AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA
Improving Smoking Cessation Counseling for Children Admitted with Bronchiolitis: The American
Academy of Pediatrics Value in Inpatient Pediatrics Bronchiolitis Collaborative Experience
Susan C. Walley, MD, University of Alabama at Birmingham, Birmingham, AL and Shawn Ralston, MD,
Dartmouth Hitchcock Medical Center, Lebanon, NH
Presenting author’s email address: swalley@peds.uab.edu
Acute viral bronchiolitis is the most common reason for pediatric hospitalization, and Tobacco Smoke Exposure
(TSE) has been demonstrated to increase the risk for and severity of bronchiolitis. The objective of the study was to improve adherence to the American Academy of Pediatrics (AAP) evidence-based bronchiolitis guideline of eliminating exposure to tobacco smoke by increasing screening of TSE and parental smoking cessation counseling of children hospitalized for bronchiolitis. This was a multi-institutional prospective quality improvement (QI) interventional study. The AAP Value in Inpatient Pediatrics Bronchiolitis Collaborative (B-QIP) was created to improve inpatient bronchiolitis care through quality improvement education and tools specific to bronchiolitis care. Hospitals received an evidence-based best practices toolkit of potential interventions to increase screening of children with TSE and smoking cessation counseling, including implementation of the 5As.
The study concluded that evidence-based interventions increased screening for tobacco smoke exposure and parental smoking cessation counseling. Implementation was feasible in both academic and community settings and may be beneficial to reduce tobacco smoke exposure in children hospitalized with bronchiolitis.
Public Support for Raising the Age of Purchase for Tobacco from 18 to 21
Jonathan P. Winickoff, MD, MPH, FAAP 1 , Robert McMillen, PhD 1 , Susanne Tanski, MD, MPH 2 , Karen
Wilson, MD, MPH, FAAP 3 , Mark Gottlieb, JD 1 and Robert Crane, MD 4
1 AAP, Elk Grove Village, IL, 2 Giesel School of Medicine at Dartmouth, Hanover, NH, 3 University of
Colorado, Children's Hospital Colorado, Aurora, CO, 4Ohio State University, Columbus, OH
Presenting author’s email address: Jwinickoff@partners.org
The vast majority of tobacco users began before the age of 21. Raising the sales age of tobacco to 21 has the potential to reduce tobacco use initiation and progression to regular smoking. Municipalities in three states have passed local laws making it illegal to sell tobacco products and electronic cigarettes to persons younger than 21 years of age. The objective of the study was to assess the level of public support nationally for “Tobacco
21” initiatives. A previously validated mixed-mode survey design was applied to obtain a representative, crosssectional sample of U.S. adults. Respondents were asked to state their level of agreement or disagreement with the statement, “The age to buy tobacco should be raised to 21.” Variation in support by smoking status, region, race, age, sex, and education was examined. This national study demonstrates broad public support for raising the sales age of tobacco to 21 and supports increased dissemination of Tobacco 21 initiatives at the state and local levels.
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AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA
Electronic Cigarettes: Risks to Nonusers
Elizabeth L. Durmowicz, MD, Ii-Lun Chen, MD and Susan F. Rudy, MSN, CRNP; Food and Drug
Administration, Rockville, MD
Presenting author’s email address: elizabeth.durmowicz@fda.hhs.gov
This study sought to evaluate potential risks of electronic cigarettes (e-cigarettes) to nonusers. Advertisements claim these products are “safe”, “odorless”, “smoke free”, and can be used anywhere. E-cigarette health effects data in nonusers are limited. Adverse event (AE) reports submitted to the U.S. Food and Drug Administration
(FDA) were reviewed to evaluate adverse health effects associated with e-cigarettes in nonusers and in non-use situations. The study concluded that e-cigarette AE reports are increasing significantly. Over one-third of reports involve nonusers or non-use situations. Secondhand aerosol exposure complaints appear consistent with airway irritation, as well as nicotine exposure and possible nicotine toxicity. Healthcare providers should be aware that exposure to e-cigarette aerosol is potentially harmful, and e-cigarettes pose risks of burns, choking, and nicotine poisoning. Additionally, aerosol deposition on indoor surfaces could result in thirdhand exposure to nicotine and other chemicals. Given the limited information available on these products and lack of regulatory oversight on manufacturing, providers may consider counseling parents to keep e-cigarettes out of reach of children and avoid use, including recharging, near children.
