• Jonathan P Winickoff, Emara Nabi-Burza, Yuchiao Chang, Stacia Finch, Susan Regan, Richard Wasserman, Deborah Ossip, Heide Woo, Jonathan Klein, Janelle Dempsey, Jeremy Drehmer, Bethany Hipple, Victoria Weiley, Sybil Murphy, and Nancy A Rigotti.
• Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA 02114, USA. jwinickoff@partners.org
• Pediatrics. 2013 Jul 1;132(1):109-17.

ObjectiveTo test whether routine pediatric outpatient practice can be transformed to assist parents in quitting smoking.MethodsCluster RCT of 20 pediatric practices in 16 states that received either CEASE intervention or usual care. The intervention gave practices training and materials to change their care delivery systems to provide evidence-based assistance to parents who smoke. This assistance included motivational messaging; proactive referral to quitlines; and pharmacologic treatment of tobacco dependence. The primary outcome, assessed at an exit interview after an office visit,was provision of meaningful tobacco control assistance, defined as counseling beyond simple advice (discussing various strategies to quit smoking), prescription of medication, or referral to the state quitline, at that office visit.ResultsAmong 18 607 parents screened after their child’s office visit between June 2009 and March 2011, 3228 were eligible smokers and 1980 enrolled (999 in 10 intervention practices and 981 in 10 control practices). Practices’ mean rate of delivering meaningful assistance for parental cigarette smoking was 42.5% (range 34%–66%) in the intervention group and 3.5% (range 0%–8%) in the control group (P < .0001).Rates of enrollment in the quitline (10% vs 0%); provision of smoking cessation medication (12% vs 0%); and counseling for smoking cessation(24% vs 2%) were all higher in the intervention group compared with the control group (P < .0001 for each).ConclusionsA system-level intervention implemented in 20 outpatient pediatric practices led to 12-fold higher rates of delivering tobacco control assistance to parents in the context of the pediatric office visit.

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