Pediatricians May Help Parents Quit Smoking

Implementing smoking cessation strategies in pediatric practices may help parents quit smoking, according to the findings of a new randomized, clinical trial.

“Most parents want to quit smoking but they don’t often get the help they need from their own doctor,” study author Jonathan Winickoff, MD, MPH, a pediatrician at Massachusetts General Hospital for Children in Boston, told Reuters.

For the study, 10 pediatric practices were randomized to either implement the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention or maintain usual care at their practices.

“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,” described the authors, whose research appeared in JAMA Pediatrics.

Parents completed an exit survey two weeks and two years after the CEASE intervention was implemented to determine tobacco use status. Those who identified as tobacco users were eligible to participate in the study. The primary outcome was parents who received a prescription for nicotine replacement therapy or quit line enrollment. Practice-level smoking prevalence and cotinine-confirmed quit rates over the two years of intervention were analyzed as well.

Pediatricians Treating Adults?

A total of 8,184 parents completed the exit survey two weeks after the CEASE intervention was implemented, of whom 961 (27.1%) were current smokers in the intervention practices and 1,103 (23.9%) were current smokers in the control practices. In the intervention practices, 822 parents were eligible for the study, and in the control practices, 701 were eligible. At that visit, meaningful treatment was provided for 364 intervention practices parents (44.3%) compared to one control practice parent (0.1%) (risk difference, 44.0% [95% CI, 9.8%-84.8%]).

Two years later, 9,794 parents were screened, of whom 1,261 (24.4%) and 1,149 (25%) from the intervention and control practices, respectively, were smokers; 804 and 727 parents, respectively, were eligible for inclusion. At that visit, 113 intervention (14.1%) and two control (0.3%) parents received meaningful treatment (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%]),” the researchers further observed.

“Parents are the most important group to invest in for tobacco cessation because when they quit, they gain over 10 years of life on average, they have $2,000 extra dollars per year to spend on their families (if they smoked a pack a day), and their kids will be healthier with lower risk of pneumonia, asthma, ear infections, ADHD, and of sudden infant death syndrome,” Dr. Winickoff told Reuters in an email.

Parents also have an additional incentive to quit: their children’s well-being, as Dr. Winickoff noted, saying, “Kids who are not exposed to second hand smoke also have higher reading and math scores, fewer missed days of school, and have a much lower chance of ever using tobacco when they grow up.”