Healthy Living

Pediatricians Target Parental Smoking, As Major Way To Improve Child's Health

Parental Smoking Good Target For Pediatricians
By getting a parent to quit smoking, a child's health and danger of dying will diminish. Creative Commons

By encouraging parents to quit smoking, clinicians may help improve the health of a child in a number of ways.

Aside from delaying the eventual death of a parent by seven years on average, such interventions eliminate most exposure to tobacco smoke and access to cigarettes in addition to the main cause of house fire deaths. It also helps to improve health for poorer children by increasing financial resources given the average smoker in the U.S. spends $1,500 to $3,300 a year on cigarettes, depending on their state of residence.

Moreover, future pregnancies in the family would avoid smoking-related complications, according to a collaboration of American researchers funded by the U.S. government and private non-profit sources — and doctor's visits for children were the perfect place to catch adults who might see their own providers seldom, if at all.

"Even modest cessation rates can have a significant impact on the health of families when applied consistently over time and when the disease burden is high," Dr. Jonathan P. Winickoff, professor of pediatrics at Harvard Medical School, reports. "One of two smokers will die of an illness attributable to their smoking [and] missing this opportunity to help parents quit smoking may mean greater cancer and cardiovascular disease risk in this population of young adults."

In 16 states across the country, researchers conducted randomized controlled trials involving 20 pediatric practices that received either no intervention or the "Clinical Effort Against Secondhand Smoke Exposure," which provides clinicians with training and materials to provide evidence-based smoking cessation help. Included in the package is motivational messaging, referral to telephone helplines, and drug treatment for nicotine dependence.

In the study, researchers judged outcomes based on delivery of assistance beyond simple advice, rather than on eventual rates of smoking cessation among parents. Between June 2009 and March 2011, 1,980 smokers enrolled of an eligible 3,228 smokers among more than 18,000 parents screened in office visits at the 20 practices. For the intervention group of smokers receiving help, clinicians delivered meaningful help 42.5 percent of the time, with one in 10 parents in this group enrolling in the smoking cessation helpline and slightly more filling prescriptions for medication. Nearly one in four of these parents opted to receive counseling to help quit smoking.

In comparison, parents in the non-intervention control group received meaningful help from their child's doctor in 8 percent of cases, with no parents receiving prescriptions or enrolling in the helpline, although 2 percent of them enrolled in counseling for smoking cessation as a result of their office visit.

"A system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit," Winickoff writes.

The intervention, also known by its acronym CEASE, is an evidence-based system to help parents quit smoking within the context of pediatric care visits for their child. While sitting in the waiting room, parents complete a tobacco use "action sheet," which allows clinicians to document smoking habits among members of the household, which are then included in the child's medical records. Smoking cessation interventions become particularly poignant when triggered by a child's illness, such as asthma or other smoking-related ailments.

The initial clinical training required one hour of the doctor's time, followed by another hour a few weeks later with all of the practice's clinical staff. "Development of the intervention was informed by more than a decade of work," Winickoff writes, noting that such interventions are most successful when promising nicotine replacement therapy, without which "enthusiasm is greatly diminished."

Nicotine replacement therapy will be covered by public insurance by 2014, as part of the Patient Protection and Affordable Care Act of 2010, otherwise known as Obamacare.

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