Helping Parents Quit Smoking in Pediatric Settings
Statement of Problem
Secondhand smoke exposure is a significant public health problem. More than 40% of children in the U.S. are exposed to secondhand smoke, increasing their risk of respiratory infections, asthma flare-ups and premature death. When parents quit smoking, they not only increase their own life expectancy by an average of 10 years and eliminate the majority of their children’s secondhand smoke exposure, they also decrease the likelihood of their children becoming smokers later in life.
Pediatricians are uniquely positioned to educate and motivate parents to protect their children from secondhand smoke. Yet, very few parents who smoke and accompany their child to the pediatrician’s office are offered treatment or given advice to help them quit. Electronic health records (EHRs) and clinical decision support (CDS) systems may improve the quality and standardization of clinical interventions for tobacco cessation. In pediatric settings, outpatient-based multilevel interventions are emerging to address these barriers; the interventions combine pediatric health care clinician advice and behavioral counseling with navigation to pharmacologic cessation aids approved by the U.S. Food and Drug Administration (FDA).
To help pediatricians provide smoking cessation treatment to parents, Dr. Jenssen and colleagues developed a CDS tool that embeds in the electronic health record and prompts clinicians to ask about secondhand smoke exposure at all visits. For parents who smoke, the tool assists physicians in prescribing nicotine replacement therapy and coordinating referral to an adult tobacco treatment program. The tobacco treatment programs offered included the PA Free Quitline, a free, evidence-based tobacco cessation service available to all Pennsylvanians.
Dr. Jenssen tested and subsequently evaluated the CDS tool among pediatric residents in two settings: an urban pediatric primary care site and a pediatric inpatient unit. He found that at the primary care site, 80% of eligible pediatric clinicians used the CDS tool at 2,286 (76%) out of 3,023 visits. 94% of clinicians surveyed were satisfied with the tool and rated its usability good to excellent. Additionally, follow-up surveys found that the majority of parents were advised to quit and offered nicotine replacement therapy, and 25% of parents were using medication to help them quit.
At the inpatient unit, the tool was used for 49% (52 of 109) of patients. All clinicians surveyed found the tool acceptable and rated its usability good to excellent. 32% of parents were referred to the PA Free Quitline through the CDS tool’s discharge instructions, and 14% parents were prescribed nicotine replacement therapy.
These data demonstrate that the CDS tool to help pediatric residents provide smoking cessation counseling is feasible, acceptable and usable in both the hospital and primary care settings. The CDS tool also influenced clinical care in the primary care setting.
While these results are promising, Dr. Jenssen plans to continue to improve the design and effectiveness of the CDS intervention.
One way Dr. Jennsen plans to do this is by better understanding pediatrician-parent communication regarding tobacco-dependence treatment, namely by investigating the most effective way to frame tobacco cessation messages to parents. Specifically, Dr. Jenssen will test the effects of gain-framed and loss-framed messages on parents’ intention to reduce their child’s secondhand smoke exposure and engage in treatment.
Dr. Jenssen also plans to address a knowledge gap in pediatric preventative services by informing how to best implement parent referral to tobacco quitlines into real-world clinical practice. Specifically, Dr. Jenssen will compare quitline enrollment using an electronic referral process (parent information sent electronically to quitline with quitline calling the parent) with the current standard manual process (giving the parent the quitline phone number).
Children's Hospital of Philadelphia, PolicyLab. Helping Parents Quit Smoking in Pediatric Settings [Online] Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].