Effect of Anti-Smoking Legislation on Hospital Admissions for Common Lower Respiratory Illnesses in the Pediatric Population
Megan Sikkema, DO, Alison Agnetta, MD, Geneva Sagun, MD, Tom Melgar, MD and Colleen Dodich,
MD; Western Michigan University School of Medicine, Kalamazoo, MI
Presenting author’s email address: megan.sikkema@med.wmich.edu
Asthma and bronchiolitis represent a significant cause of hospitalizations and morbidity within the pediatric population. Public policies enforcing statewide anti-smoking legislation have become widespread, but their clinical impact on morbidity and rates of hospitalization for pediatric asthma and bronchiolitis has not been studied. The purpose of the study was to determine if anti-smoking legislation has an impact on severity of asthma and bronchiolitis as determined by hospital discharges for children ages 0-17 years. Data was queried from the Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) for asthma and bronchiolitis. Patients aged 0-17 years old were included, and data from before and after state smoking bans were compared. The study concluded that following implementation of statewide public indoor smoking bans, there was a significant decrease in hospital admissions for asthma and bronchiolitis within the pediatric population. This highlights an acute clinical benefit in response to legislated health-improvement policies.
Pediatric Residents' Knowledge of and Comfort with Aiding Families in Smoking Cessation
Lindsay Frost, MD, MPH, Brian P. Jenssen, MD and Tyra Bryant-Stephens, MD; Children's Hospital of
Philadelphia, Philadelphia, PA
Presenting author’s email address: frostl@email.chop.edu
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AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA
The purpose of the study was to assess current resident practices and perspectives surrounding tobacco cessation counseling and nicotine replacement therapy (NRT) prescribing for pediatric patients’ caregivers in order to advise future resident training on this topic. Residents in a large pediatric teaching hospital completed an anonymous survey that assessed medical school training in smoking cessation counseling, perspectives on the role of pediatricians in parental counseling, current smoking cessation efforts and comfort, and areas for education improvement. The study concluded that while residents feel comfortable with smoking cessation counseling, they have had minimal training in NRT use and dosing. Additional significant barriers include time constraints and lack of follow up with the non-patient family members receiving aid. Methods to overcome barriers to aiding family members include implementing more resident training about NRT, instituting systems to ensure continuity with the patient and tobacco-using family members, and partnering with other disciplines invested in reducing environmental tobacco smoke exposure, such as nursing and/or respiratory therapists.
Where There's Smoke, There's Fire! - Recognizing Adolescent Tobacco Use as a Harbinger of Co-
Morbid Substance Use
Jennifer Morrison, MD, April Lee, MD, FAAP, and Edward McCabe, DO, MPH, FAAP; Staten Island
University Hospital, Staten Island, NY
Presenting author’s email address: jen_morrison17@hotmail.com
Adolescent tobacco, alcohol, and substance use are significant public health problems. Youth Risk Behavior
Survey (2011) data revealed that youth from the authors' area had the highest percentage of tobacco use throughout their city. To determine factors related to the initiation of tobacco and alcohol/substance abuse, they set out to quantify the prevalence of tobacco and alcohol-/substance-related visits among patients aged
13-20 to their Emergency Department (ED), and to identify variables associated with these visits. Retrospective data from patients aged 13-20 was collected from ED visits. The study concluded that tobacco use was significantly more prevalent in substance-related ED visits. The data also confirmed the concurrent growing opioid abuse problem in their community. Their findings suggest that there are identifiable, at-risk populations to whom support should be provided during the emergency room visit. The results of this study underscore the importance of early identification of tobacco, alcohol and other substance use and timely implementation of prevention strategies designed to target these high-risk groups.
Motivational Interview as an Adjunct to ‘Ask, Advise, Refer' Smoking Cessation Counseling in
Pediatric Primary Care
Maya Bunik, MD, MSPH 1 , Emily F. Muther, PhD 2 , Katherine Johnston, MPH 3 , Valencia Lopez, MA 3 ,
Ayelet Talmi, PhD 2 , Sharon Scarbro, MS 4 , Jini E. Puma, PhD 4 , Karen Wilson, MD, MPH, FAAP 1 and
Gwendolyn S Kerby, MD 1
1 University of Colorado, Children's Hospital Colorado, Aurora, CO, 2 University of Colorado, Children's
Hospital Colorado, Psychiatry and Pediatrics, Aurora, CO, 3 Children's Hospital Colorado, Aurora, CO,
4 University of Colorado School of Public Health, Aurora, CO
Presenting author’s email address: maya.bunik@childrenscolorado.org
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AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA
Pediatric providers are beginning to screen and address Secondhand Smoke (SHS) exposure in clinical settings.
While the authors’ ONE Step Quality Improvement (QI) Initiative was associated with a 13-14% cessation rate and also changes in parent-caregiver smoking behaviors, recent evidence suggested to them that addition of motivational interviewing (MI) may assist smokers to quit. The objective of the study was to 1) Evaluate the addition of a brief MI session by a trained provider to the established ONE Step QI Initiative toward reducing SHS exposure and 2) Evaluate clinical outcomes for SHS exposure reduction and parent/caregiver smoking behaviors after the MI. Participants were parent/caregivers of patients seen in a large urban teaching clinic at Children's
Hospital Colorado. They utilized time-series design and one group, pre-test/post-test design (multiple posttests). The study concluded that the addition of the MI session may be a good adjunct to the ONE Step SHS
Initiative and was highly acceptable to parent/caregivers. Results also show changes in parent-caregiver behaviors conducive to SHS exposure reduction and cessation.
