Parental Tobacco Screening and Counseling in the Pediatric Emergency Department: Practitioners’ Attitudes, Perceived Barriers, and Suggestions for Implementation and Maintenance

Abstract

Objective The pediatric emergency department (PED) is a venue that underutilizes parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners’ attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, and to solicit suggestions for improving the sustainability and maintenance of such practices. Methods We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice. Results Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing “pre-arranged” counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (e.g., changes in children’s secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of on-site tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, and the importance of intervention “champions” in the PED. Conclusions By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.

Assessment of tobacco smoke exposure in the pediatric emergency department

“…Potential barriers that may have contributed to low rates of screening include time constraints within the busy PED and/or provider discomfort with tobacco screening and counseling. 17 Further research is warranted to determine how universal TSE screening can be best implemented in the PED.…”

The Difference a Decade Makes: Smoking Cessation Counseling and Screening at Pediatric Visits

“…52,59 They have also have cited lack of counseling skills and educational resources and stress as reasons why they do not routinely screen for or counsel regarding smoking. [60][61][62][63][64] Lack of time is often one of the most commonly given reasons for not counseling on cessation. 65,66 Although the present results do not show an increase in visit length, it has been shown that the effectiveness of counseling does increase with the session length.…”

Challenges and Opportunities to Engaging Emergency Medical Service Providers in Substance Use Research: A Qualitative Study

“…Recently, studies identifying factors to understand and mitigate use of emergency services have been conducted. 37,38 However, many of these studies have been conducted in the ED rather than with EMS providers. [37][38][39][40][41][42][43] Irrespective of intervention type, important facilitators identified include demonstrated effectiveness of screening and health interventions and study "champions" to maintain the impact of the interventions.…”

“…[37][38][39][40][41][42][43] Irrespective of intervention type, important facilitators identified include demonstrated effectiveness of screening and health interventions and study "champions" to maintain the impact of the interventions. 1,11,[37][38][39][40][41] Among studies of research in out-of-hospital settings, a major barrier identified is lack of knowledge of ethical research standards, such that participants may not be aware of institutional safeguards to protect privacy and ensure maximum benefits. 39 Alternatively, a facilitator of prehospital research is incorporation of study elements into existing EMS workflow and protocols, though more research is needed in prehospital settings to identify factors which facilitate research.…”