Despite public health gains, cigarette smoking remains the leading cause of preventable death in the United States. Additionally, more than 40% of U.S. children are regularly exposed to the harms of secondhand smoke, most often by a parent. However, visits to pediatricians are rarely used as opportunities to reach parents who smoke and help them quit.

Most smokers, including parents, want to quit. Parents who quit smoking eliminate most of their children’s secondhand smoke exposure and decrease their risk of becoming smokers when they grow up, while increasing their own life expectancy. Parents who smoke may not routinely visit an adult health care provider, but they do see their child’s pediatrician an average of three to four times per year.

Using the pediatric setting as a touch point to support the health of parents is a promising new avenue to combat tobacco use. Pediatric providers are well-positioned to protect children from secondhand smoke exposure by promoting tobacco use screening and treatment for parents who smoke.

But a variety of barriers stand in the way of using pediatric visits to help parents quit smoking. It’s difficult for pediatricians to address new issues in busy 15- to 20-minute well-child office visits. Reimbursement for services for adults may be absent. Pediatricians may find it hard to communicate with parents about their health behaviors and habits. Office systems, such as electronic health records (EHRs), may not be well-suited to delivering care to parents.

Our work has focused on overcoming some of these barriers to tap into the potential of pediatric office visits to address parental smoking. Our main goal: offer evidence-based treatment to all parents who smoke.

A New Intervention

Our recent paper describes a new intervention to engage parents in smoking cessation. The intervention, implemented within the Children’s Hospital of Philadelphia’s (CHOP) Primary Care Network, starts with a survey of parents prior to routine pediatric preventive care visits. We ask parents about smoking in a nonjudgmental way. If they report smoking, they see motivational messages on the survey screen with key points that are informed by behavioral science such as: “Your child’s doctor and nurse practitioner want you to know that quitting smoking will improve your child’s health by preventing respiratory illnesses like coughs, colds, and wheezing.”

Parent responses about smoking are directly integrated into the EHR so that the pediatricians can start a discussion with them. The EHR also prompts the pediatrician with scientifically proven talking points to guide their conversation. To address time pressures in office visits, parents are automatically connected to treatment even if there isn’t time for a discussion.

In our study, 90% of the physicians reported the system worked well in their usual clinical operations. Also, 90% of parent participants felt comfortable answering the initial survey questionnaire.

Future Work

We know that parents will still face other challenges in quitting. Our team is currently exploring ways to better support parents once the treatment connection is made. In addition, getting insurance companies to reimburse pediatricians for parental smoking cessation would decrease financial barriers. But for now, our work shows that addressing adult smoking in pediatric settings is an exciting new avenue for potentially helping children and their parents live tobacco-free lives.

The study, “Electronic Health Record-Embedded, Behavioral Science-Informed System for Smoking Cessation for the Parents of Pediatric Patients,” was published in the May 18, 2022, issue of Applied Clinical Informatics. Authors include Brian P. Jenssen, Dean J. Karavite, Shannon Kelleher, Ekaterina Nekrasova, Jeritt G. Thayer, Raj Ratwani, Judy Shea, Emara Nabi-Burza, Jeremy E. Drehmer, Jonathan P. Winickoff, Robert W. Grundmeier, Robert A. Schnoll, and Alexander G. Fiks.


Brian Jenssen, MD, MSHP

Assistant Professor, Pediatrics

Shannon Kelleher, MPH

Clinical Research Coordinator, PolicyLab at Children’s Hospital of Philadelphia

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