Prenatal to pediatrics: Coordinated interventions to promote tobacco-free homes

Parental smoking is a reversible risk to fetal and child health. Within north-central PA, 20% of women reported smoking in the last 3 months of pregnancy. Nationwide, 50% of women who quit smoking during pregnancy rebound within 6-months. Over 15% of children in Pennsylvania live with a smoker. Tobacco use is highest among the younger, lower-income, and less educated, many of whom are without access to healthcare. Conclusive evidence identifies effective smoking cessation programs, although few studies are specific to rural areas. This project seeks to reduce the proportion of children exposed to tobacco smoke in rural Pennsylvania homes. We are piloting a systematic approach to support parents' smoking cessation and promote tobacco-free homes for young children. Cessation messages are synchronized across prenatal, childbirth and pediatric care settings. Interventions are delivered by physicians and nurses that have recurring contact with young families. Key components include brief intensive counseling strategies and readily available resources for parent smokers. All tobacco-using parents receive consistent messages: those ready to quit are provided NRT and referrals for community-based cessation counseling; other parents are encouraged to use strategies to reduce children's' exposure to second-hand smoke. The effectiveness of this intervention is examined using data obtained from electronic health records and providers' and counselors' observations. Outcomes include parental reports of sustained smoking cessation beyond pregnancy, positive changes in smoking behaviors and maintenance of a smoke free home.