206882 Pediatric Providers' Role in Addressing Parental Smoking and Child Exposure

Tuesday, November 10, 2009

Bradley N. Collins, PhD , Department of Public Health, Temple University, Philadelphia, PA
Katherine F. Isselmann, MPH , Department of Public Health, Temple University, Philadelphia, PA
Brian P. Daly, PhD , Department of Public Health, Temple University, Philadelphia, PA
Darryl Mueller, MD , Department of Public Health, Temple University, Philadelphia, PA
Background: Pediatric providers are expected to routinely address patient exposure to secondhand smoke according to surgeon general and professional association statements. However, providers continue to site barriers undermining their ability to adhere to guidelines. This study examined provider and parent reports of general and pediatric specialist actions to reduce patient exposure, and will examine changes in adherence following an ongoing academic detailing pilot study.

Methods: Three studies examined general pediatrician (n=93) and pediatric otolaryngologist (n=115) adherence to tobacco intervention guidelines based on the “5 A's” via provider and parent (n=213) survey. These surveys also identified barriers to adherence. Academic detailing was provided by behavioral scientists to physicians and staff following pre-intervention parent survey collection. Changes to adherence will be tested following completion of post-test.

Results: Among general pediatricians in clinic, 39% reported always explaining hazards of exposure to smoking parents, 8% always encouraged a smoke-free home, and 38% always advised parents about cessation. Barriers cited included lack of time and lack of confidence, while greater years in practice related to greater confidence in tobacco counseling as well as guideline adherence. Adherence and barriers among specialists was similar, with additional barriers, lack of responsibility and lack of awareness of guidelines.

Conclusion: Academic detailing provides collaborative strategies that address common and idiosyncratic barriers to tobacco guideline adherence within the context of individual practice settings.

Learning Objectives:
To define pediatric guidelines around parental smoking and child exposure to secondhand smoke; describe barriers to guideline adherence among general pediatricians, specialists and obstetricians, and discuss strategies to assist physicians in improving adherence.

Keywords: Tobacco Control, Pediatrics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a clinical health psychologist/researcher and an Assistant Professor of Public Health and Pediatrics at Temple University. I have over 10 years of clinical and research experience in addiction (primarily tobacco) intervention research at the individual and community level. I am currently, or have been, PI on three funded intervention trials including two funded by NCI that focused on maternal smoking and child exposure to secondhand smoke. I have published my work in peer-reviewed journals, including the Journal of Clinical and Consulting Psychology, Journal of Pediatrics, Nicotine and Tobacco Research, and Addictive Behaviors. I also have presented annually at professional conferences for over 10 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.