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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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Abstract
This clinical case presentation discusses a family in which 3 generations are affected by tobacco. The discussants discuss approaches to be taken to minimize the exposure of an infant to tobacco smoke from older relatives, behavioral and pharmacological approaches to assist smoking cessation, and concerns regarding electronic cigarettes.
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Huang K, Abdullah AS, Liao J, Huo H, Yang L, Zhang Z, Winickoff JP, Nong G. Chinese pediatrician beliefs about counseling and medications for parents who smoke: a survey in southern China. Tob Induc Dis 2015; 13:10. [PMID: 25866497 PMCID: PMC4392465 DOI: 10.1186/s12971-015-0035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background Pediatricians play an important role in promoting smoking cessation among the parents of young children as more behavioral counseling and cessation treatment are made available in the Chinese healthcare system. However, beliefs about the effectiveness of these interventions can influence pediatricians’ recommendations to their patients. This study examined pediatricians’ beliefs regarding effectiveness of counseling and medications for smoking cessation. Methods A cross-sectional survey of pediatricians was conducted in thirteen conveniently selected southern Chinese hospitals, during September to December 2013. A self-administered questionnaire was used for data collection. We used chi square tests and multinomial logistic regression analysis to identify factors associated with beliefs regarding effectiveness of counseling and medications for smoking cessation. Results Beliefs of the respondents (504/550; 92% response rate) were divided regarding the effectiveness of counseling and medications for smoking cessation. Sixty percent believed that physician counseling is effective for smoking cessation; 53% believed pharmacological products (or medications) are effective. Factors that were associated with positive beliefs towards the effectiveness of counseling included: believing about the professional responsibility to discuss smoking cessation, being confident in discussing smoking cessation or SHS exposure reduction with patients’ parents, believing that health professionals should routinely ask about their patients smoking habits, believing that health professionals should routinely advise their smoking patients to quit smoking, possessing adequate knowledge in quitting smoking, and being able to assess smokers different stages of readiness to quit. Most of the above factors were also associated with the belief that medication is effective for smoking cessation. Conclusions A substantial proportion of Chinese pediatricians believed that cessation counseling and medications are not effective, which is not supported by current evidence in the field. Several factors including individual, practice level and health system level characteristics were associated with their belief. Training efforts are needed to influence pediatricians’ beliefs regarding the effectiveness of cessation counseling and medications.
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Affiliation(s)
- Kaiyong Huang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Duke Avenue, Kunshan, Jiangsu 215316 China ; Duke Global Health Institute, Duke University, Durham, North Carolina USA ; Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts USA
| | - Jing Liao
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Haiying Huo
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Li Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Zhiyong Zhang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, USA
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 China
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Winickoff JP, Nabi-Burza E, Chang Y, Regan S, Drehmer J, Finch S, Wasserman R, Ossip D, Hipple B, Woo H, Klein J, Rigotti NA. Sustainability of a parental tobacco control intervention in pediatric practice. Pediatrics 2014; 134:933-41. [PMID: 25332492 PMCID: PMC4210792 DOI: 10.1542/peds.2014-0639] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether an evidence-based pediatric outpatient intervention for parents who smoke persisted after initial implementation. METHODS A cluster randomized controlled trial of 20 pediatric practices in 16 states that received either Clinical and Community Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care. The intervention provided practices with training to provide evidence-based assistance to parents who smoke. The primary outcome, assessed by the 12-month follow-up telephone survey with parents, was provision of meaningful tobacco control assistance, defined as discussing various strategies to quit smoking, discussing smoking cessation medication, or recommending the use of the state quitline after initial enrollment visit. We also assessed parental quit rates at 12 months, determined by self-report and biochemical verification. RESULTS Practices' rates of providing any meaningful tobacco control assistance (55% vs 19%), discussing various strategies to quit smoking (25% vs 10%), discussing cessation medication (41% vs 11%), and recommending the use of the quitline (37% vs 9%) were all significantly higher in the intervention than in the control groups, respectively (P < .0001 for each), during the 12-month postintervention implementation. Receiving any assistance was associated with a cotinine-confirmed quitting adjusted odds ratio of 1.89 (95% confidence interval: 1.13-3.19). After controlling for demographic and behavioral factors, the adjusted odds ratio for cotinine-confirmed quitting in intervention versus control practices was 1.07 (95% confidence interval: 0.64-1.78). CONCLUSIONS Intervention practices had higher rates of delivering tobacco control assistance than usual care practices over the 1-year follow-up period. Parents who received any assistance were more likely to quit smoking; however, parents' likelihood of quitting smoking was not statistically different between the intervention and control groups. Maximizing parental quit rates will require more complete systems-level integration and adjunctive cessation strategies.
