Published online March 1, 2005
PEDIATRICS Vol. 115 No. 3 March 2005, pp. 750-760 (doi:10.1542/peds.2004-1055)
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SPECIAL ARTICLE

State-of-the-Art Interventions for Office-Based Parental Tobacco Control

Jonathan P. Winickoff, MD, MPH*, Anna B. Berkowitz, MPH*, Katie Brooks{ddagger}, Susanne E. Tanski, MD§, Alan Geller, RN, MPH||, Carey Thomson, MD, MPH, Harry A. Lando, PhD#, Susan Curry, PhD**, Myra Muramoto, MD, MPH{ddagger}{ddagger}, Alexander V. Prokhorov, MD, PhD§§, Dana Best, MD, MPH||||, Michael Weitzman, MD¶¶, Lori Pbert, PhD## for the Tobacco Consortium, Center for Child Health Research of the American Academy of Pediatrics

* General Pediatrics Division, MGH Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, and Tobacco Research and Treatment Center, Boston, Massachusetts
{ddagger} Department of Dermatology, Cancer Control Center, Boston University School of Medicine, Boston, Massachusetts
§ Strong Children’s Research Center, University of Rochester, Rochester, New York
|| Department of Dermatology, Cancer Control Center, and Department of Epidemiology, Boston University School of Medicine, Boston University School of Public Health
MGH Tobacco Research and Treatment Center and the Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
# Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota
** Health Research and Policy Centers, University of Illinois, Chicago, Illinois
{ddagger}{ddagger} Department of Family and Community Medicine, University of Arizona Health Sciences Center, Tucson, Arizona
§§ University of Texas M.D. Anderson Cancer Center, Houston, Texas
|||| Children’s National Medical Center, George Washington University, Washington, DC
¶¶ Center for Child Health Research and Strong Children’s Research Center, University of Rochester, Rochester, New York
## Division of Preventive and Behavioral Medicine, University Massachusetts Medical School, Worcester, Massachusetts

Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A’s framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.

Key Words: tobacco • smoking • adolescent • child • parent • pediatrician • nicotine-replacement therapy • NRT • nicotine • tobacco dependence • guideline • clinical practice guideline • environmental tobacco smoke • secondhand smoke • SHS

Abbreviations: SHS, secondhand smoke • ETS, environmental tobacco smoke • NRT, nicotine-replacement therapy • PHS, US Public Health Service • AAP, American Academy of Pediatrics • OR, odds ratio • CI, confidence interval

Accepted Aug 26, 2004.




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