Treatment for Parental Tobacco Use Shown to Be Significantly Effective in a Pediatric Setting, Study Shows

Treatment for parental tobacco use in pediatric practices showed markedly higher rates of treatment delivery, and a decline in practice-level parent smoking rates compared to usual care, according to a study published this week in the journal JAMA Pediatrics.

Researchers sought to determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention program could be implemented and sustained in pediatric practices, as well as test whether implementing CEASE altered practice-level prevalence of smoking among parents over 2 years. CEASE is a program that helps clinicians tailor their office setting to address parental tobacco use. The intervention program aims to limit family secondhand tobacco smoke (SHS) exposure by promoting routine screening of family tobacco use in pediatric settings and delivering tobacco cessation treatment to smokers in households where residents are screened for tobacco use.

CEASE conducted a cluster randomized clinical trial from April 2015 to October 2017 on 10 pediatric practices in 5 states:

• Pediatric practices randomized to either implement the CEASE protocol or maintain usual care (control group)
• All parents who screened positive for tobacco use in the exit survey after their child’s clinical visit 2 weeks (April to October 2015) and 2 years after intervention implementation (April to October 2017) were eligible to participate
• Researchers screened 8184 parents 2 weeks after their child’s clinical visit and exhibited 961 (27.1%) currently smoking parents in intervention practices, and 1103 (23.9%) currently smoking parents in control practices. Among the 822 CEASE implemented and 701 control group eligible parents, 364 (44.3%) in the intervention groups received meaningful treatment at the visit as opposed to only 1 (0.1%) in the control practices (risk difference of 44% [95% CI, 9.8%-84.8%]). This data showcases the immediate impact of CEASE implementation after only 2 weeks.

Data on long-term effectiveness revealed similar effectiveness of CEASE intervention to curb parental smoking. Researchers screened 9794 parents 2 years after their child’s clinical visit with 1261 (24.4%) currently smoking parents placed in intervention practices and 1149 (25%) in control practices. Among the 804 CEASE implemented and 727 control group eligible parents, 113 (14.1%) in the intervention groups received meaningful treatment at the visit compared to 2 (0.3%) in the control practices (risk difference of 12.8% [95% CI, 3.3%-37.8%]).

Smoking prevalence over the 2 years of intervention implementation revealed a stark contrast (−2.7% vs 1.1%; difference −3.7% [95% CI, −6.3% to −1.2%]), as did the cotinine-confirmed quit rate (2.4% vs −3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]) compared to the control group.

Both short-term and long-term results reveal a significant impact that the CEASE intervention program has on parental tobacco use. As SHS exposure contributes to heart disease, lung cancer, and stroke, public health officials have focused on SHS exposure on children and in the workplace, looking for ways to reduce risks. A recent study published by the CDC estimated that 41,000 deaths among nonsmoking adults were associated with SHS workplace exposure. While smoke-free policies reduce exposure, not all states adopt these policies, which can be potentially fatal for workers.

In addition, work by CDC led the Department of Housing and Urban Development to implement a rule that took effect in July 2018 that bans smoking in public housing. The rule is designed to protect children who live in these multi-family dwellings from growing up around SHS and to reduce the cost of maintaining units.

Reference

Nabi-Burza E, Drehmer JE, Walters BH, et al. The Clinical Effort Against Secondhand Smoke Exposure Cluster Randomized Clinical Trial. [published online August 12, 2019]. JAMA Pediatrics. doi: 10.1001/jamapediatrics.2019.2639.