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Affiliation(s)
- Jonathan P Winickoff
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; AAP Richmond Center of Excellence, and Tobacco Research and Treatment Center, and
| | - Emara Nabi-Burza
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, and
| | - Yuchiao Chang
- Tobacco Research and Treatment Center, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan Regan
- Tobacco Research and Treatment Center, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeremy Drehmer
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, and
| | - Stacia Finch
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois
| | - Richard Wasserman
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois; Department of Pediatrics, University of Vermont, Burlington, Vermont
| | - Deborah Ossip
- University of Rochester Medical Center, Rochester, New York; and
| | - Bethany Hipple
- Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, and
| | - Heide Woo
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois; University of California-Los Angeles, Los Angeles, California
| | | | - Nancy A Rigotti
- Tobacco Research and Treatment Center, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts
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Feasibility and efficacy of an intervention to reduce secondhand smoke exposure among infants discharged from a neonatal intensive care unit. J Perinatol 2013; 33:811-6. [PMID: 23619375 DOI: 10.1038/jp.2013.43] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 02/28/2013] [Accepted: 03/20/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the feasibility and efficacy of a hospital-based, motivational intervention to reduce secondhand smoke exposure (SHSe) with mothers of infants in a neonatal intensive care unit (NICU). STUDY DESIGN One-hundred and forty-four mothers with infants ( ≤ 1500 g at birth or ≥ 12 h ventilation) in a NICU who reported a smoker in the household were randomized to two sessions of motivational interviewing (MI) conducted in the hospital, usual care (UC) or usual care-reduced measurement (UC-RM); follow-up occurred at 1- and 6-months post discharge. RESULT For households that did not have a total smoking ban at baseline, 63.6% of those in the MI group instituted a ban by 1-month post discharge compared with 20% of the UC group, P<0.02. Six months post discharge, fewer smoking bans were noted in the UC-RM group relative to MI and UC, P<0.01. CONCLUSION A need for SHSe interventions among NICU parents exists and initial evidence suggests MI can impact SHSe after discharge.
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Winickoff JP, Nabi-Burza E, Chang Y, Finch S, Regan S, Wasserman R, Ossip D, Woo H, Klein J, Dempsey J, Drehmer J, Hipple B, Weiley V, Murphy S, Rigotti NA. Implementation of a parental tobacco control intervention in pediatric practice. Pediatrics 2013; 132:109-17. [PMID: 23796741 PMCID: PMC3691536 DOI: 10.1542/peds.2012-3901] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking. METHODS Cluster RCT of 20 pediatric practices in 16 states that received either CEASE intervention or usual care. The intervention gave practices training and materials to change their care delivery systems to provide evidence-based assistance to parents who smoke. This assistance included motivational messaging; proactive referral to quitlines; and pharmacologic treatment of tobacco dependence. The primary outcome, assessed at an exit interview after an office visit,was provision of meaningful tobacco control assistance, defined as counseling beyond simple advice (discussing various strategies to quit smoking), prescription of medication, or referral to the state quitline, at that office visit. RESULTS Among 18 607 parents screened after their child’s office visit between June 2009 and March 2011, 3228 were eligible smokers and 1980 enrolled (999 in 10 intervention practices and 981 in 10 control practices). Practices’ mean rate of delivering meaningful assistance for parental cigarette smoking was 42.5% (range 34%–66%) in the intervention group and 3.5% (range 0%–8%) in the control group (P < .0001).Rates of enrollment in the quitline (10% vs 0%); provision of smoking cessation medication (12% vs 0%); and counseling for smoking cessation(24% vs 2%) were all higher in the intervention group compared with the control group (P < .0001 for each). CONCLUSIONS A system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit.
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Affiliation(s)
- Jonathan P Winickoff
- Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA 02114, USA.
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Cubbins LA, Buchanan T. Racial/Ethnic Disparities in Health: The Role of Lifestyle, Education, Income, and Wealth. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/00380237.2009.10571349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
This study identified the underlying demographic and socioeconomic factors associated with insurance status among nonelderly Americans (age 19-64), as well as compared health care utilization between insured and uninsured. Data from the Community Tracking Study 1996-1997 Household Survey were analyzed. Approximately 74 percent of uninsured Americans are nonelderly Americans. Among the nonelderly Americans, about 17 percent are uninsured. Our findings show that insurance status varies significantly by region, age, race, gender, marital status, income, education, employment status, and health status. Also, the insured nonelderly Americans were found to have better access to health care than the uninsured nonelderly.
