Fewer parents smoke when pediatricians offer tobacco screening, treatment

[August 14, 2019]  By Lisa Rapaport

(Reuters Health) - Parents who smoke may be more likely to quit when they receive tobacco screening and smoking cessation treatment from their child's pediatrician than when they don't get this support, a new study suggests.

"Most parents want to quit smoking but they don't often get the help they need from their own doctor," said Dr. Jonathan Winickoff, senior author of the study and a pediatrician at Massachusetts General Hospital for Children in Boston.

"Parents may be especially willing to quit smoking when they are thinking about the health of their own children," Winickoff said by email.

To see whether pediatricians might succeed in getting more parents to quit smoking, Winickoff and colleagues randomly assigned 10 pediatric practices either to start providing tobacco screening and treatment to parents who smoke or to continue usual care without this support.

Over two years, the proportion of parents who were current smokers declined 2.7% when practices offered tobacco screening and treatment but rose 1.1% with usual care, according to a report in JAMA Pediatrics.

"Parents are twice as likely to set a quit date in the pediatric office than in other contexts," Winickoff said. "By failing to offer parents the help they need right at that teachable moment, we really are missing the best opportunity to improve the health of that family."

Out of 8,184 parents screened early on, 961, or 27%, were current smokers at pediatrics offices offering treatment, and 1,103, or 24%, were current smokers at practices sticking with usual care.

At the practices offering smokers help to quit, 44% of parents who smoke got treatment at the same visit when they were screened, compared with only a single parent at the control group of practices sticking with usual care.

When smokers got support to quit, clinicians helped them set a goal date to stop smoking, establish rule for smoke-free homes and cars, and prescribed nicotine replacement therapy to make cessation easier.

Two years later, about 24% of parents in the practices offering tobacco screening and treatment smoked, compared with 25% in practices sticking with usual care.

It's possible that results might be different outside of the experiment, which helped monitor practices' screening rates and track how often smokers got treatment. Pediatric practices that wanted to run a similar program would have to manage this work themselves, the study authors note.

But even small reductions in smoking among parents could make a big different in health for smokers and for their children, Winickoff notes.

"Parents are the most important group to invest in for tobacco cessation because when they quit, they gain over 10 years of life on average, they have $2,000 extra dollars per year to spend on their families (if they smoked a pack a day), and their kids will be healthier with lower risk of pneumonia, asthma, ear infections, ADHD, and of sudden infant death syndrome," Winickoff said.

"Kids who are not exposed to second hand smoke also have higher reading and math scores, fewer missed days of school, and have a much lower chance of ever using tobacco when they grow up," Winickoff added.

SOURCE: http://bit.ly/33t8K7H and http://bit.ly/33pjjIW JAMA Pediatrics, online August 12, 2019.

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