title: Targeting pregnant and parental smokers: long-term outcomes of a practice-based intervention.
abstract: BACKGROUND
  This study aimed to assess the change in obstetric and pediatric provider smoking cessation practices following implementation of a practice guideline-driven office-based program.
  
  
  METHODS
  This pre-post evaluation took place between May 2003 and August 2006 in 1 pediatric and 1 obstetric hospital-based clinic. The intervention involved provider training combined with office system supports. A total of 1,080 exit interviews were collected to measure outcomes of clinic practices at baseline and at 1 month, 6 months, 1 year (obstetric), and 2 years (pediatric) after implementation. Trend analysis was used to assess change in practice rates over time.
  
  
  RESULTS
  Following program implementation, pediatric provider "Ask" rates increased (49% before to 86% 2 years after, p < .0001); changes in pediatric "Advise" and "Assist" rates were not significant: 44%-59% (p = .19) and 18%-28% (p = .26), respectively. In the obstetric clinic, whereas no significant changes were detected in provider "Ask" (59%-65% 1 year after, p = .17) or "Advise" (72%-85%, p = .27) rates, "Assist" rates rose from 28% to 62% (p = .0075) 1 year after program implementation.
  
  
  CONCLUSIONS
  Implementation of the office-based program achieved significantly improved trends in pediatric provider "Ask" rates and obstetric provider "Assist" rates over time. Further research is needed on office strategies to create long-term provider behavior changes in smoking cessation practices.
authors.affiliation: Division of General Academic Pediatrics, Children's Hospital of Pittsburgh, 3705 5th Avenue, Pittsburgh, PA 15213, USA. deborah.moss@chp.edu
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Moss
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Cluss
authors.forename: Margaret
authors.initials: M
authors.lastname: Watt-Morse
authors.forename: Francis
authors.initials: F
authors.lastname: Pike
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009774:Obstetrics; D017063:Outcome Assessment, Health Care / Q000379:methods; D010044:Outpatient Clinics, Hospital; D010290:Parents; D010372:Pediatrics; D010414:Pennsylvania; D011247:Pregnancy; D011248:Pregnancy Complications; D012907:Smoking; D016540:Smoking Cessation / Q000379:methods*; D055815:Young Adult