The Clinical Effort against Secondhand Smoke Exposure (CEASE) California: Implementing a Pediatric Clinical Intervention to Reduce Secondhand Smoke Exposure

Abstract

Introduction: The Clinical Effort against Secondhand Smoke Exposure (CEASE) is an evidence based intervention to reduce secondhand smoke exposure (SHSE) in children. The goals of this study were: 1. To improve pediatric providers’ perceived knowledge of the consequences of and need for SHSE screening. 2. Increase screening rates of SHSE and the provision of smoking cessation support services for identified smokers including nicotine replacement therapy (NRT) and referrals to the California Smoker’s Helpline (Helpline). Methods: Pediatric clinics in Northern California were trained to implement CEASE. The evaluation had three components: (1) An evaluation of the training and its impact on participants’ knowledge and ability to implement CEASE (via anonymous post-training survey). (2) Referrals received by the California Smokers’ Helpline (Helpline); and (3) pre-post changes in perceived knowledge, screening practices, and provision of smoking cessation support (nicotine replacement therapy prescriptions and referrals to the Helpline) to family members who were identified as smokers (using a retrospective pre-post design). In addition, clinician champions were interviewed to gather information on barriers and facilitators to the implementation of CEASE 6 months after the training. Result: A total of 24 practice sites with 315 staff were trained to implement CEASE. Training participants rated the quality of the training high and most either strongly agreed or agreed that the training improved their knowledge and ability to implement CEASE. Referrals to the Helpline increased significantly and there were significant pre-post improvements in the provision of smoking cessation support services but not in rates of screening for SHSE. Barriers and facilitators to implementing CEASE are discussed. Conclusion: The CEASE California training is a practical and replicable model for pediatric providers to screen patients for SHSE and provide smoking cessation support services. Practice support tools, on-site champions, and coverage for NRT facilitated implementation of CEASE. However, not all patients referred to the Helpline followed up and there was no system for providers to track referrals. In addition, in-person trainings are costly and require significant travel time. Future interventions should leverage electronic health records to facilitate screening for SHSE and to improve referral and follow-up care for smokers. Future studies should examine other training modalities to more cost-effectively disseminate the CEASE training.