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Automated Smoking Interventions in Pediatric Care

Recent research conducted by the Children's Hospital of Philadelphia (CHOP) and Mass General Brigham has highlighted a promising new approach to reducing parental smoking through automated interventions integrated into pediatric primary care. The findings, published in JAMA Network Open, suggest that offering automated smoking cessation support during children's medical visits can significantly enhance treatment uptake and reduce the number of cigarettes smoked by parents.

The study focused on a cluster-randomized clinical trial involving 817 smoking parents enrolled across 12 pediatric primary care practices in the Philadelphia region from July 2021 to August 2023. These parents completed questionnaires before their child's visit, allowing for efficient screening protocols. In practices using the intervention, parents were proactively offered automated support, including home delivery of nicotine replacement therapy and enrollment in quitline programs or SmokefreeTXT, an SMS-based support system designed to help individuals quit smoking.

This automated approach is an evolution of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention that had previously aimed to tackle parental smoking but faced challenges in implementation due to the complexities associated with busy primary care environments. The goal of the new study was to refine this intervention by leveraging electronic health records to ensure consistent screening and access to cessation resources when parents engage with the healthcare system.

The results of the study were compelling. Of the parents who completed the follow-up, 48.2% from the intervention group reported using nicotine replacement therapy, which is a significant increase compared to just 16% in the control group. Similarly, 22.8% utilized a quitline or SmokefreeTXT, compared to only 2.2% of their control counterparts. The intervention group also noted a higher attempt to quit smoking in the past three months (over 80%) compared to the control group (just over 70%). Notably, there was a significant decline in the average daily cigarette consumption and the percentage of daily smokers among those receiving the automated support.

However, despite the encouraging data, the biochemically confirmed abstinence rate, which is a key metric in smoking cessation studies, revealed that only 8.3% of participants in the intervention arm abstained from smoking for a week, compared to 6.4% in the control arm. This indicates that while automated interventions have shown potential for increasing treatment engagement and decreasing tobacco use, there is still a need for supplementary strategies to truly enhance quit rates.

Dr. Alexander Fiks, one of the co-senior authors of the study, expressed optimism regarding the results: "The significantly increased engagement with treatment and reductions in cigarette use are particularly encouraging. This suggests that if we incorporate additional strategies alongside the automated intervention, we can further reduce smoking rates among parents." His co-author, Dr. Jonathan P. Winickoff, reinforced this perspective by noting the success of the approach in identifying smoking parents and effectively engaging them in treatment without disrupting primary care processes.

The practical implications of these findings are profound. As Dr. Winickoff articulated, health systems across the country can and should routinely assist parents struggling with tobacco use, potentially improving quit rates by offering a broader range of FDA-approved medications in future interventions.

Overall, the findings present a roadmap for healthcare systems aiming to integrate tobacco cessation resources into pediatric care, presenting a proactive step towards fostering healthier family environments and reducing the harmful effects of tobacco across generations. The study was supported by the NIH, which highlights the importance of ongoing innovation in healthcare practices to maximize the health outcomes for parents and their children alike.

For additional information, you can explore the resources provided by both Children's Hospital of Philadelphia and Mass General Brigham, which are committed to enhancing public health through specialized programs and interventions.

About the Organizations

Children's Hospital of Philadelphia, founded in 1855, is recognized as the first pediatric hospital in the United States and has a long history of providing exceptional patient care and pioneering significant research in pediatric medicine. Mass General Brigham combines a diverse range of healthcare services and research disciplines in its mission to address some of the most challenging medical problems facing communities today.