Electronic Health Record Aids Identification of Secondhand Smoke Exposure among NICU Patients
Susan Niermeyer, MD, MPH 1 , Valencia Lopez, MA 2 , Katherine Johnston, MPH 2 , Patrisha Adkins, BSN,
RN 1 , Elinor Towler, BA 1 , Sharon Scarbro, MS 3 , Maya Bunik, MD, MSPH 1 , Karen Wilson, MD, MPH, FAAP 1 and Gwendolyn Kerby, MD 1
1 University of Colorado/Children's Hospital Colorado, Aurora, CO, 2 Children's Hospital Colorado,
Aurora, CO, 3 University of Colorado School of Public Health, Aurora, CO
Presenting author’s email address: susan.niermeyer@ucdenver.edu
Patients leaving the neonatal intensive care unit (NICU) are especially vulnerable to the adverse effects of secondhand smoke (SHS), but inpatient care tends to focus on acute management. Neonatologists express discomfort in addressing smoking by parents and caregivers. Best Practice Alerts (BPAs) within the electronic health record (EHR) can help promote change in behavior of health care professionals. This study evaluated the effect of adding EHR tools on the rate of identified SHS exposure. The authors utilized features of the EHR for collection of caregiver smoking history in addition to routine questions on the nursing intake database. All caregivers who smoked were given voluntary referral to QuitLine resources. The study concluded that routine admission screening by nursing staff identified the majority of SHS exposure. Addition of a BPA for physicians and nurse practitioners yielded an increased rate of identified SHS exposure. Documentation in the history and physical failed to capture all SHS exposure. Improved documentation of SHS in discharge summaries sent to referring and follow-up primary care providers will be necessary to improve continuity of care.
Implementation of an Inpatient Smoking Cessation Referral Program: Nursing Staff's Attitudes and
Barriers to Change
Rachel Boykan, MD 1 , Catherine R Messina, PhD 2 and Ahmed Erakat, DO 1
1 Stony Brook Long Island Children's Hospital, Stony Brook, NY, 2 Stony Brook University Hospital, Stony
Brook, NY
Presenting author’s email address: rachel.boykan@stonybrookmedicine.edu
The objective of the study was to evaluate nurses’ attitudes towards the implementation of a smoking cessation referral program in the inpatient setting. At the authors’ children’s hospital it has been standard practice to
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AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA identify patients and families who are smokers and to offer them written referrals to New York State (NYS)
Smoker’s Quitline. In 2013, a partnership with the NYS Quitline Opt-to-Quit™ program was initiated. HIPAA compliant templates were designed to function within the existing electronic medical record to facilitate direct referral and electronic data transfer to the Quitline for consenting smoking caregivers of admitted patients.
Nurses were educated and tasked with making referrals. Data from self-reported surveys concluded that nurses feel it is their responsibility to advocate for their patients. Self-reported improvement in asking and referring smokers to the Quitline and Opt-to-Quit™ indicates early success of this program and indicated continued need for education regarding second and thirdhand smoke. Next steps include elucidating other barriers to full implementation of Opt-to-Quit™ by conducting a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis with all nursing staff.
Non-Cigarette Tobacco Use among Adolescent Clinic Patients
Shenecia Beecher, MD, MPH, Olivia Gibson, Joseph Schwab, MD, MPH, Pauline Thomas, MD, Paulette
Stanford, MD and Marian Passannante, PhD; Rutgers-New Jersey Medical School, Newark, NJ
Presenting author’s email address: beechesn@njms.rutgers.edu
Tobacco is the leading preventable cause of death and disease among adults in the U.S., with 90% of adult smokers starting by age 18. While cigarette use has decreased, use of non-cigarette tobacco (NCT) products is increasing. The objective of the study was to assess the prevalence of and factors associated with NCT use among inner city, low-income adolescent clinic patients. Cross-sectional data was collected using a selfadministered questionnaire adapted from the 2011 National Youth Tobacco Survey. Participants were asked about use of tobacco products including cigarettes, blunts, e-cigarettes, cigars, and hookah; age at first use; perceived safety of each product relative to cigarettes; and exposure to tobacco at home. The study concluded that over 1/3 of their adolescent patients had tried NCT products. Given the current lack of regulation, advocacy and targeted intervention is needed to curb the potential health consequences of the rising popularity of NCT, which may include increased initiation into cigarette use and increased risk for lifelong tobacco addiction and the associated mortality and morbidity.
