title: Parental tobacco screening and counseling in the pediatric emergency department: practitioners' attitudes, perceived barriers, and suggestions for implementation and maintenance.
abstract: BACKGROUND
  The pediatric emergency department (PED) is a venue that underuses parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners' attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, as well as to solicit suggestions for improving the sustainability and maintenance of such practices.
  
  
  METHODS
  We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice.
  
  
  RESULTS
  Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing "prearranged" counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (eg, changes in children's secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of onsite tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, as well as the importance of intervention "champions" in the PED.
  
  
  CONCLUSIONS
  By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.
authors.affiliation: Cincinnati, OH; Tucson, AZ. Electronic address: melinda.mahabee-gittens@cchmc.org.
authors.forename: E Melinda
authors.initials: EM
authors.lastname: Mahabee-Gittens
authors.affiliation: Cincinnati, OH; Tucson, AZ.
authors.forename: Cinnamon A
authors.initials: CA
authors.lastname: Dixon
authors.affiliation: Cincinnati, OH; Tucson, AZ.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Vaughn
authors.affiliation: Cincinnati, OH; Tucson, AZ.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Duma
authors.affiliation: Cincinnati, OH; Tucson, AZ.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Gordon
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003376:Counseling; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009820:Ohio; D010290:Parents; D010372:Pediatrics; D016540:Smoking Cessation; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000628:therapy*
keywords: Emergency department; Parental smoking; Secondhand smoke exposure; Smoking cessation counseling; Tobacco screening
references.citation: Cochrane Database Syst Rev. 2011 Dec 07;(12):CD008743
references.pmid: 22161436
references.citation: Am J Public Health. 2003 Aug;93(8):1261-7
references.pmid: 12893608
references.citation: Am J Prev Med. 2010 Nov;39(5):449-56
references.pmid: 20965382
references.citation: Prehosp Emerg Care. 2010 Apr-Jun;14(2):250-8
references.pmid: 20144019
references.citation: BMC Med Inform Decis Mak. 2012 Feb 24;12:10
references.pmid: 22364529
references.citation: Lancet. 2011 Jan 8;377(9760):139-46
references.pmid: 21112082
references.citation: Nicotine Tob Res. 2007 Mar;9(3):341-9
references.pmid: 17365766
references.citation: J Gen Intern Med. 2012 Dec;27(12):1690-6
references.pmid: 22865018
references.citation: Ann Emerg Med. 2006 Oct;48(4):e417-26
references.pmid: 16997678
references.citation: Aust Fam Physician. 2008 Apr;37(4):285-8
references.pmid: 18398531
references.citation: Ann Fam Med. 2007 May-Jun;5(3):209-15
references.pmid: 17548848
references.citation: Pediatr Emerg Care. 2002 Feb;18(1):4-7
references.pmid: 11862128
references.citation: WMJ. 2010 Dec;109(6):335-40
references.pmid: 21287886
references.citation: Resuscitation. 2010 Jul;81(7):836-40
references.pmid: 20398994
references.citation: Arch Intern Med. 2009 Apr 27;169(8):781-7
references.pmid: 19398690
references.citation: Arch Pediatr Adolesc Med. 2012 Jan;166(1):18-27
references.pmid: 21893640
references.citation: Inform Prim Care. 2007;15(4):207-16
references.pmid: 18237477
references.citation: J Am Med Inform Assoc. 2008 Jul-Aug;15(4):430-8
references.pmid: 18436904
references.citation: Public Health Nurs. 2011 Nov-Dec;28(6):475-84
references.pmid: 22092457
references.citation: Nurse Res. 2004;12(1):47-61
references.pmid: 15493214
references.citation: J Pediatr Psychol. 2008 Mar;33(2):145-55
references.pmid: 18192298
references.citation: Fam Med. 2011 Oct;43(9):638-42
references.pmid: 22002775
references.citation: CA Cancer J Clin. 2009 Sep-Oct;59(5):314-26
references.pmid: 19706827
references.citation: Arch Intern Med. 2007 Jul 9;167(13):1400-5
references.pmid: 17620534
references.citation: Nicotine Tob Res. 2005 Apr;7 Suppl 1:S35-43
references.pmid: 16036268
references.citation: Pediatrics. 2010 Jul;126(1):e251-2
references.pmid: 20587681
references.citation: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD000165
references.pmid: 15494989
references.citation: Acad Emerg Med. 2012 Feb;19(2):161-73
references.pmid: 22320367
references.citation: Natl Health Stat Report. 2008 Aug 6;(7):1-38
references.pmid: 18958996
references.citation: J Med Syst. 2007 Dec;31(6):489-96
references.pmid: 18041282
references.citation: J Am Diet Assoc. 2010 Oct;110(10):1511-22, 1522.e1-3
references.pmid: 20869490
references.citation: Am J Emerg Med. 2005 Nov;23(7):916-8
references.pmid: 16291459
references.citation: Prev Med. 2006 Dec;43(6):472-6
references.pmid: 16920185
references.citation: J Emerg Nurs. 2009 Sep;35(5):402-5
references.pmid: 19748018
references.citation: Res Nurs Health. 1993 Jun;16(3):213-8
references.pmid: 8497673
references.citation: Am J Prev Med. 2010 Dec;39(6 Suppl 1):S77-82
references.pmid: 21074681
references.citation: Health Promot Int. 2004 Dec;19(4):489-500
references.pmid: 15520036
references.citation: Health Educ Res. 2006 Oct;21(5):688-94
references.pmid: 16945984
references.citation: Pediatrics. 2006 Sep;118(3):e890-903
references.pmid: 16950972
references.citation: Am J Public Health. 1999 Sep;89(9):1322-7
references.pmid: 10474547
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1127-37
references.pmid: 16162555
references.citation: Contemp Nurse. 2005 Jul-Aug;19(1-2):75-87
references.pmid: 16167437
references.citation: Int J Telemed Appl. 2009;2009:853524
references.pmid: 19081787
references.citation: Am J Prev Med. 2005 Aug;29(2):77-84
references.pmid: 16005802
references.citation: Pediatrics. 2009 Nov;124(5):1474-87
references.pmid: 19841108
references.citation: Nicotine Tob Res. 2008 Dec;10(12):1745-51
references.pmid: 19023825
references.citation: Cochrane Database Syst Rev. 2012 Jun 13;(6):CD000259
references.pmid: 22696318
references.citation: Aust Fam Physician. 2004 Jan-Feb;33(1-2):87-90
references.pmid: 14988972
references.citation: Eur J Cardiovasc Prev Rehabil. 2008 Apr;15(2):173-8
references.pmid: 18391644
references.citation: Healthc Q. 2005;8(4):92-8
references.pmid: 16323520