Context of Anti-smoking Message Improves Quit Rate for Parents

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Children's Doctor

Brian Jenssen, MD, a primary care pediatrician at CHOP and a Robert Wood Johnson Foundation Clinical Scholar, focuses on use of health information technology to find novel approaches to improve care for children and families.

Secondhand smoke exposure is a significant public health problem. More than 40% of U.S. children 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 child’s secondhand smoke exposure, they end the cycle of tobacco dependence, decreasing the risk their children will become smokers.

As pediatricians we’re uniquely positioned to educate and motivate parents to protect their children from secondhand smoke. Although interventions through pediatric settings are effective in helping parents quit, various system-level barriers have limited adoption and sustainability. Both nationally, and in Pennsylvania, very few parents who smoke and accompany their child to the pediatrician’s office are offered treatment or given advice to help them quit.

In a recent study published in Pediatrics, we describe the development and evaluation of a tool embedded in the electronic health record (EHR) that prompts clinicians to ask about secondhand smoke exposure at all visits and, for parents who smoke, prescribe nicotine replacement therapy and coordinate referral to an adult tobacco treatment program. Our intervention more than doubled rates of smoking cessation counseling and led clinicians to provide treatment for parents interested in quitting.

In developing the tool, we made sure it fit within clinical workflows and complemented communication between doctors and families around secondhand smoke exposure and tobacco treatment. We found the majority of pediatric clinicians used it at the majority of visits. More importantly, in follow-up surveys, the majority of parents were advised to quit and offered nicotine replacement therapy, and 25% of parents were using medication to help them quit.

Finally, more broadly, we learned the value of communication framing, especially around behavioral interventions. Parents noted they became motivated because quitting smoking was framed around helping their child. Additionally, this sort of messaging engendered positive regard for the pediatrician, with parents saying that their child’s doctor acted in the family’s best interest. Our study shows that simple tools embedded in EHRs can empower pediatricians to help children and families lead tobacco-free lives.

Jenssen BP, Bryant-Stephens T, Leone FT, Grundmeier RW, Fiks AG. Pediatrics. Clinical decision support tool for parental tobacco treatment in primary care. 2016;137(5):pii:e20154185.