The Real Cost: The FDA's National Public Education Campaign to Prevent Youth Tobacco Use
Lucinda L. Miner, PhD, Center for Tobacco Products/Food and Drug Administration, Rockville, MD
Presenting author’s email address: lucinda.miner@fda.hhs.gov
Tobacco use is the leading preventable cause of disease, disability and death in the US. Tobacco use is almost always initiated and established during adolescence, making it a pediatric disease. To reduce the number of youth who experiment and to ultimately reduce the number of future tobacco users, FDA has researched and launched its first public education campaign to prevent youth tobacco use. Based on data from focus groups and ad copy testing on youth aged 12-17, two themes emerged as engaging to the target audience: short-term, cosmetic consequences of tooth loss and skin damage and the loss of control leading to addiction. Based on these themes “The Real Cost” campaign was developed. Based on preliminary data, the authors are confident that they have begun to engage their at-risk teen audience, educating them about the harms of tobacco to ultimately reduce the number of youth smokers. FDA plans outcome evaluations of the campaign, and intends
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AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA to launch additional campaigns targeted at high-risk teens such as those in rural communities and those that identify as LGTB.
Predictors of Susceptibility to Smoking and Smokeless Tobacco Use in Rural and Suburban High
Schools in Southeast Texas
Alexander V. Prokhorov, MD, PhD, AAP Tobacco Consortium, Elk Grove Village, IL
Presenting author’s email address: aprokhor@mdanderson.org
CURBING is an online interactive, multi-media school curriculum that educates about the dangers of smoking and smokeless tobacco (ST). Individually tailored tracks are designed to help adolescents adopt a tobacco-free lifestyle. A key innovation is social networking through a virtual support community. The authors hypothesized that established individual risk factors for smoking/ST and the cumulative effect of these risks will be significantly associated with susceptibility. The additive approach yields power to detect the combined effects of multiple risk factors. The high-risk group was defined by the following student characteristics: male gender, being Hispanic, presence of depressive-symptoms, having close friends and parents who smoke or use ST, low decisional balance, poor academic performance, suspensions/detentions and seeing pro-tobacco messages in movies. The overall risk index was computed as a sum of the individual risk factors. Culturally diverse high school students were recruited from 16 suburban and rural high schools in southeast Texas to participate in a grouprandomized trial. The study concluded that examination of the cumulative risk factor model revealed significant additive effects of multiple risk factors on smoking/ST use. Prevention programs ought to diligently address the known risk factors for smoking and ST initiation.
Caregivers' Interest in Using Smokeless Tobacco Products to Reduce Their Child's Secondhand Smoke
Exposure or Quit Smoking
Theodore Wagener, PhD 1 , Alayna Tackett, MS 2 , and Belinda Borrelli, PhD 3
1 University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2 Oklahoma State University,
Stillwater, OK, 3 Warren Alpert Medical School at Brown University, Providence, RI
Presenting author’s email address: theodore-wagener@ouhsc.edu
Interventions to reduce children’s secondhand smoke exposure (SHS) have had only modest effectiveness for children living with smokers. The current study examined caregiver interest in using Potentially Reduced
Exposure Tobacco Products (PREPs; e.g., snus, dissolvable tobacco lozenges) as a means of reducing SHS in the home or as a way to quit smoking. A 19-item survey was completed by 136 caregivers of a child with asthma, following their participation in a randomized clinical trial that consisted of home based asthma education and a smoking cessation induction intervention. The study concluded that very few caregivers had ever used PREPs but a majority was interested in trying them as means of smoking reduction or smoking cessation, or as a way to reduce SHS to their child. PREPs may be a useful means of reducing children’s SHS.
Decision Aid Tool Kit for Family Based Smoking Cessation
Avni Joshi, MD, MSc and Krista Despins, RN; Mayo Clinic, Rochester, MN
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AAP National Conference & Exhibition 2014
Provisional Section on Tobacco Control Abstract Session
Sunday, October 12, 2014; San Diego, CA
Presenting author’s email address: joshi.avni@mayo.edu
Healthy People 2020 objectives have set the goal for 10% reduction (currently 50%) in the proportion of children and adolescents exposed to secondhand smoke (SHS). With support from Center for Innovation, the authors developed a unique family centered smoking cessation initiative in the outpatient pediatric practice. SHS was identified by the Clinical Assistants (CA) during the rooming process. The providers would review that information and then offer option of consultation with the tobacco treatment specialist (TTS) with nicotine replacement supplies and consultation available free of cost and during the same visit. In Phase 1 of the pilot,
413 patients were screened for SHS and prevalence was 20.2 %, and only 3 families (2.8%) were referred to TTS.
Using input from the providers, patients and clinical assistants, the authors developed tools for families to empower themselves with the decision for smoking cessation. These tools were implemented in the Phase 2 of the pilot. The study s concluded that Family based smoking cessation choice tool significantly improved the uptake for counselling and treatment.
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