Collins BN, Scheuermann TS, Baishya M, Kilby L, Lepore SJ. Translating pediatric primary care best practice guidelines for addressing tobacco in the WIC system. Transl Behav Med 2023; 13:57-63. [PMID: 36434752 PMCID: PMC9972351 DOI: 10.1093/tbm/ibac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development-nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre-post outcomes were assessed using bivariate statistics and multiple regression models. Controlling for baseline AAR-related practices and other covariates, nutrition managers were more likely to engage in post-training AAR practices than nutrition assistants. Sociodemographics and smoking status were not related to post-training AAR. Lower perceived barriers and higher reported frequency of tobacco intervention practices at baseline were associated with higher engagement in post-test AAR practices. WIC-system interventions aimed at reducing child TSE and maternal tobacco smoking may be more effective if nutrition management-level staff are involved in assessment and by addressing barriers related to TSE among nutrition assistants. Findings suggest that WIC in-clinic training may help to increase self-efficacy for staff engagement in brief screening, intervention, and referral practices.
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Affiliation(s)
- Brittany R Schuler
- School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Taneisha S Scheuermann
- Department of Population Health, School of Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Mona Baishya
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Linda Kilby
- N.O.R.T.H., Inc—Philadelphia WIC Program, Philadelphia, PA, USA
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
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Gittelman M, Southworth H, Carle AC, Anzeljc S, Qian X, Wervey Arnold M, Mahabee-Gittens EM. Types of Tobacco Products Used by Caregivers of Newborns in the Primary Care Setting. Clin Pediatr (Phila) 2022; 61:535-541. [PMID: 35484841 PMCID: PMC10134048 DOI: 10.1177/00099228221091030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study determined the types of tobacco products used by caregivers who presented to infant well-child visits (WCVs), tobacco product use by other household members, and caregivers' readiness to quit. The Ohio Chapter of the American Academy of Pediatrics conducted a 10-month quality improvement collaborative to improve providers' tobacco screening and cessation counseling practices. A sub-analysis of the initial screenings was performed to determine types of tobacco products used and caregivers' readiness to quit. Fourteen practices (60 providers) participated, and 3972 initial screens were analyzed; 320 (8.1%) caregivers and 490 (12.4%) household members used tobacco products. Most smoking caregivers and household members exclusively used cigarettes (79% and 72%, respectively). There was no difference in caregiver intention to quit by tobacco type, yet 53% of smoking caregivers were ready to quit. Providers should provide screening and cessation counseling to caregivers of infants at WCVs since many are ready to quit.
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Affiliation(s)
- Michael Gittelman
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Hayley Southworth
- Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Adam C Carle
- James M Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samantha Anzeljc
- Ohio Chapter of the American Academy of Pediatrics, Columbus, OH, USA
| | - Xiaokun Qian
- Ohio Colleges of Medicine, Government Resource Center, Columbus, OH, USA
| | | | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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3
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Nayak MM, Mazzola E, Jaklitsch MT, Drehmer JE, Nabi-Burza E, Bueno R, Winickoff JP, Cooley ME. Feasibility of collecting computer-facilitated patient-reported
tobacco use, interest, and preferences for smoking cessation
in an outpatient thoracic surgery and oncology setting. Tob Induc Dis 2022; 20:63. [PMID: 35854879 PMCID: PMC9251647 DOI: 10.18332/tid/150335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/13/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Effective strategies are needed to facilitate collection of tobacco use information and integrate smoking cessation treatment into the routine care of all high-risk patient populations to improve clinical outcomes. The objective of this study was to establish the feasibility of collecting computer-facilitated patient-reported tobacco use, identify patient interest and preferences for smoking cessation in an outpatient thoracic surgery and oncology setting with higher prevalence of tobacco use than the general population. METHODS A brief patient-administered tobacco screening survey was handed out on an iPad in the waiting room of a thoracic surgery and oncology practice setting to sequential patients with varying diagnoses. Tobacco use, household exposure to tobacco, and interest and preferences for smoking cessation treatment were recorded. Descriptive statistics and Pearson’s chi-squared test were used for analysis. RESULTS Of the 599 surveys administered, 594 (99%) were completed. Self-reported smoking status included 36.4% (n=218) never smokers, 53.3% (n=319) former smokers, and 10.4% (n=62) current smokers. Among current smokers, 45.2% (n=28) were interested in receiving smoking cessation treatment. Preferences for treatment included: 21.4% (n=6) who wanted Quitline only, 25% (n=7) medication alone, and 53.6% (n=15) combined Quitline plus medication. Current smokers (55.7%, n=34) were more likely to live in households with tobacco exposure compared to those with former (11.4%, n=36) or never smokers (8.3%, n=18) (p<0.0001). CONCLUSIONS Implementing a computer-facilitated system to screen for current smoking and provide smoking cessation services was feasible in the outpatient thoracic surgery and oncology setting. Almost half of the smokers indicated an interest in receipt of smoking cessation treatment. Household exposure was more frequent among current smokers, therefore routine screening for secondhand smoke exposure from other household members is an important consideration in developing smoking cessation treatment plans to mitigate health risks among vulnerable patient populations.
