A smoking cessation intervention plus proactive quitline referral in the pediatric emergency department: A pilot study

Abstract

The prevalence of adult tobacco users who utilize the emergency department as patients or parents is disproportionately higher than the national average rates of tobacco use. Thus, it is advised that the emergency department be utilized as a venue for providing tobacco cessation counseling to adult tobacco users. Using a randomized control trial design, this pilot study evaluated the effect of a brief tobacco cessation intervention for tobacco using parents of children brought to a pediatric emergency department. Participants received either usual care or a brief tobacco cessation intervention based on the first 2 of the 5A's of the Clinical Practice Guidelines and fax referral to the Quitline. The primary outcome was self-reported repeated point prevalence of tobacco use at 6 weeks and 3 months following the intervention. Secondary aims included number of quit attempts, increases in readiness to quit, comparisons of participants who were successfully retained, and contact rates by Quitline counselors. At 3-month follow-up, compared to the Usual Care Control group, intervention participants were more likely to have made at least one quit attempt (59% vs. 34%; p<.01), be seriously thinking about quitting (68% vs. 37%; p<.001), and have higher Ladder scores (6.2 vs. 5.3; p<.05). Study personnel were able to contact 68% and 52%, respectively, of participants at 6-week and 3-month follow-up. Quitline counselors were unable to reach 54% of participants. Our results reveal increased intentions to quit and trends toward quitting, however we experienced difficulties with participant retention. Suggestions for improvements in point prevalence and retention are given.

The Pediatrician as Smoking Cessation Counselor: Rationale and Review of the Literature

“…Several other studies involving the pediatrician as counselor have been done, though these were either underpowered or plagued by loss to follow-up [14,[17][18][19]. Despite these limitations, each reported significant parental willingness to receive cessation counseling by a pediatrician and trends toward more successful cessation in the intervention groups.…”

“…There were some statistically significant impacts reported in these small studies. In one randomized, controlled trial of a brief intervention in an emergency department setting, 59% of the intervention group vs. 34% of the control group (p <0.01) reported attempting to quit at 3 months post-intervention [18]. Also, a small German study reported a significant decrease in number of cigarettes smoked and cotinine levels after a brief, office based intervention, though it was not a controlled trial [17].…”

“…There is a large body of literature related to provision of smoking cessation services to adults when they are hospitalized and comprehensive programs for hospitalized adults achieve quit rates above 25% [36]. Five of the above-referenced studies specifically used sick visits or hospitalization as the access point for discussing smoking cessation with parents, 3 inpatient and 2 urgent/emergent care [18,19,31,32,35]. Each achieved some measure of success, and all reported measures of parental willingness to participate in smoking cessation during sick visits or hospitalization.…”

“…Cessation studies are often categorized based on duration of the intervention; however, for the purposes of this review they will be categorized into studies where the pediatrician serves as the smoking cessation counselor and those where other trained practitioners do the counseling. Eight trials were identified where pediatricians were trained to provide at least a portion of the smoking cessation counseling [12][13][14][15][16][17][18][19]. The largest of these trials took place in 49 private practices in Oregon [12].…”

“…There is also a growing body of literature that suggests that pediatricians themselves can serve as tobacco cessation counselors in multiple clinical settings [12][13][14][15][16][17][18][19]. Finally, there is a very large body of evidence to draw upon in choosing the type of smoking cessation intervention to offer including a national clinical practice guideline [20].…”