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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1127-1133

Intervention With Parental Smokers in an Outpatient Pediatric Clinic Using Counseling and Nicotine Replacement

Jonathan P. Winickoff, MD, MPH*,{ddagger}, Valerie J. Buckley{ddagger}, Judith S. Palfrey, MD§, James M. Perrin, MD* and Nancy A. Rigotti, MD{ddagger}

* MGH Center for Child and Adolescent Health Policy, Division of General Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
{ddagger} Tobacco Research and Treatment Center, Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts
§ Children’s Hospital, Division of General Pediatrics, Boston, Massachusetts

Objective. To evaluate the feasibility of implementing a smoking cessation intervention for parents at the time of the pediatric visit.

Methods. A prospective cohort of smoking parents whose child was seen in an outpatient pediatric practice was offered the Stop Tobacco Outreach Program, which includes 3 brief counseling sessions, written materials, free nicotine replacement therapy (NRT), proactive referral to a free state telephone quitline, and fax referral to the parents’ primary clinician. The primary outcome was completion of all three counseling sessions. Other outcomes were quit attempts, cessation, NRT use, state quitline use, and household smoking assessed at 2-month follow-up.

Results. One hundred fifty-eight smoking parents met eligibility criteria and 100 (63%) enrolled in the study. Of the 100 enrollees, 81% completed all three counseling sessions and 78% accepted free NRT at the time of enrollment. At 2-month follow-up, of the 100 enrollees, 56% reported making a quit attempt of ≥24 hours, 18% reported 7-day tobacco abstinence, 34% used NRT, and 42% received additional counseling from the state telephone quitline. The mean number of cigarettes smoked inside the home and car declined over 2 months (home, 5.1 vs 1.4; and car, 2.5 vs 1.4).

Conclusions. This study demonstrates the feasibility of engaging parents in a smoking cessation intervention at the time of a child’s clinic visit. This approach may be an effective way to reach smokers who otherwise are unlikely to access smoking cessation interventions. High rates of program enrollment, use of NRT, and completion of telephone counseling in this study support the hypothesis that a child’s clinic visit is a teachable moment to address parental smoking cessation.

Key Words: parent • smoking • tobacco • smoking cessation • tobacco control • proactive • telephone counseling • nicotine replacement therapy • pediatrics • outpatient • clinic • environmental tobacco smoke • secondhand smoke • respiratory illness • asthma

Abbreviations: ETS, environmental tobacco smoke • PCP, primary care provider • S.T.O.P., Stop Tobacco Outreach Program • NRT, nicotine replacement therapy

Received for publication Oct 15, 2002; Accepted Feb 21, 2003.




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