Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. e810-e824 (doi:10.1542/peds.2005-2869)
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ARTICLE

Smoking Prevention and Cessation Intervention Delivery by Pediatric Providers, as Assessed With Patient Exit Interviews

Lori Pbert, PhDa, Kenneth E. Fletcher, PhDb, Alan J. Flint, MD, MPHc, Martin H. Young, PhDd, Susan Druker, MAa and Joseph DiFranza, MDe

a Division of Preventive and Behavioral Medicine
b Department of Psychiatry and Graduate School of Nursing
d Division of Developmental and Behavioral Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
c Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
e Family and Community Health, University of Massachusetts Medical Center, Worcester, Massachusetts

OBJECTIVE. The goal was to evaluate the degree to which a smoking prevention and cessation intervention was delivered by providers to adolescents in the pediatric office setting.

METHODS. Eight pediatric clinics in central Massachusetts were assigned randomly to either a special intervention (brief pediatric provider-delivered intervention plus peer counseling) or the usual care condition. Subjects (n = 2710) were adolescents 13 to 17 years of age, both smokers (smoked in the past 30 days) and nonsmokers/former smokers. The degree to which smoking prevention and treatment interventions were delivered by providers was assessed through patient exit interviews with adolescents after their clinic visits; interviews assessed the occurrence of 10 possible intervention steps.

RESULTS. The percentage of providers engaging in the smoking interventions differed significantly between the special intervention and usual care conditions, according to adolescent reports in the patient exit interviews. For nonsmokers/former smokers, overall patient exit interview scores were 7.24 for the special intervention condition and 4.95 for the usual care condition. For current smokers, overall patient exit interview scores were 8.40 and 6.24 for the special intervention and usual care conditions, respectively. Intervention fidelity of special intervention providers was 72.2% and 84.0% for nonsmokers/former smokers and current smokers, respectively.

CONCLUSIONS. Pediatric providers who receive training and reminders to deliver a brief smoking prevention and cessation intervention to adolescents in the context of routine pediatric primary care practice can do so feasibly and with a high degree of fidelity to the intervention protocol.

Key Words: smoking prevention and cessation • adolescents • pediatric providers • intervention delivery • patient exit interview

Abbreviations: CDI-S—Children's Depression Inventory-Short Form • HONC—Hooked on Nicotine Checklist • PEI—patient exit interview • SI—special intervention • UC—usual care • ADD—attention-deficit disorder • ADHD—attention-deficit/hyperactivity disorder

Accepted Mar 31, 2006.




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