Caregiver smoking is an important cause of morbidity and mortality in both adult smokers and their children who are involuntarily exposed to secondhand smoke (SHSe). Our research has found that caregivers who visit the Pediatric Emergency Department (PED) with their children have a high prevalence of smoking (up to 48%), their children have high levels of SHSe equivalent to that of active smokers, and they regularly use the PED for nonurgent, SHSe-related complaints. These smokers are motivated to quit and eager to receive cessation counseling in this setting. Annually, more than 3 million PED visits involve treatment of children with SHSe- related illnesses. These visits provide a unique teachable moment to motivate caregiver quitting, given the relationship between quitting and improvements in their child's health. Because of the long, unavoidable wait times and the frequent use of the PED for non-urgent care, this is an ideal venue for intervening with this population. Moreover, we and others have demonstrated the feasibility of conducting complex randomized trials in PEDs without disrupting clinical flow. Building on our prior research, we propose to conduct the first randomized trial to test whether a cessation intervention in the PED setting can reduce caregiver smoking and decrease children's SHSe. This study will test the efficacy of a cessation intervention for caregivers in a large, inner-city PED that is a major noda site for the federally funded Pediatric Emergency Care Applied Research Network (PECARN). The proposed Screening, Brief Intervention, and Assisted Referral to Treatment (SBIRT) will highlight the effects of SHSe on their child's health. We will randomize 750 caregivers who smoke who present to our PED with their child who has a SHSe-related illness to either one of two conditions: 1) SBIRT; or 2) Healthy Habits Control (HHC). The SBIRT condition will use components shown to be effective in the out- patient setting but not yet tested in the PED setting. It will include a brief form of the Clinical Practice Guideline: Treating Tobacco Use and Dependence, motivational interviewing, engaging and personalized materials on the effects of smoking and SHSe, immediate access to caregivers' choice of cessation resources (e.g., Quitline, smokefree.gov, or txt2quit), a 12-week supply of nicotine replacement therapy and weekly booster materials for 12 weeks. The HHC program has been previously developed and used in the out-patient setting, and will be used as an attention control in which caregivers will receive instruction on healthy lifestyle choices to improve their child's health. Cessation assistance will be offered at the study's conclusion. If effective, the SBIRT model could be routinely used in the PED setting, which could reach at least one million smokers a year, and could result in significant reductions in caregivers' tobacco use, SHSe-related pediatric illness, and costs in this population. In addition, our results will inform the conduct of public health research efforts aimed at adults via the PED. If successful, we will create a comprehensive package of materials for disseminating the implementation of the intervention throughout PECARN and non-PECARN PEDs, and EDs nationwide.
The prevalence of secondhand smoke exposure is disproportionately high among children who visit the pediatric emergency department with their caregivers and these caregivers are highly motivated to quit and willing to receive smoking cessation interventions in the pediatric emergency department. The proposed project will test an innovative, multi-level public health intervention that could reduce children's secondhand smoke exposure and activate caregivers to quit smoking for the sake of their child's health. If effective this research model has the potential to reach at least one million smokers a year and could result in significant reductions in secondhand smoke-related pediatric illness, caregivers' tobacco use, and related costs in this population.
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