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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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Winickoff JP, Tanski SE, McMillen RC, Hipple BJ, Friebely J, Healey EA. A national survey of the acceptability of quitlines to help parents quit smoking. Pediatrics 2006; 117:e695-700. [PMID: 16585283 DOI: 10.1542/peds.2005-1946] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Provision of telephone smoking cessation counseling can increase the rate of quitting smoking. The US Public Health Service recently helped to establish a free national quitline enrollment service. No previous surveys have assessed the acceptability to parents of enrollment in quitline counseling in the context of their child's health care visits. Therefore, the objective of this study was to assess acceptability to parents of enrollment in quitline counseling and to compare that with the reported rate of actually being enrolled in any smoking cessation counseling outside the office in the context of the child's health care visit. METHODS Data were collected by a national random-digit-dial telephone survey of households from September to November 2004. The sample is weighted by race and gender on the basis of the current US Census to be representative of the US population. RESULTS Of 3615 eligible respondents contacted, 3011 (83.3%) completed surveys; 958 (31.8%) who completed the survey were parents with children under the age of 18 years. Of these parents, 187 (19.7%) were self-identified smokers. Of the parents who smoked, 113 (64.2%) said that they would accept enrollment in a telephone cessation program if the child's doctor offered it to them. In contrast, of the 122 smoking parents who accompanied their child to the doctor in the past year, only 11 (9%) had any counseling recommended to them, and only 1 (0.8%) was actually enrolled. These results did not vary by parent age, gender, race, or child age. CONCLUSIONS When interacting with parents who smoke, child health care providers have low rates of referring and enrolling parents in any services related to smoking. Enrollment in quitlines would be acceptable to the majority of parents in the context of their child's health care visit. Tobacco control efforts in the child health care setting should include implementation of office systems that can facilitate enrollment of parental smokers in telephone quitlines.
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Winickoff JP, Tanski SE, McMillen RC, Klein JD, Rigotti NA, Weitzman M. Child health care clinicians' use of medications to help parents quit smoking: a national parent survey. Pediatrics 2005; 115:1013-7. [PMID: 15805379 DOI: 10.1542/peds.2004-1372] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Smokers who use cessation medications when they attempt to quit double their likelihood of success. No prior survey has assessed the acceptability to parents of receiving smoking cessation medication prescriptions in the context of their child's primary care visits. OBJECTIVE To assess acceptability to parents of receiving smoking cessation medication prescriptions and to compare that with the reported rate of actually receiving smoking cessation medication prescriptions in the context of the child's health care visit. METHODS Data were collected through a national random-digit dial telephone survey of households from July to September 2003. The sample was weighted according to race and gender, on the basis of the 2002 US Census, to be representative of the US population. RESULTS Of 3990 eligible respondents contacted, 3010 (75%) completed surveys; 1027 (34%) of those were parents. Of those parents, 211 (21%) were self-identified smokers. One half would consider using a smoking cessation medication and, of those, 85% said that it would be acceptable if the child's doctor prescribed or recommended it to them. In contrast, of the 143 smoking parents who accompanied their child to the doctor, only 15% had pharmacotherapy recommended and only 8% received a prescription for a smoking cessation medication. These results did not vary according to parent age, gender, race, or child age. CONCLUSIONS Child health care clinicians have low rates of recommending and prescribing cessation therapies that have proved effective in other settings. The recommendation or provision of cessation medications would be acceptable to the majority of parents in the context of their child's health care visit.
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Affiliation(s)
- Jonathan P Winickoff
- Massachusetts General Hospital Center for Child and Adolescent Health Policy, Boston, Massachusetts 02114, USA.
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Winickoff JP, Berkowitz AB, Brooks K, Tanski SE, Geller A, Thomson C, Lando HA, Curry S, Muramoto M, Prokhorov AV, Best D, Weitzman M, Pbert L. State-of-the-art interventions for office-based parental tobacco control. Pediatrics 2005; 115:750-60. [PMID: 15741382 DOI: 10.1542/peds.2004-1055] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A's framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.
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Affiliation(s)
- Jonathan P Winickoff
- General Pediatrics Division, MGH Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, and Tobacco Research and Treatment Center, 50 Staniford St, Suite 901, Boston, Massachusetts 02114, USA.
