Abstract
BackgroundEvery U.S. state has a free telephone quitline that tobacco users can access to receive cessation assistance, yet referral rates for parents in the pediatric setting remain low. This study evaluates, within pediatric offices, the impact of proactive enrollment of parents to quitlines compared to provider suggestion to use the quitline and identifies other factors associated with parental quitline use.MethodsAs part of a cluster randomized controlled trial (Clinical Effort Against Secondhand Smoke Exposure), research assistants completed post-visit exit interviews with parents in 20 practices in 16 states. Parents’ quitline use was assessed at a 12-month follow-up interview. A multivariable analysis was conducted for quitline use at 12 months using a logistic regression model with generalized estimating equations to account for provider clustering. Self-reported cessation rates were also compared among quitline users based on the type of referral they received at their child’s doctor’s office.ResultsOf the 1980 parents enrolled in the study, 1355 (68 %) completed a 12-month telephone interview and of those 139 (10 %) reported talking with a quitline (15 % intervention versus 6 % control; p < .0001). Parents who were Hispanic (aOR 2.12 (1.22, 3.70)), black (aOR 1.57 (1.14, 2.16)), planned to quit smoking in the next 30 days (aOR 2.32 (1.47, 3.64)), and had attended an intervention practice (aOR 2.37 (1.31, 4.29)) were more likely to have talked with a quitline. Parents who only received a suggestion from a healthcare provider to use the quitline (aOR 0.45 (0.23, 0.90)) and those who were not enrolled and did not receive a suggestion (aOR 0.33 (0.17, 0.64)) were less likely to talk with a quitline than those who were enrolled in the quitline during the baseline visit. Self-reported cessation rates among quitline users were similar regardless of being proactively enrolled (19 %), receiving only a suggestion (25 %), or receiving neither a suggestion nor an enrollment (17 %) during a visit (p = 0.47).ConclusionsThese results highlight the enhanced clinical effectiveness of not just recommending the quitline to parents but also offering them enrollment in the quitline at the time of their child's visit to the pediatric office.Trial registrationClinicalTrials.gov, Identifier: NCT00664261
Highlights
Every U.S state has a free telephone quitline that tobacco users can access to receive cessation assistance, yet referral rates for parents in the pediatric setting remain low
In a previous paper that compared intervention practices trained in Clinical Effort Against Secondhand Smoke Exposure (CEASE) to usual care control practices, we showed that of the 981 smoking parents who visited pediatric practices in the control group at baseline, 0 % reported being enrolled at the visit in a tobacco quitline [11]
To better understand quitline usage by parents who were seen in the pediatric outpatient setting, we examined whether proactive enrollment was associated with greater quitline use, after controlling for other factors that could influence the likelihood of using a quitline
Summary
Every U.S state has a free telephone quitline that tobacco users can access to receive cessation assistance, yet referral rates for parents in the pediatric setting remain low. Through the CEASE intervention, clinical and administrative staffs at pediatric offices were trained to work as a team to routinely and effectively address family tobacco use and exposure through identifying smokers and offering brief assistance with smoking cessation. This assistance comes through prescribing nicotine replacement therapy (NRT) and referring parents who smoke to free smoking cessation counseling services, including telephone quitlines [10, 11]
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