"Until now, pediatricians have been afraid to address smoking when parents are stressed about their child being sick," says lead author Jonathan Winickoff, MD, MPH of the MGH Center for Child and Adolescent Health Policy. "But the results show that parents are very receptive to the intervention." The research was carried out in collaboration with Boston Children's Hospital.
During the four-month study, the parents of children admitted to Children's Hospital with respiratory illness were invited to participate in The Stop Tobacco Outreach Program (STOP), which included an initial motivational interview, written materials, nicotine replacement therapy, phone counseling and referral to their own primary care physician.
"This is the first time that parents have been given treatment for smoking, including nicotine replacement, in the context of a child's visit to the hospital," Winickoff says." "We're offering the parents medication because their addiction has such profound consequences for their children."
Of the 71 smoking parents enrolled in the study, 80 percent completed all counseling sessions, and 56 percent accepted free nicotine replacement therapy at the time of enrollment. After two months, half reported making an attempt to quit that lasted at least 24 hours, and 20 percent reported sustained tobacco abstinence. Although there was no control group in the study, the quit rate is higher than the 2 to 3 percent per year overall quit rate of U.S. smokers.
Also at the two-month follow-up, 27 percent of participants reported still using nicotine replacement therapy, and 38 percent had consulted with their own primary care physician. Overall, more than three-quarters of parents thought the program was very useful.
"The parents in the study liked the program. All of them said that STOP should be offered to parents who smoke at the time a child is hospitalized," Winickoff says.
The researchers note that the study's results indicate that some opportunities for pediatricians to impact their patients' well-being may not always be obvious. "When it comes to the health of a child, we have to consider the family unit, which includes focusing on the parents, too," says principal investigator Nancy Rigotti, MD, director of the Tobacco Research and Treatment Center at MGH. She explains that the hospital-based approach used in this study may represent a good "teachable moment" for parents.
The other members of the research team are Valerie Hillis and James Perrin, MD of MGH and Judith Palfrey, MD of Children's Hospital. The study was supported by grants from The Deborah Munroe Noonan Memorial Fund through The Medical Foundation, Agency for Healthcare Research and Quality, and Midcareer Investigator Award in Patient-Oriented Research from the National Institutes of Health.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $300 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women's Hospital to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.
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PEDIATRICS