Abstract
Caregiver smoking is a significant risk factor for children with acute and chronic diseases. Hospitalization presents an opportunity to explore caregiver smoking as a modifiable risk factor during a time of crisis when the motivation to change could be heightened. To date, there has not been a published review on inpatient smoking cessation interventions in pediatrics that focus on supporting caregivers of hospitalized children. The goals of this review were to identify and assess the reach and efficacy of tobacco cessation strategies implemented across inpatient units in pediatrics and mother-baby units. This review also proposes clinical and research implications along with program-building recommendations that can help inform future practice in tobacco cessation. A narrative review of the literature identified 14 peer-reviewed studies that described smoking cessation interventions between 2002 and 2021. There were five randomized controlled trials, seven prospective studies, and one retrospective study. The primary kinds of interventions were counseling to heighten caregiver contemplation to quit (n = 12), provision of Nicotine Replacement Therapy (NRT) medications (n = 7), and follow-up with the local Quitline (n = 12). A diverse range of deliverers implemented interventions across studies. Variation in defining quit attempts along with tobacco reduction and cessation outcomes contributed to mixed findings across studies.
Highlights
Among the remaining 436 records, 409 of them were subsequently excluded for one or more of the following reasons: (1) were not full-text articles; (2) involved a different target population than caregivers of children; (3) implemented in ambulatory or other outpatient and community settings; and (4) did not assess tobacco reduction or cessation outcomes, 27 full-text articles were assessed for inclusion in this narrative review
13 were further excluded for the following reasons: (1) presented only a study protocol; (2) did not involve conducting research to assess for tobacco reduction or cessation outcomes; (3) there was no intervention implemented in the study; (4) the target population comprised a combination of both inpatients and outpatients; and (5) study locations included both inpatient and outpatient settings
Fourteen articles met the criteria for an inpatient tobacco cessation program for caregivers of pediatric patients as elucidated in Figure 1 [7,14,15,16,17,18,19,20,21,22,23,24,25,26]
Summary
Caregiver tobacco use is a significant risk factor for pediatric acute and chronic diseases as well as a leading cause of environmental tobacco smoke (ETS) exposure among children. Caregivers who smoke or vape tobacco products substantially elevate their child’s risk for adverse health outcomes that include respiratory and ear infections, sudden unexpected infant death, premature death, and asthma exacerbations [1,2,3,4,5,6,7,8,9,10]. Caregiver tobacco use increases the likelihood that their children will initiate smoking using conventional cigarettes or electronic nicotine delivery devices in the future and thereby heighten intergenerational transmission of tobacco use [4,5,8,9,11,12]
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