TABLE 3

Possible Operationalization of the CEASE Intervention Materials in Practice

A parent and child arrive at the practice and check in; if smoking status is unknown, a CEASE annual card with attached CEASE sticker serves as the brief screener.
If the smoker is indeed present at the visit, then the parent fills out the self-assessment portion of the CEASE action sheet and returns it to the receptionist (see below for when smoker is not present).
The receptionist places the self-assessment portion of the CEASE action sheet on the chart and puts the CEASE sticker on the problem list.
The clinician quickly reviews the self-assessment portion of the CEASE action sheet and turns it over for the clinician portion of the CEASE action sheet.
The clinician briefly documents the tobacco control counseling delivered.
The clinician hands the parent an appropriate CEASE “halflet” about tobacco use for the parent's situation.
The clinician offers to enroll the parent into the proactive state quit line (where available), using the enrollment portion of the CEASE action sheet. Where proactive quit lines are not available, the parent will be referred to the quit line without direct fax.
The clinician hands the enrolled parent a CEASE Welcome halflet, which reinforces the parent's decision to quit and reminds the parent that the proactive quit line will be calling.
For the parent resistant to quitting smoking or enrolling in the quit line, the clinician offers them a CEASE “Think About It” halflet, which details the contact information of the state quit line. The CEASE Think About It halflet is also suitable to give to a nonsmoking parent to take home to the smoking parent, because it encourages the smoker to attend the child's next clinic visit to obtain additional help with addressing smoking.
If desired and appropriate, the clinician offers the parent a prescription for or more information about NRT using the CEASE preprinted NRT pads.
  • The menu of available intervention materials include (1) a questionnaire that screens parents of pediatric patients for smoking status of the patients' household members; (2) a label that affixes to the child's problem list for documenting parent smoking status and indicating the child's SHS exposure, encouraging continuity of cessation support in cross-coverage situations; (3) a 3-item self-assessment of the smoker's readiness to quit, interest in pharmacotherapy, and willingness to enroll in quit line counseling (the parent's own self-assessment helps guide the clinician's approach, thereby reducing the offering of unwanted services and increasing the clinician's confidence that they will not risk harming the therapeutic relationship with the parents of their patients); (4) decision support for clinicians that prompts a brief motivational messaging approach and exposure-reduction counseling, thus increasing systematic adherence to guidelines58; (5) a Health Insurance Portability and Accountability Act-compliant form for enrolling the smoker in the telephone quit line; (6) preprinted, practice-embossed prescription pads for prescribing over-the-counter NRT when desired by the smoker; (7) posters for examination rooms to activate parents of patients and cue clinicians for tobacco dependence treatment; (8) low-literacy written information to support smoking cessation and SHS exposure reduction; and (9) a simple 1-page implementation guide to support integrating the parent, clinician, and practice levels of the intervention (see www.ceasetobacco.org for most recent version). A more detailed training manual discusses additional topics, such as how an office can bill and obtain reimbursement for tobacco control services rendered and how to establish initial contact with the quit line while the parent is still in the office (in places where faxed enrollment is not yet available). The manual includes research demonstrating high parent satisfaction while addressing parental smoking as part of the child health care visit.