Addressing Parental Smoking by Changing Pediatric Office Systems
- To compare the effectiveness of the Clinical Effort Against Secondhand Smoke (CEASE)
intervention vs no intervention in increasing clinicians' delivery of evidence-based
parental smoking cessation assistance in pediatric healthcare settings.
- To compare the effectiveness of this intervention vs no intervention on parental
- To test the level of systematic practice implementation of the intervention using
existing validated measures in an Implementation Process Survey (IPS).
- To evaluate, in an exploratory fashion, additional key implementation step measures
mapped from the five A's (Ask, Advise, Assess, Assist, Arrange) to see how well they
predict tobacco control service delivery in pediatric healthcare settings.
- To use process results from the IPS (i.e., previously validated and exploratory
measures) to improve the adoption, implementation, and maintenance of the intervention
in this study.
OUTLINE: This is a multicenter study. Participants are stratified according to practice.
Participants are randomized to 1 of 2 intervention arms.
- Arm I (Clinical Effort Against Secondhand Smoke [CEASE] intervention): The CEASE
intervention incorporates a number of materials into the operations of the pediatric
practice, including baseline questionnaires that screen for parental tobacco use and
readiness to quit smoking, enroll in quitline counseling, or explore pharmacotherapy; a
label that affixes to the child's problem list in the medical record, documenting
parental smoking status and indicating the patient's secondhand exposure, thus
encouraging continuity of cessation support in cross-coverage situations; and decision
support for clinicians that prompts delivery of exposure-reduction counseling and
distribution of motivational-messaging handouts (i.e., halflets) to parents for
education, skills training, and psychosocial support. Parental messaging elements
include strategies or methods for quitting, collaborative goal setting, identifying
personal barriers to quitting, and focused strategies for reducing secondhand-smoke
exposure of the patient. Additional intervention materials include a HIPAA-compliant
form for enrolling the smoker in counseling through the telephone quitline;
pre-printed, practice-embossed prescription pads for prescribing over-the-counter
nicotine-replacement therapy when desired by the smoker; pharmacotherapy posters in
pediatric patient examination rooms to inform parental smokers and assist clinicians in
discussing tobacco dependence treatment; and a simple implementation guide to support
integrating the parent, clinician, and practice levels of the intervention.
The CEASE intervention also incorporates telephone counseling after the pediatric healthcare
visit to ensure that parents receive professional, ongoing smoking-cessation counseling.
Parental smokers undergo an exit interview survey and follow-up telephone surveys at 3
months and 12 months for evaluation of content of tobacco control delivered during the
visit; use of messaging materials, medications, and telephone counseling sessions; current
smoking status; and rules about smoking in the home and car. If the parent has had a 7-day
quit at the 12-month follow-up, the parent is also asked to provide a saliva sample for
cotinine analysis to confirm nonsmoking status.
- Arm II (control): Participants complete a questionnaire at baseline and an exit
interview survey. They also complete telephone interviews at 3 month and 12 months. If
the parent has had a 7-day quit at the 12-month follow-up, the parent is also asked to
provide a saliva sample for cotinine analysis to confirm nonsmoking status.
In both arms, participating practitioners and key office staff complete Implementation
Process Surveys at baseline and at 6 weeks and 6 months.
Allocation: Randomized, Masking: Open Label, Primary Purpose: Health Services Research
Rates of clinician delivering cessation assistance other than advice as assessed by parent surveys at baseline and 12 months after clinic visit
Jonathan Winickoff, MD, MPH
Massachusetts General Hospital
|Massachusetts General Hospital||Boston, Massachusetts 02114-2617|