Public Release: 

Outpatient pediatric visits good opportunity to help parents quit smoking

Studies find that screening and counseling are effective, but underused

Massachusetts General Hospital

Children's visits to pediatricians or other medical practitioners offer an excellent opportunity to counsel parents about their own smoking and offer smoking cessation services. However, U.S. pediatricians and family practitioners are not regularly discussing smoking with parents, despite the fact that their professional organizations recommend they do so. These findings, by research teams based at MassGeneral Hospital for Children, are reported in two papers in the November 2003 issue of Pediatrics.

"Our overall goal is to bring evidence-based, effective tobacco control measures into the pediatric setting," says Jonathan Winickoff, MD, MPH of the MGH Center for Child and Adolescent Health Policy, the lead author of both reports. "Most physicians treating children are not currently intervening effectively with parents about smoking, and our research has shown that doing so is both feasible and welcomed by the parents."

The research team, which includes a physician from Boston Children's Hospital, had previously published a study showing that a child's hospitalization for respiratory illness was a good occasion for offering stop-smoking services to parents. One of the current studies was designed to see if outpatient-visit counseling could lead to the same results.

During a four-month period, parents or other adults bringing a child to a Children's Hospital outpatient clinic for respiratory illness or other conditions related to tobacco smoke were asked about their own smoking habits. Those who reported smoking were invited to participate in the Stop Tobacco Outreach Program (STOP), a free service including a motivational interview, nicotine replacement, follow-up phone counseling and referrals to both their primary care physicians and to the Massachusetts Smokers Quitline.

Of 100 parents enrolling in the program, 78 percent accepted nicotine replacement therapy, and 81 percent completed both the in-person and telephone counseling sessions. A follow-up call two months after the program began found that 44 percent of those who received nicotine replacement had used it and 42 percent had received additional counseling from the Quitline.

Quitting for 24 hours or more was reported by 86 percent of those reached for follow-up, and almost 20 percent reported continuing tobacco abstinence, a figure that compares with a usual U.S. annual quit rate of 2 to 3 percent. Almost 90 percent of parents reached for follow-up thought the program was useful, and all of them said it should be offered to all smoking parents.

"Harnessing the pediatric visit sets up a teachable moment for smoking parents, because they are concerned about the health of their child," says Winickoff. "Many physicians think that parents would refuse smoking cessation services, but we had 80 percent saying they wanted it, which is similar to what we saw in the hospitalization study."

In the second Pediatrics study, the researchers conducted a phone survey of households across the U.S. Of the 900 parents who had a child seen by a pediatrician or family practitioner in the previous year, 21 percent reported they were smokers. Almost half of the parents - both smokers and non-smokers - recalled being asked by the child's physician whether they or anyone in their household smoked. About 40 percent of smokers were asked whether smoking was allowed inside their homes, and 20 percent were asked about their cars. A third of smokers reported being advised about the health risks of second-hand smoke or the fact that smokers' children were more likely to smoke themselves, and only 40 percent said the physician had advised them to stop smoking.

"We found there is a tremendous opportunity for both pediatricians and family practitioners to improve their activities in this area, which could lead to a tremendous benefit to child health," says Winickoff, an instructor in Pediatrics at Harvard Medical School.

Co-authors of the intervention study were Valerie Buckley, James Perrin, MD, and Nancy Rigotti, MD, of the MGH, and Judith Palfrey, MD, of Children's Hospital. The survey study was co-authored by Rigotti; Robert McMillen, PhD, of Mississippi State University; Bronwen Carroll of the University of Massachusetts Medical School; and Jonathan Klein, MD, MPH, Susan Tanski, MD, and Michael Weitzman, MD, of the University of Rochester.

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The studies were supported by grants from the Deborah Munroe Noonan Memorial Fund through the Medical Foundation, the Agency for Healthcare Research and Quality, a Midcareer Investigator Award in Patient-Oriented Research, the Flight Attendant Medical Research Institute, the Department of Health and Human Services, and the Center for Child Health Research of the American Academy of Pediatrics.

Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $350 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, medical imaging, neurodegenerative disorders, transplantation biology and photomedicine. In 1994, MGH and Brigham and Women's Hospital joined to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.

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