Are Chinese pediatricians missing the opportunity to help parents quit smoking?

Abstract

BackgroundSecondhand smoke (SHS) exposure of children due to parental tobacco use is a particularly prevalent health issue and is associated with adverse health outcomes. Following the US Clinical Practice guidelines, pediatricians in the United States deliver 5A’s (ask, advise, assess, assist, and arrange) counseling to smoking parents which has proven to be effective. We examined Chinese pediatricians’ adherence to the clinical practice guidelines for smoking cessation (i.e. 5A’s counseling practices) with smoking parents, and identified factors associated with these practices.MethodsA cross-sectional paper-and-pencil survey of pediatricians was conducted in twelve conveniently selected southern Chinese hospitals. Factors associated with any of the 5A’s smoking cessation counseling practices were identified by logistic regression.ResultsOf respondents (504/550), only 26 % routinely provided 5A’s smoking cessation counseling to smoking parents. More than 80 % of pediatricians didn’t receive formal training in smoking cessation and had not read China smoking cessation guidelines; 24 % reported being “very confident” in discussing smoking or SHS reduction with parents. Pediatricians who had never smoked (OR: 2.29, CI:1.02-5.12), received training in smoking cessation (OR: 2.50, CI:1.40-4.48), had read China smoking cessation guidelines (OR: 2.17, CI:1.10-4.26), and felt very (OR: 7.12, CI:2.45-20.70) or somewhat (OR: 3.05, CI:1.11-8.37) confident in delivering cessation counseling were more likely to practice 5A’s. Pediatricians who reported “it is hard to find a time to talk with parents” (OR: 0.32, CI: 0.11-0.92) or “lack of a standard of care requiring pediatricians to provide smoking cessation or SHS exposure reduction intervention” (OR: 0.45, CI: 0.21-0.98) as a barrier were less likely to follow the 5A’s guidelines.ConclusionsSmoking cessation counseling to address parental smoking is infrequent among Chinese pediatricians. There is a need to develop and test intervention strategies to improve the delivery of 5A’s smoking cessation counseling to parental smokers.

Effectiveness of Interventions to Reduce Exposure to Parental Secondhand Smoke at Home among Children in China: A Systematic Review

“…Smokers with a history of 24 h of abstinence in the past year and those who have tried more methods of stopping smoking are more likely to achieve a longer quit period in smoking cessation programs [36]. Given that only 22.4% of pediatricians in China regularly advise parents to quit smoking and that only 3.8% of pediatricians arrange a follow-up appointment to assess the effects of their advice [37], it might be practical for community health workers and nurses in China to provide smoking cessation services. However, a lack of training in reducing tobacco consumption and in cessation counseling is a primary barrier to the provision of SHS exposure reduction services by pediatric nurses [38].…”

Evaluation of the effectiveness of a WHO-5A model based comprehensive tobacco control program among migrant workers in Guangdong, China: a pilot study

“…This model has shown to be an effective way to help patients to quit smoking in primary care outpatient settings in most of the developed countries [22,23]. To our knowledge, few studies have reported the use of WHO-5A model in developing countries [24]. It has not yet been used in non-medical workplaces and its application and effectiveness among Chinese migrant workers are unknown.…”