title: Sustainability of a parental tobacco control intervention in pediatric practice.
abstract: OBJECTIVE
  To determine whether an evidence-based pediatric outpatient intervention for parents who smoke persisted after initial implementation.
  
  
  METHODS
  A cluster randomized controlled trial of 20 pediatric practices in 16 states that received either Clinical and Community Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care. The intervention provided practices with training to provide evidence-based assistance to parents who smoke. The primary outcome, assessed by the 12-month follow-up telephone survey with parents, was provision of meaningful tobacco control assistance, defined as discussing various strategies to quit smoking, discussing smoking cessation medication, or recommending the use of the state quitline after initial enrollment visit. We also assessed parental quit rates at 12 months, determined by self-report and biochemical verification.
  
  
  RESULTS
  Practices' rates of providing any meaningful tobacco control assistance (55% vs 19%), discussing various strategies to quit smoking (25% vs 10%), discussing cessation medication (41% vs 11%), and recommending the use of the quitline (37% vs 9%) were all significantly higher in the intervention than in the control groups, respectively (P < .0001 for each), during the 12-month postintervention implementation. Receiving any assistance was associated with a cotinine-confirmed quitting adjusted odds ratio of 1.89 (95% confidence interval: 1.13-3.19). After controlling for demographic and behavioral factors, the adjusted odds ratio for cotinine-confirmed quitting in intervention versus control practices was 1.07 (95% confidence interval: 0.64-1.78).
  
  
  CONCLUSIONS
  Intervention practices had higher rates of delivering tobacco control assistance than usual care practices over the 1-year follow-up period. Parents who received any assistance were more likely to quit smoking; however, parents' likelihood of quitting smoking was not statistically different between the intervention and control groups. Maximizing parental quit rates will require more complete systems-level integration and adjunctive cessation strategies.
authors.affiliation: Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; AAP Richmond Center of Excellence, and Tobacco Research and Treatment Center, and jwinickoff@partners.org.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Winickoff
authors.affiliation: Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, and.
authors.forename: Emara
authors.initials: E
authors.lastname: Nabi-Burza
authors.affiliation: Tobacco Research and Treatment Center, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts;
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Tobacco Research and Treatment Center, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts;
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
authors.affiliation: Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, and.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Drehmer
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois;
authors.forename: Stacia
authors.initials: S
authors.lastname: Finch
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois; Department of Pediatrics, University of Vermont, Burlington, Vermont;
authors.forename: Richard
authors.initials: R
authors.lastname: Wasserman
authors.affiliation: University of Rochester Medical Center, Rochester, New York; and.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ossip
authors.affiliation: Center for Child and Adolescent Health Research and Policy, Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, and.
authors.forename: Bethany
authors.initials: B
authors.lastname: Hipple
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois; University of California-Los Angeles, Los Angeles, California.
authors.forename: Heide
authors.initials: H
authors.lastname: Woo
authors.affiliation: AAP Richmond Center of Excellence, and.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Klein
authors.affiliation: Tobacco Research and Treatment Center, and General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts;
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003625:Data Collection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010287:Parent-Child Relations; D010353:Patient Education as Topic / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D012907:Smoking / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D055815:Young Adult
keywords: parental smoking; secondhand smoke; smoking cessation