An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial

Collins, Bradley N.; Lepore, Stephen J.; Winickoff, Jonathan P.; Nair, Uma S.; Moughan, Beth; Davey, Adam; Taylor, Denise; Fleece, David; Godfrey, Melissa

doi:10.1542/peds.2017-1026k

Cited by 25 publications

(24 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, quitlines may need to provide more intensive home smoking ban interventions that are integrated within their standard cessation intervention protocol. They may want to adapt clinical interventions that have effectively reduced child tobacco smoke exposure and promoted parent tobacco cessation [12]. Alternatively, quitlines may want to consider the feasibility and impact of community-based interventions like the one created by Escoffery and colleagues [21] that promoted smoke-free homes using telephone coaching protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary analysis of the maternal smoking study demonstrated that home smoking ban restrictions partially mediated the association between the counseling intervention and maternal smokers' bioverified quit status [11]. Additional evidence comes from a study that compared a behavioral intervention integrating pediatrician advice with telephone-based skills training and support from a health counselor compared to standard care in pediatrician primary care [12].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Impact of changes in home smoking bans on tobacco cessation among quitline callers

Yuan

Nair

Crane

et al. 2019

Health Education Research

View full text Add to dashboard Cite

Home smoking bans may be an effective way to promote tobacco cessation among treatment seeking smokers. Few studies have examined this relationship in a quitline setting. Data were obtained from 14,296 adults who were enrolled in a state quitline between January 2011 and July 2016. This study investigated whether cessation rates varied by changes in home smoking ban implementation between enrollment and 7-month follow-up. The impact of changes in home smoking bans on cessation at follow-up was significantly modified by having other smokers living in the home at follow-up (p<0.0001). Among callers who did not live with other smokers in the home, the highest odds ratio of 30-day cessation was for callers who reported bans at follow-up only (OR=10.50, 95%CI: 8.00, 13.70), followed by callers who reported bans at both enrollment and follow-up (OR=8.02, 95%CI: 6.27, 10.30) and callers who reported bans at enrollment only (OR=2.06, 95%CI:1.47, 2.89) compared to callers with no home smoking bans. When callers reported that they lived with other smokers in the home, the effect of home smoking bans on cessation was much smaller. Quitlines should support the implementation of home smoking bans as a part of callers' goal setting activities to achieve tobacco cessation.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of changes in home smoking bans on tobacco cessation among quitline callers

Yuan

Nair

Crane

et al. 2019

Health Education Research

View full text Add to dashboard Cite

show abstract

“…Providers faxed interested parents’ contact information to study staff. Clinician adherence was good [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

“…Previously, we reported on the theory, methods, and short-term (three-month, end of treatment; EOT) outcomes of our Kids Safe and Smokefree (KiSS) program, a child TSE reduction and parent cessation intervention that uses a multilevel intervention approach to deliver evidence-based interventions to low-income and minority parents who smoke [ 22 , 23 ]. Since the target population in KiSS faces considerable barriers to accessing evidence-based treatments, and confronts more challenges to quitting than the general population due to high levels of life stress [ 24 , 25 , 26 , 27 ], we hypothesized that a multilevel treatment model would be especially effective.…”

Section: Introductionmentioning

confidence: 99%

“…Treatment fidelity analyses revealed high adherence among the clinicians (>80% of respondents recalled being encouraged to avoid smoking indoors, being advised about child TSE harms, and being advised about the benefits of reducing TSE) and the telephone counselors (≥90% protocol adherence among counselors) [ 22 ]. Analyses of parent-reported outcomes at EOT suggested that significantly more parents in the multilevel AAR + counseling condition than the AAR + control condition eliminated all of the sources of child TSE (45.8% versus 29.9%) and quit smoking (28.2% versus 8.2%) [ 22 ]. In addition, relative to the AAR + control condition, parents in the AAR + counseling condition at EOT were more likely to report home and car smoking restrictions, greater use of smoking urge management strategies, greater self-efficacy to protect children from TSE, and greater self-efficacy to quit smoking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial

Lepore

Collins

Coffman

et al. 2018

IJERPH

Self Cite

View full text Add to dashboard Cite

Background: Pediatricians following clinical practice guidelines for tobacco intervention (“Ask, Advise, and Refer” [AAR]) can motivate parents to reduce child tobacco smoke exposure (TSE). However, brief clinic interventions are unable to provide the more intensive, evidence-based behavioral treatments that facilitate the knowledge, skills, and confidence that parents need to both reduce child TSE and quit smoking. We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone. Methods: Pediatricians were trained to implement AAR with parents during clinic visits and reminded via prompts embedded in electronic health records. Following AAR, parents were randomized to intervention (AAR + counseling) or nutrition education attention control (AAR + control). Child TSE and parent quit status were bioverified. Results: Participants (n = 327) were 83% female, 83% African American, and 79% below the poverty level. Child TSE (urine cotinine) declined significantly in both conditions from baseline to 12 months (p = 0.001), with no between-group differences. The intervention had a statistically significant effect on 12-month bioverified quit status (p = 0.029): those in the intervention group were 2.47 times more likely to quit smoking than those in the control. Child age was negatively associated with 12-month log-cotinine (p = 0.01), whereas nicotine dependence was positively associated with 12-month log-cotinine levels (p = 0.001) and negatively associated with bioverified quit status (p = 0.006). Conclusions: Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation.

show abstract

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Shojania

Jennings²,

Mayhew

et al. 2009

Cochrane Database of Systematic Reviews

362

339

View full text Add to dashboard Cite

Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

show abstract

An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial

Cited by 25 publications

References 55 publications

Impact of changes in home smoking bans on tobacco cessation among quitline callers

Impact of changes in home smoking bans on tobacco cessation among quitline callers

Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Contact Info

Product

Resources

About