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Affiliation(s)
- Manan M. Nayak
- The Phyllis F. Cantor Center Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, United States
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, United States
| | - Emanuele Mazzola
- Department of Data Science, Dana-Farber Cancer Institute, Boston, United States
| | - Michael T. Jaklitsch
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, United States
| | - Jeremy E. Drehmer
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, United States
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, United States
| | - Raphael Bueno
- Division of Thoracic and Cardiac Surgery, Brigham and Women’s Hospital, Boston, United States
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, United States
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, United States
| | - Mary E. Cooley
- The Phyllis F. Cantor Center Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, United States
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Jenssen BP, Karavite DJ, Kelleher S, Nekrasova E, Thayer JG, Ratwani R, Shea J, Nabi-Burza E, Drehmer JE, Winickoff JP, Grundmeier RW, Schnoll RA, Fiks AG. Electronic Health Record-Embedded, Behavioral Science-Informed System for Smoking Cessation for the Parents of Pediatric Patients. Appl Clin Inform 2022; 13:504-515. [PMID: 35584789 DOI: 10.1055/s-0042-1748148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Helping parents quit smoking is a public health priority. However, parents are rarely, if ever, offered tobacco use treatment through pediatric settings. Clinical decision support (CDS) systems developed for the workflows of pediatric primary care may support consistent screening, treatment, and referral. OBJECTIVES This study aimed to develop a CDS system by using human-centered design (HCD) that identifies parents who smoke, provides motivational messages to quit smoking (informed by behavioral science), and supports delivery of evidence-based tobacco treatment. METHODS Our multidisciplinary team applied a rigorous HCD process involving analysis of the work environment, user involvement in formative design, iterative improvements, and evaluation of the system's use in context with the following three cohorts: (1) parents who smoke, (2) pediatric clinicians, and (3) clinic staff. Participants from each cohort were presented with scenario-based, high-fidelity mockups of system components and then provided input related to their role in using the CDS system. RESULTS We engaged 70 representative participants including 30 parents, 30 clinicians, and 10 clinic staff. A key theme of the design review sessions across all cohorts was the need to automate functions of the system. Parents emphasized a system that presented information in a simple way, highlighted benefits of quitting smoking, and allowed direct connection to treatment. Pediatric clinicians emphasized automating tobacco treatment. Clinical staff emphasized screening for parent smoking via several modalities prior to the patient's visit. Once the system was developed, most parents (80%) reported that it was easy to use, and the majority of pediatricians reported that they would use the system (97%) and were satisfied with it (97%). CONCLUSION A CDS system to support parental tobacco cessation in pediatric primary care, developed through an HCD process, proved easy to use and acceptable to parents, clinicians, and office staff. This preliminary work justifies evaluating the impact of the system on helping parents quit smoking.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Dean J Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Shannon Kelleher
- Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Ekaterina Nekrasova
- Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jeritt G Thayer
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare, Washington, Dist. of Columbia, United States
| | - Judy Shea
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics and Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Jeremy E Drehmer
- Division of General Academic Pediatrics and Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics and Tobacco Research and Treatment Center, Massachusetts General Hospital for Children, Boston, Massachusetts, United States
| | - Robert W Grundmeier
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.,Center for Pediatric Clinical Effectiveness, PolicyLab, and The Possibilities Project, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
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5
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A Qualitative Study of Factors Influencing Implementation of Tobacco Control in Pediatric Practices. J Smok Cessat 2022; 2022:4156982. [PMID: 35603037 PMCID: PMC9098360 DOI: 10.1155/2022/4156982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Clinical effort against secondhand smoke exposure (CEASE) is an evidence-based intervention that prepares child healthcare clinicians and staff with the knowledge, skills, and resources needed to ask family members about tobacco use, provide brief counseling and medication assistance, and refer to free cessation services. Aim This study sought to identify factors that influenced the implementation of CEASE in five pediatric intervention practices in five states that participated in a cluster randomized clinical trial of the CEASE intervention. Methods Guided by questions from the consolidated framework for implementation research (CFIR) interview guide, semistructured qualitative interviews were conducted with 11 clinicians and practice staff from five intervention practices after the practices had implemented CEASE for two years. Interviews were conducted by a trained qualitative researcher, recorded with permission, and transcribed verbatim. An interview codebook was inductively developed; two researchers used the codebook to code data. After coding, data was analyzed to identify factors, as described by the CFIR domains that influenced the implementation of CEASE. Results The implementation of CEASE in practices was influenced by the adaptability and complexity of the intervention, the needs of patients and their families, the resources available to practices to support the implementation of CEASE, other competing priorities at the practices, the cultures of practices, and clinicians' and office staffs' knowledge and beliefs about family-centered tobacco control. Conclusion Identifying and influencing certain critical factors guided by information gathered through interviews may help improve implementation and sustainability of family-centered tobacco control interventions in the future. Trial Registration: ClinicalTrials.gov Identifier: NCT01882348.
