Parents’ smoking habits can be curbed at child patient visits

Pediatricians and family physicians can help their smallest patients’ health in an unconventional way: turning their attention to the parents’ health for part of the visit.

In a recent study, pediatricians incorporated a system called Clinical Effort Against Secondhand Smoke Exposure, or CEASE, to ask a child’s parents if they smoke. If the answer was yes, the doctor encouraged smoking cessation in a way that addressed the parents’ concern for their health and their children’s health.

The pediatricians then asked the parents what might help them quit. Physicians helped start parents’ quest to kick the habit by referring them to state-run quitlines or recommending, and possibly supplying them with, nicotine replacement gum or patches.

Practices that used CEASE had a 12-fold higher rate of delivering tobacco control assistance to parents compared with practices that had not adopted the program. The findings were published online June 24 in Pediatrics.

“Traditionally, pediatricians would ask a parent ‘Do you smoke in the home?’ And if they said no, that would be the end of the conversation. The study shows we can do more now and help parents quit smoking,” said pediatrician Jonathan P. Winickoff, MD, MPH, the study’s lead author and a member of the Center for Child & Adolescent Health Research and Policy at Massachusetts General Hospital for Children.

For the study, 20 pediatric practices in 16 states received CEASE intervention or usual care. The 10 intervention practices received CEASE training and materials so they could provide evidence-based assistance to parents who smoke.

The intervention approach was used for 999 parents, and 981 parents were enrolled in control practices.

System backed by facts

Practices that used CEASE had a 42.5% mean rate of delivering “meaningful assistance for parental cigarette smoking.” The rate was 3.5% in practices that did not use CEASE.

Rates of enrollment in the quitline were 10% in CEASE practices versus 0% for practices that didn’t use the program. Provision of smoking cessation medication was 12% in CEASE practices and 0% in the other practices. Similarly, counseling for smoking cessation was 24% in the CEASE practice versus 2% in the control group.

The CEASE materials and intervention do not apply solely to pediatricians, Dr. Winickoff said. Family physicians can incorporate them, too.

“It is designed for any child health care physician,” he said. “And it handles a real problem that has bothered pediatricians and family physicians for a long time — exposure to tobacco smoke. … If the program becomes more fully adopted, it can make a big change in the health of children.”

Beyond reducing child exposure to secondhand smoke, getting parents to stop smoking has other effects, Dr. Winickoff said. For example, quitting smoking adds an average seven years to a parent’s life, research shows.

When a parent quits, a child is four times less likely to become a smoker, Dr. Winickoff said. Kicking the habit of “a pack-a-day parent saves $2,000 a year,” he added.

CEASE provides a systematic approach for doctors that is quick and does not add cost to implement into their practice, Dr. Winickoff said. It can be adapted to a practice’s staffing, resources and physical configuration.

CEASE’s website provides physicians information on how to incorporate the program and contains printable general smoking cessation materials, as well as specific information for every state and the District of Columbia.

“Before, clinicians had to reinvent the wheel,” Dr. Winickoff said.

CEASE seizes on the opportunity of a teachable moment, he said. When children come into the office to be treated for asthma or for another health issue made worse or caused by smoking, parents are more likely to take the opportunity to change their habits because they see how it impacts their children.

“Parents are extra-receptive to dealing with their smoking at these visits,” Dr. Winickoff said. “And for many parents, the child’s visit is their only encounter with the health care system because they do not have a doctor of their own.”