Clinical Effort Against Secondhand Smoke (CEASE) Program or Standard Care in Helping Parents Stop Smoking

Addressing Parental Smoking by Changing Pediatric Office Systems

RATIONALE: The Clinical Effort Against Secondhand Smoke (CEASE) program may be more effective than standard care in increasing the number of parents who stop smoking.

PURPOSE: This randomized clinical trial is studying how well the CEASE program works compared with standard care in helping parents stop smoking.

OBJECTIVES:

• To compare the effectiveness of the Clinical Effort Against Secondhand Smoke (CEASE) intervention vs no intervention in increasing clinicians' delivery of evidence-based parental smoking cessation assistance in pediatric healthcare settings.
• To compare the effectiveness of this intervention vs no intervention on parental smoking behaviors.
• To test the level of systematic practice implementation of the intervention using existing validated measures in an Implementation Process Survey (IPS).
• To evaluate, in an exploratory fashion, additional key implementation step measures mapped from the five A's (Ask, Advise, Assess, Assist, Arrange) to see how well they predict tobacco control service delivery in pediatric healthcare settings.
• To use process results from the IPS (i.e., previously validated and exploratory measures) to improve the adoption, implementation, and maintenance of the intervention in this study.

OUTLINE: This is a multicenter study. Participants are stratified according to practice. Participants are randomized to 1 of 2 intervention arms.

• Arm I (Clinical Effort Against Secondhand Smoke [CEASE] intervention): The CEASE intervention incorporates a number of materials into the operations of the pediatric practice, including baseline questionnaires that screen for parental tobacco use and readiness to quit smoking, enroll in quitline counseling, or explore pharmacotherapy; a label that affixes to the child's problem list in the medical record, documenting parental smoking status and indicating the patient's secondhand exposure, thus encouraging continuity of cessation support in cross-coverage situations; and decision support for clinicians that prompts delivery of exposure-reduction counseling and distribution of motivational-messaging handouts (i.e., halflets) to parents for education, skills training, and psychosocial support. Parental messaging elements include strategies or methods for quitting, collaborative goal setting, identifying personal barriers to quitting, and focused strategies for reducing secondhand-smoke exposure of the patient. Additional intervention materials include a HIPAA-compliant form for enrolling the smoker in counseling through the telephone quitline; pre-printed, practice-embossed prescription pads for prescribing over-the-counter nicotine-replacement therapy when desired by the smoker; pharmacotherapy posters in pediatric patient examination rooms to inform parental smokers and assist clinicians in discussing tobacco dependence treatment; and a simple implementation guide to support integrating the parent, clinician, and practice levels of the intervention.

The CEASE intervention also incorporates telephone counseling after the pediatric healthcare visit to ensure that parents receive professional, ongoing smoking-cessation counseling. Parental smokers undergo an exit interview survey and follow-up telephone surveys at 3 months and 12 months for evaluation of content of tobacco control delivered during the visit; use of messaging materials, medications, and telephone counseling sessions; current smoking status; and rules about smoking in the home and car. If the parent has had a 7-day quit at the 12-month follow-up, the parent is also asked to provide a saliva sample for cotinine analysis to confirm nonsmoking status.

• Arm II (control): Participants complete a questionnaire at baseline and an exit interview survey. They also complete telephone interviews at 3 month and 12 months. If the parent has had a 7-day quit at the 12-month follow-up, the parent is also asked to provide a saliva sample for cotinine analysis to confirm nonsmoking status.

In both arms, participating practitioners and key office staff complete Implementation Process Surveys at baseline and at 6 weeks and 6 months.

DISEASE CHARACTERISTICS:

• Parents or guardians meeting the following criteria:

  • Self-identified as smokers on the baseline survey

  • Must have a child who is seen by a pediatrician in a participating practice

    • Child must not have a medically emergent condition that requires transfer outside the practice for immediate medical intervention

  • Must be present at the child's healthcare visit

• Pediatric practice meeting the following criteria:

  • Participates in the Pediatric Research in Office Settings (PROS) network

  • Practice manager and a majority of pediatricians are willing to implement a tobacco control strategy for parental smokers

  • Cares for at least 2,000 families

  • Located in a geographically distinct location to minimize contamination effects of the intervention

    • No practices at the same geographic location

PATIENT CHARACTERISTICS:

• Have a telephone at home (parent or guardian)
• Able to speak English (parent or guardian)
• Have a working fax machine (practice)

PRIOR CONCURRENT THERAPY:

• No prior enrollment in this study during a previous visit to the pediatric healthcare clinician (parent or guardian)
• No prior participation in phase II focus groups or other pilot tobacco control studies (practice)
• No active enrollment of patients onto other PROS trials (practice)