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Balabanova DC, Falkingham J, McKee M. Winners and losers: expansion of insurance coverage in Russia in the 1990s. Am J Public Health 2004; 93:2124-30. [PMID: 14652345 PMCID: PMC1448163 DOI: 10.2105/ajph.93.12.2124] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study sought to describe the evolution of the Russian compulsory health insurance system and to identify factors associated with noncoverage. METHODS Data from successive waves of the Russian Longitudinal Monitoring Survey (1992-2000) were analyzed. RESULTS Insurance coverage grew rapidly throughout the 1990s, although 11.8% of the country's citizens were still uninsured by 2000. Coverage initiation rates were greater at first among citizens who were better off, but this gap closed over the study period. Among individuals of working age, coverage rates diminished with age and were lower for the unemployed, for the self-employed, and for those residing outside Moscow or St. Petersburg. CONCLUSIONS The growth of insurance coverage in Russia slowed toward the end of the 1990s, and gaps remain. Achievement of universal coverage will require new, targeted policies.
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Affiliation(s)
- Dina C Balabanova
- Health Systems Development Programme, London School of Hygiene and Tropical Medicine, London, England.
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Winickoff JP, McMillen RC, Carroll BC, Klein JD, Rigotti NA, Tanski SE, Weitzman M. Addressing parental smoking in pediatrics and family practice: a national survey of parents. Pediatrics 2003; 112:1146-51. [PMID: 14595060 DOI: 10.1542/peds.112.5.1146] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, and decreased lung growth. No prior parent surveys have assessed national rates of screening and counseling for parental tobacco use in the context of their child's visit to primary care. OBJECTIVE To assess and compare rates of pediatrician and family practitioner screening and counseling for parental smoking. Design/Methods. Data were collected by telephone survey of households from July to September 2001. The sample is weighted by race and gender based on 1999 US Census estimates to be representative of the US population. RESULTS Of 3566 eligible respondents contacted, 3002 (84%) completed surveys; 902 of those were parents who had a child seen by a pediatrician (62%) or family practitioner (38%) in the past year. About half of all parents who visited a pediatrician or family practitioner reported that they had been asked about household member smoking status (52% vs 48%). More parents who visited pediatricians had been asked if they had rules prohibiting smoking in the home than those who visited family practitioners (38% vs 29%). Of 190 (21%) parents who were smokers, fewer than half reported being counseled by either specialty about dangers of second-hand smoke (41% vs 33%) or risks of modeling smoking behavior (31% vs 28%). Similarly, fewer than half of parental smokers received advice to quit (36% vs 45%). CONCLUSION Overall rates of screening and counseling for parental smoking in pediatric and family practice are low. Despite some differences between specialties, significant opportunities exist to improve tobacco control activities in primary care settings that serve children.
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Affiliation(s)
- Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Policy, Harvard Pediatric Health Services Research Program, Boston, Massachusetts 02114, USA.
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Winickoff JP, Buckley VJ, Palfrey JS, Perrin JM, Rigotti NA. Intervention with parental smokers in an outpatient pediatric clinic using counseling and nicotine replacement. Pediatrics 2003; 112:1127-33. [PMID: 14595057 DOI: 10.1542/peds.112.5.1127] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of implementing a smoking cessation intervention for parents at the time of the pediatric visit. METHODS A prospective cohort of smoking parents whose child was seen in an outpatient pediatric practice was offered the Stop Tobacco Outreach Program, which includes 3 brief counseling sessions, written materials, free nicotine replacement therapy (NRT), proactive referral to a free state telephone quitline, and fax referral to the parents' primary clinician. The primary outcome was completion of all three counseling sessions. Other outcomes were quit attempts, cessation, NRT use, state quitline use, and household smoking assessed at 2-month follow-up. RESULTS One hundred fifty-eight smoking parents met eligibility criteria and 100 (63%) enrolled in the study. Of the 100 enrollees, 81% completed all three counseling sessions and 78% accepted free NRT at the time of enrollment. At 2-month follow-up, of the 100 enrollees, 56% reported making a quit attempt of >or=24 hours, 18% reported 7-day tobacco abstinence, 34% used NRT, and 42% received additional counseling from the state telephone quitline. The mean number of cigarettes smoked inside the home and car declined over 2 months (home, 5.1 vs 1.4; and car, 2.5 vs 1.4). CONCLUSIONS This study demonstrates the feasibility of engaging parents in a smoking cessation intervention at the time of a child's clinic visit. This approach may be an effective way to reach smokers who otherwise are unlikely to access smoking cessation interventions. High rates of program enrollment, use of NRT, and completion of telephone counseling in this study support the hypothesis that a child's clinic visit is a teachable moment to address parental smoking cessation.
