Pediatric Providers' Role in Addressing Parental Smoking and Child Exposure

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.