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Drouin O, Sato R, Drehmer JE, Nabi-Burza E, Hipple Walters B, Winickoff JP, Levy DE. Cost-effectiveness of a Smoking Cessation Intervention for Parents in Pediatric Primary Care. JAMA Netw Open 2021; 4:e213927. [PMID: 33792730 PMCID: PMC8017473 DOI: 10.1001/jamanetworkopen.2021.3927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. OBJECTIVE To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. EXPOSURES The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. MAIN OUTCOMES AND MEASURES The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. RESULTS The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. CONCLUSIONS AND RELEVANCE These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.
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Affiliation(s)
- Olivier Drouin
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada
- Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Québec, Canada
| | - Ryoko Sato
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeremy E. Drehmer
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Bethany Hipple Walters
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston
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7
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Drehmer JE, Luo M, Nabi-Burza E, Walters BH, Winickoff JP. Smoking Cessation Treatment for Parents Who Are Light or Very Light Smokers in the Pediatric Setting. Acad Pediatr 2021; 21:646-653. [PMID: 33035731 PMCID: PMC8024405 DOI: 10.1016/j.acap.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 09/05/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The percentage of US smokers who smoke <10 cigarettes per day has increased, yet it is not known how often light parental smokers are offered and accept cessation assistance in pediatric offices. METHODS A secondary analysis of parent interview data collected April to October 2017 at 10 pediatric practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention. RESULTS Forty percent of 725 usual care control (UCC) group smokers smoked lightly (<10 cigarettes per day); of these 58% smoked very lightly (<5 per day). Compared to heavier smokers in UCC practices, light and very light smokers in UCC practices were more likely to have made a recent quit attempt (P < .001), yet less likely to have used cessation medication (P = .001). In intervention practices, compared to heavier smokers, light (P = .04) and very light (P < .01) smokers were less likely to be asked if they smoke and very light smokers were less likely to be advised to quit (P = .02) and to receive a nicotine replacement therapy (NRT) prescription (P < .01). However, light smokers (P < .001), very light smokers (P < .001), and light smokers who use e-cigarettes (P = .01) were more likely to receive assistance (NRT or quitline enrollment) in intervention versus UCC practices. CONCLUSIONS The CEASE intervention increased assistance to light and very light smokers, yet heavier smokers received more assistance than light smokers. Improving cessation interventions for light and very light smokers is warranted.
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Affiliation(s)
- Jeremy E. Drehmer
- Massachusetts General Hospital, Division of General Academic Pediatrics, Boston, MA, United States,Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, United States
| | - Man Luo
- Massachusetts General Hospital, Division of General Academic Pediatrics, Boston, MA, United States,Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, United States
| | - Emara Nabi-Burza
- Massachusetts General Hospital, Division of General Academic Pediatrics, Boston, MA, United States,Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, United States
| | - Bethany Hipple Walters
- Massachusetts General Hospital, Division of General Academic Pediatrics, Boston, MA, United States,Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, United States
| | - Jonathan P. Winickoff
- Massachusetts General Hospital, Division of General Academic Pediatrics, Boston, MA, United States,Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, United States,Harvard Medical School, Boston, MA, United States
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8
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Nabi-Burza E, Drehmer JE, Hipple Walters B, Rigotti NA, Ossip DJ, Levy DE, Klein JD, Regan S, Gorzkowski JA, Winickoff JP. Treating Parents for Tobacco Use in the Pediatric Setting: The Clinical Effort Against Secondhand Smoke Exposure Cluster Randomized Clinical Trial. JAMA Pediatr 2019; 173:931-939. [PMID: 31403675 PMCID: PMC6692696 DOI: 10.1001/jamapediatrics.2019.2639] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite the availability of free and effective treatment, few pediatric practices identify and treat parental tobacco use. OBJECTIVE To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial was conducted from April 2015 to October 2017. Ten pediatric practices in 5 states were randomized to either implement the CEASE protocol or maintain usual care (as a control group). All parents who screened positive for tobacco use by exit survey after their child's clinical visit 2 weeks (from April to October 2015) and 2 years after intervention implementation (April to October 2017) were eligible to participate. Data analysis occurred from January 2018 to March 2019. INTERVENTIONS The CEASE intervention is a practice-change intervention designed to facilitate both routine screening in pediatric settings of families for tobacco use and delivery of tobacco cessation treatment to individuals in screened households who use tobacco. MAIN OUTCOMES AND MEASURES The primary outcome was delivery of meaningful tobacco treatment, defined as the prescription of nicotine replacement therapy or quit line enrollment. Furthermore, changes in practice-level smoking prevalence and cotinine-confirmed quit rates over the 2 years of intervention implementation were assessed. RESULTS Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-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%]). CONCLUSIONS AND RELEVANCE In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01882348.
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Affiliation(s)
- Emara Nabi-Burza
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Jeremy E. Drehmer
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Bethany Hipple Walters
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Nancy A. Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts,Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston
| | - Deborah J. Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Douglas E. Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts,Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston
| | - Jonathan D. Klein
- American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, Illinois,Department of Pediatrics, University of Illinois at Chicago
| | - Susan Regan
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
| | - Julie A. Gorzkowski
- American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, Illinois
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston,Harvard Medical School, Boston, Massachusetts,American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, Illinois
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