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Affiliation(s)
- Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Policy, Division of General Pediatrics, Massachusetts General Hospital for Children, Boston, MA 02114, USA.
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Stroupe KT, Kinney ED, Kniesner TJ. Does chronic illness affect the adequacy of health insurance coverage? JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2000; 25:309-341. [PMID: 10946382 DOI: 10.1215/03616878-25-2-309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Although chronically ill individuals need protection against high medical expenses, they often have difficulty obtaining adequate insurance coverage due to medical underwriting practices used to classify and price risks and to define and limit coverage for individuals and groups. Using data from healthy and chronically ill individuals in Indiana, we found that chronic illness decreased the probability of having adequate coverage by about 10 percentage points among all individuals and by about 25 percentage points among single individuals. Preexisting condition exclusions were a major source of inadequate insurance, though not the only cause. Our results emphasize the impact of enforcing the Health Insurance Portability and Accountability Act (HIPAA) of 1997, which limits preexisting condition exclusions.
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Affiliation(s)
- K T Stroupe
- Indiana University School of Law, Indianapolis, USA
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Abstract
Managed care organizations (MCOs) face an uncertain future. While consolidation and price competition have expanded their market share, health care expenditures are expected to rise in the near future, and the cost containment premise--and promise--of MCOs is being threatened by mixed blessing and nonsupportive stakeholders. To shed light on MCOs' situation, we discuss four drivers for change in health management in the U.S.: technology, regulation, consumerism, and demographics. Using those four drivers, we then assess the various stakeholders in the industry through a competitive analysis and a stakeholder analysis. These analyses suggest that the munificence of the MCO business environment has significantly declined, especially among supplier and buyer stakeholders. Hence, MCOs cannot continue to manage health care costs alone as this will no longer generate sufficient support among buyer and supplier stakeholders. Instead, MCOs must tackle five critical health care issues by working closely with other stakeholders and also by learning what they can from innovative health care initiatives both inside and outside the United States.
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Affiliation(s)
- G T Savage
- Department of Management & Marketing, Culverhouse College of Commerce and Business Administration, University of Alabama, Tuscaloosa, USA
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18
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Darr K. Myths in the health services field. Hosp Top 1999; 73:4-7. [PMID: 10144626 DOI: 10.1080/00185868.1995.9950561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Oliver TR. The dilemmas of incrementalism: logical and political constraints in the design of health insurance reforms. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 1999; 18:652-683. [PMID: 10915452 DOI: 10.1002/(sici)1520-6688(199923)18:4<652::aid-pam6>3.0.co;2-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Health care reform became a premier issue on the U.S. policy agenda in the 1990s. While the comprehensive proposal put forth by President Clinton failed, states and the federal government successfully pursued a variety of lesser initiatives. This article focuses on a set of reforms intended to make private health insurance more accessible and affordable to individuals and workers in small firms. It outlines the key arguments made by experts to justify stronger regulation of health insurance and the options and difficult tradeoffs that must be considered in policy design. It then examines the scope and strength of legislation adopted by 45 states and the federal government from 1990 to 1996. The substantial variation in state policies demonstrates that even though insurance market reform was the one issue that commanded nearly universal support in the health care debate, few design features were universally accepted by those who crafted the reforms. The article concludes by assessing the pattern of state and federal action. The reforms represent some progress on nominal access to insurance but little progress on the affordability of insurance for individuals and small groups. Few of the reforms present a serious challenge to existing practices and interests of the insurance industry. This pattern of policy design reflects the logical and political constraints of incrementalism. In a system where insurance coverage is voluntary, changes to increase access for one group tend to increase costs and thereby decrease access for another segment of the population. In addition, because incremental reforms will not attract sustained attention and support from the general public, it is politically difficult to impose substantial new regulation on a powerful industry.
