Automated smoking cessation interventions at pediatric primary care locations helped reduce parental smoking.
RT’s Three Key Takeaways:
- Automated support works — Embedding an automated smoking cessation program in pediatric primary care increased parents’ use of nicotine replacement therapy, quitlines, and text-based support while reducing daily cigarette use.
- Parental engagement is high — Nearly half of parents in the intervention group used nicotine replacement therapy, and over 80% attempted quitting, showing strong engagement when treatment is integrated into their child’s healthcare visits.
- Quit rates remain modest — While abstinence rates were low, researchers emphasize that combining automated interventions with broader FDA-approved treatments could further improve parental quit success and reduce child tobacco exposure.
Integrating an automated smoking cessation intervention for parents into pediatric primary care demonstrated increased treatment received and reduced cigarettes smoked, according to new data published in JAMA Network Open.
While additional interventions are needed to improve quit rates, the research from Children’s Hospital of Philadelphia (CHOP) and Mass General Brigham found that the benefits of pediatric primary care support in reducing parental smoking.
Prior studies have shown a variety of benefits for parents who quit smoking, including elimination of future tobacco-related poor pregnancy outcomes, reducing the likelihood of their children becoming smokers and decreasing childhood exposure to tobacco smoke, as well as less risk of developmental delays and increased financial resources. While some parents who smoke may not have their own primary care health physician, they will seek primary care for their children multiple times a year.
To take advantage of when and where parents interact with the healthcare system, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was developed prior to this study to address parental smoking by providing routine access to cessation resources. However, this approach has not been used broadly, in part because of difficulties in scaling the intervention in busy primary care settings. To address this gap in knowledge, this study aimed to automate adult smoking cessation support in pediatric primary care using the electronic health care records to consistently screen parents and connect them to treatment.
In this cluster-randomized clinical trial, 817 parents who smoke were enrolled across 12 pediatric primary care practices in the Philadelphia area between July 2021 and August 2023. Household members completed questionnaires about tobacco use before their child’s visit, and parents in intervention practices were proactively offered automated home delivery of nicotine replacement therapy and enrollment in a quitline and/or SmokefreeTXT, a text messaging program to help people quit smoking. They were also offered health navigator support at the time of enrollment.
Among parents who completed the follow up, 48.2% of participants reported using nicotine replacement therapy compared with 16% in the control arm, and 22.8% of the intervention arm utilized a quitline or SmokefreeTXT compared with only 2.2% in the control arm. Just over 80% of parents in the intervention group had attempted to quit in the last three months compared with just over 70% in the control group with intervention practices leading to a greater reduction in the average number of cigarettes smoked daily as well as the percentage of daily smokers. However, the 7-day biochemically confirmed abstinence rate was only 8.3% in the intervention arm of the study compared with 6.4% in the control arm.
“The significantly increased treatment engagement and reductions in cigarette use are particularly encouraging and suggest that additional strategies, integrated with automated intervention, may work even better to reduce smoking among parents,” said co-senior study author Alexander Fiks, MD, a pediatrician and the Director of Clinical Futures and the Possibilities Project: Innovation in Pediatric Primary Care at CHOP.
“We were surprised to see how effectively our approach identified parents who smoke and automatically engaged them in treatment,” said co-senior author Jonathan P. Winickoff, MD, MPH, a pediatrician and researcher in the Department of Pediatrics at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. “Now, any health system in the country can routinely help parents with tobacco use and will likely be able to improve the quit rates seen in this study by offering additional FDA-approved medications, not just the nicotine replacement therapies offered in this trial.”
