Provision of free nicotine replacement therapy to parental smokers in the pediatric emergency setting

Exploration of experiences and attitudes associated with lung health promotion among Black males with a history of smoking

To examine knowledge and attitudes about lung health promotion (smoking cessation and lung cancer screening) among Black male smokers in a large Midwestern city in the United States. Semi-structured, in-depth interviews were conducted with 25 study participants. Each interview lasted approximately 45 minutes. Participants also completed a brief (5-10 minutes) survey measuring demographic characteristics, smoking experiences and knowledge and attitudes about lung health promotion activities. Descriptive statistics were used for quantitative data, and deductive thematic analysis for qualitative data analysis. The mean age of study participants was 57.5 years. Eighty-four percent of participants were current smokers, with the majority being daily smokers. Perceived risk for lung cancer was mixed, with 56% of participants endorsing that they considered themselves to be at high or moderate risk and the remaining 44% at low or no risk for lung cancer. Forty percent of participants reported having had a test to check their lungs for cancer. Participants were aware of the health risks associated with smoking but reported limited assistance from providers regarding the receipt of smoking cessation treatments. Awareness of lung cancer screening was limited, but participants expressed openness to screening; however, barriers were anticipated, including costs, fear and a reduced willingness to be screened in the absence of symptoms. Study participants reported limited experiences with lung health promotion activities. Knowledge about the facilitators and barriers can be used to develop health promotion interventions targeting smoking cessation and lung cancer screening.

Evaluation of tobacco screening and counseling in a large, midwestern pediatric emergency department

INTRODUCTION

The study objective was to assess tobacco screening and cessation counseling practices of pediatric emergency department (PED) and urgent care (UC) nurses and physicians, and factors associated with these practices. Secondarily, we assessed factors associated with performing tobacco smoke exposure reduction and tobacco cessation counseling.

METHODS

We conducted a cross-sectional survey of 30 PED/UC nurses and physicians working at one large, urban, Midwestern children’s hospital. Measures included current practices of performing the 5 As of tobacco counseling (Ask, Advise, Assess, Assist, Arrange), and attitude and practice factors that may influence practices.

RESULTS

Overall, 90.0% of participants had not received recent tobacco counseling training, 73.3% were unaware of the 5 As, and 63.3% did not have a standardized, routine screening system to identify patients exposed to secondhand smoke. The majority of participants reported that they: asked about patients’ secondhand smoke exposure status (70.0%) and parents’ tobacco use status (53.3%), and advised parental smokers to not smoke around their child (70.0%) and to quit smoking (50%). One in five participants reported they assessed smokers’ interest in quitting smoking, and 16.7% talked with smokers about cessation techniques and tactics; of these, 10% referred/enrolled smokers to the Tobacco Quitline or cessation program, and 6.7% made a quit plan or recommended nicotine replacement therapy medication.

CONCLUSIONS

Key findings identified are the need for professional tobacco counseling training, standardizing efforts during visits, and emphasizing pediatric patients’ potential health benefits. This information will be used for developing a PED/ UC-based parental tobacco cessation and child tobacco smoke exposure reduction intervention.

Costs to provide a tobacco cessation intervention with parents of pediatric emergency department patients

INTRODUCTION

Pediatric emergency department (PED) visits are opportune times in which to provide smoking cessation interventions for parents who smoke. This study reports on the costs of providing parental smokers who bring their children to the emergency setting, with a screening, brief intervention, and assisted referral to treatment (SBIRT) intervention, which includes counseling about tobacco cessation and nicotine replacement therapy.

METHODS

Cost data were collected during a randomized controlled trial with 750 parental smokers whose child was presented to a PED or pediatric Urgent Care unit with a potential tobacco smoke exposure-related illness. Interventionist training, screening, and SBIRT costs are reported from the organizational perspective (i.e. that of the providing hospital). A spreadsheet tool was created to allow for organizations to estimate their own costs based on their settings, for each aspect of the intervention.

RESULTS

The mean costs per parent included interventionist training, screening and enrollment, SBIRT delivery, distribution of take-home materials and nicotine replacement therapy, booster text messages, and follow-up phone contact. The total cost per parent was approximately $97. Varying the underlying cost assumptions led to total costs ranging from $85 to $124 per treated parent.

CONCLUSIONS

The emergency setting is an important locus of tobacco control that could have a large public health benefit to parents and children. The costs reported in this report and the accompanying spreadsheet tool will permit emergency settings to estimate the costs and assist with planning, staffing and resource allocation necessary to implement an SBIRT smoking cessation intervention in research-based and clinically-based cessation interventions into adult or pediatric emergency visits.

A Parental Smoking Cessation Intervention in the Pediatric Emergency Setting: A Randomized Trial

We examined the efficacy of a pediatric emergency visit-based screening, brief intervention, and referral to treatment (SBIRT) condition compared to a control condition (Healthy Habits Control, HHC) to help parental smokers quit smoking. We enrolled 750 parental smokers who presented to the pediatric emergency setting with their child into a two-group randomized controlled clinical trial. SBIRT participants received brief cessation coaching, quitting resources, and up to 12-weeks of nicotine replacement therapy (NRT). HHC participants received healthy lifestyle coaching and resources. The primary outcome was point-prevalence tobacco abstinence at six weeks (T1) and six months (T2). The mean (SD) age of parents was 31.8 (7.7) years, and 86.8% were female, 52.7% were Black, and 64.6% had an income of ≤$15,000. Overall abstinence rates were not statistically significant with 4.2% in both groups at T1 and 12.9% and 8.3% in the SBIRT and HHC groups, respectively, at T2. There were statistically significant differences in SBIRT versus HHC participants on the median (IQR) reduction of daily cigarettes smoked at T1 from baseline (-2 [-5, 0] versus 0 [-4, 0], p = 0.0008),at T2 from baseline (-4 [-9, -1] vs. -2 [-5, 0], p = 0.0006), and on the mean (SD) number of quit attempts at T2 from baseline (1.25 (6.5) vs. 0.02 (4.71), p = 0.02). Self-reported quitting rates were higher in SBIRT parents who received NRT (83.3% vs. 50.9%, p = 0.04). The novel use of the pediatric emergency visit to conduct cessation interventions helped parents quit smoking. The near equivalent abstinence rates in both the SBIRT and HHC groups may be due to underlying parental concern about their child's health. Cessation interventions in this setting may result in adult and pediatric public health benefits.