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Affiliation(s)
- T R Oliver
- School of Hygiene and Public Health, Johns Hopkins University, USA
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Hagdrup NA, Simoes EJ, Brownson RC. Health care coverage: traditional and preventive measures and associations with chronic disease risk factors. J Community Health 1997; 22:387-99. [PMID: 9353685 DOI: 10.1023/a:1025131721791] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Physician counseling of patients on health related activities is an essential component of chronic disease prevention, however this requires patients to have ready access to health care providers. Previous studies have explored access to health care in terms of health plans and cost without accounting for the lack of preventive coverage inherent in many insurance policies. This study compares two measures of health care access, one using an assessment of cost and health plan availability, and a new coverage measure including preventive services. Data was collected from 2574 adult respondents to the 1991-92 Missouri Behavioral Risk Factor Surveillance System Surveys. Odds ratios were generated for demographic variables, health related behaviors and preventive screening and the two coverage measures. Using health plan and cost 22% lacked full coverage, however including availability of preventive coverage almost 60% lacked full coverage for preventive care. For both coverage measures significant associations were found with age, exercise, marital status, routine checkup and mammography screening. Using the measure of coverage of preventive services, rural residents and those who had never had cholesterol screening were more likely to lack coverage. Inclusion of preventive care in measures of health care coverage may alter previously reported associations with socio-demographic and health related factors. Policy makers should realize that including preventive services in health care coverage greatly increases the number of individuals lacking adequate coverage, and that those lacking adequate coverage are the least likely to undergo preventive screening.
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Affiliation(s)
- N A Hagdrup
- Saint Louis University Health Sciences Center, Department of Community and Family Medicine, MO 63104, USA
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Schoen C, Lyons B, Rowland D, Davis K, Puleo E. Insurance matters for low-income adults: results from a five-state survey. Health Aff (Millwood) 1997; 16:163-71. [PMID: 9314687 DOI: 10.1377/hlthaff.16.5.163] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Using survey data from 2,000 low-income adult respondents in each of five states, this DataWatch assesses how uninsured, low-income adults differ from low-income adults who have public or private insurance and how Medicaid expansions have affected insurance coverage patterns across states with different eligibility policies. Findings show that the proportion of low-income uninsured adults is two to three times higher in states that have not expanded Medicaid eligibility beyond relatively low welfare levels. Compared with persons who have either Medicaid or private insurance, uninsured persons report more difficulties getting needed care, are less likely to have a regular provider, and rate the care they do receive as lower quality.
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Affiliation(s)
- C Schoen
- Commonwealth Fund, New York City, USA
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Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health 1997; 87:811-6. [PMID: 9184511 PMCID: PMC1381055 DOI: 10.2105/ajph.87.5.811] [Citation(s) in RCA: 280] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The National Hospital Discharge Survey (NHDS) was used to evaluate potentially avoidable hospital conditions as an indicator of equity and efficiency in the US health care system. METHODS With the use of 1990 data from the NHDS, the National Health Interview Survey, and the census, national rates of hospitalization were calculated for avoidable conditions by age, race, median income of zip code, and insurance status. RESULTS An estimated 3.1 million hospitalizations were for potentially avoidable conditions. This was 12% of all hospitalizations in 1990 (excluding psychiatric admissions, women with deliveries, and newborns). Rates of potentially avoidable hospitalizations were higher for persons living in middle- and low-income areas than for persons living in high-income areas, and were higher among Blacks than among Whites. These class and racial differences were also found among the privately insured. Differences among income and racial groups for persons aged 65 and over were not significant. CONCLUSIONS Inequalities in potentially avoidable hospitalizations suggest inequity and inefficiency in the health care delivery system. Avoidable hospital conditions are a useful national indicator to monitor access to care.
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Affiliation(s)
- G Pappas
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD 20782, USA
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Kinney ED, Freund DA, Camp ME, Jordan KA, Mayfield MC. Serious illness and private health coverage: a unique problem calling for unique solutions. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 1997; 25:180-83. [PMID: 11066491 DOI: 10.1111/j.1748-720x.1997.tb01892.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Authors examine the experience of two nonelderly adult populations in Indiana and their difficulties in obtaining and retaining health insurance once diagnosed with a serious chronic or catastrophic disease.
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Affiliation(s)
- E D Kinney
- Center for Law and Health, Indiana University School of Law, Indianapolis, USA
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Affiliation(s)
- S A Schroeder
- Robert Wood Johnson Foundation, Princeton, NJ 08543, USA
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Affiliation(s)
- L G Pawlson
- Dept. of Health Care Sciences, George Washington University Medical Center, Washington, DC 20037, USA
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Evans RW. Liver transplantation in a managed care environment. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1995; 1:61-75; discussion 80-2. [PMID: 9346544 DOI: 10.1002/lt.500010114] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- R W Evans
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
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