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Pediatrician training to prevent children's tobacco exposure

Institution: University of California, San Francisco
Investigator(s): Eliseo Perez-Stable, M.D.
Award Cycle: 1997 (Cycle 6) Grant #: 6RT-0368 Award: $133,852
Subject Area: Public Health, Public Policy, and Economics
Award Type: Research Project Awards
Abstracts

Initial Award Abstract
Environmental tobacco smoke (ETS) exposure has been associated with a significant increase in acute upper and lower respiratory infections, hospitalizations for bronchitis and pneumonia, and sudden infant death syndrome in children younger than 5 years of age. Cigarette smoking by a parent is strongly associated with increased smoking by their children who learn the utility and acceptability of smoking, and ETS exposure during childhood has been found to significantly increase the risk of lung cancer in adults who never actively smoke. An estimated 53% to 76% of U.S. households contain one adult resident who smoke, and in the San Francisco Bay Area, only 57% of homes were completely smoke-free.

The proposed research is to develop and pilot test an educational intervention targeting pediatric clinicians in San Francisco to train them to detect and prevent exposure to environmental tobacco smoke in children five years of age and younger. During the year, we plan to evaluate the current knowledge and practice about assessing ETS exposure, counseling about smoking prevention and initiation, and counseling about smoking cessation in a random sample of 800 California pediatricians and family physicians. We will use the results of the survey, the established experiences of teaching physicians how to counsel adult smokers to quit, existing guidelines to teach pediatric clinicians how to prevent smoking, and pilot testing of specific components to develop the educational intervention. The intervention will teach pediatric clinicians how to counsel parents to prevent exposure of their children to ETS, counsel parents who smoke to quit, counsel parents how to advise their children to prevent smoking, and how to directly promote smoking prevention and cessation among children. The main intervention component will consist of a three-session interactive seminar led by physicians and implemented by integrating into a functioning clinical system. The intervention will also include printed educational materials for parents adapted and modified from existing materials for adult cessation to target ETS exposure, prevention of smoking initiation and cessation with children. Other components of the intervention will include tools to assist the clinician in the office setting such as chart reminders, ETS change prescript-ions and a designated smoking prevention coordinator within each clinic.

Final Report
Extensive research has demonstrated that environmental tobacco smoke (ETS) exposure in children five years of age and younger causes more frequent.and more severe colds, bronchitis, pneumonia, ear infections, more hospitalizations for these infections, and sudden infant death syndrome. These consequences of ETS exposure are especially severe when cigarette smoking by a parent is more likely to lead to increased smoking by their children who learn the utility and acceptability of smoking. Furthermore, ETS exposure during childhood has also been found to significantly increase the risk of lung cancer in adults who never actively smoke. In the U.S. an estimated 53% to 76% of households contain one adult resident who smokes cigarettes. In California, the proportion of households with a child or adolescent resident that are smoke free was reported to be 75% in 1993. However, in the San Francisco area only 57% of homes were completely smoke free. Parents of young children visit the pediatrician more often than any other physician and this presents a window of opportunity for young parents to effect behavior change and quit smoking. Pediatric clinicians may be uniquely positioned to counsel these adults to quit smoking but need to be comfortable with delivering this intervention. We planned to develop, implement, and evaluate an educational intervention targeting pediatric clinicians in the University of California, San Francisco Pediatric Residency Program to train physicians to detect and prevent exposure to environmental tobacco smoke in children five years of age and younger.

During the first year, we evaluated the current knowledge and practice of California pediatricians and family physicians about assessing ETS exposure, counseling about smoking prevention and initiation, and counseling about smoking cessation. We used the results of our survey and other data to develop an educational intervention targeting pediatric clinicians. Our goal was to teach pediatric residents how to counsel parents to prevent exposure of their children to ETS, counsel parents who smoke to quit, counsel parents how to advice their children to prevent smoking, and how to directly promote smoking prevention and cessation among children. The main intervention components was to consist of a three-session interactive seminar led by physicians and implemented through the structure of the pediatric residency program and printed educational materials for parents. We were only funded for one year to conduct the needs assessment survey and initiate development of intervention components. We found that overall physicians in California were not counseling parents who smoke with effective interventions. Pediatricians were more aware of the harms of ETS exposure, but counseled parents less frequently than family physicians.
Publications

Role of clinicians in cigarette smoking prevention
Periodical: Western Journal of Medicine Index Medicus:
Authors: Perez-Stable EJ, Fuentes-Afflick E ART
Yr: 1998 Vol: 169 Nbr: Abs: Pg: 23-29