Given the dangers posed by tobacco use and tobacco smoke exposure, pediatricians should
address tobacco use and exposure with patients and parents at every opportunity, but
this is not consistently done in practice. One reason may be that many medical residents
do not receive education on how to address tobacco use and tobacco smoke exposure
with patients and their parents. In a 2012 survey of U.S. pediatric program directors,
65% of programs reported covering tobacco control in their curricula, but most training
programs focused on tobacco's health effects and not intervention strategies for clinical
practice. Since that survey, electronic health records have been implemented broadly
nationwide and utilized to address tobacco smoke exposure. Investigators surveyed
U.S. program directors in 2018 and residents in 2019 to explore the ways in which
the residents learn about tobacco use and tobacco smoke exposure, components and use
of the electronic record specific to tobacco use and tobacco smoke exposure, and perceived
resident effectiveness in this area. All the program directors and 85% of the residents
valued training, but 21% of the residents reported receiving none. Moreover, a minority
of the residents assessed themselves as effective at counseling parents (19%) or adolescents
(23%), and their perceived effectiveness was related to small group learning and active
learning workshops, modalities that were infrequently implemented in training. Respondents
also reported infrequent use of electronic health record prompts regarding tobacco
and the absence of prompts about critical issues (e.g., addressing tobacco smoke exposure
in vehicles or other settings or offering treatment or referrals to parents who smoke).
This paper provides recommendations about augmenting pediatric resident training in
simple ways.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Preventive MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
The toll of tobacco in the United States. Campaign for Tobacco Free Kids. https://www.tobaccofreekids.org/problem/toll-us. Updated January 15, 2020. Accessed July 20, 2020.
National Center for Chronic Disease Prevention and Health Promotion (U.S.) Office on Smoking and Health. The health consequences smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention (U.S.);https://www.ncbi.nlm.nih.gov/books/NBK179276/#:∼:text=Fifty%20years%20have%20passed%20since,and%20death%20caused%20by%20smoking. Published 2014. Accessed September 9, 2020.
- Secondhand smoke and asthma: what are the effects on healthcare utilization among children?.Prev Med. 2013; 57: 125-128
- Addressing parental smoking in pediatrics and family practice: a national survey of parents.Pediatrics. 2003; 112: 1146-1151
- Tobacco counseling at well-child and tobacco-influenced illness visits: opportunities for improvement.Pediatrics. 2003; 111: E162-E167
- Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking.Pediatrics. 2004; 113: 78-81
- What factors are important for pediatric residents’ smoking cessation counseling of parents?.Clin Pediatr (Phila). 2008; 47: 237-243
- Pediatric residency training director tobacco survey II.Pediatrics. 2012; 130: 712-716
- The electronic medical record's role in support of smoking cessation activities.Nicotine Tob Res. 2016; 18: 1019-1024
- Increases in smoking cessation interventions after a feedback and improvement initiative using electronic health records – 19 community health centers, New York City, October 2010-March 2012.MMWR Morb Mortal Wkly Rep. 2014; 63: 921-924
- System change interventions for smoking cessation.Cochrane Database Syst Rev. 2017; CD010742
- Electronic medical record reminders and smoking cessation activities in primary care.Addict Behav. 2018; 77: 203-209
- Impact of an electronic alert and order set on smoking cessation medication prescription.Nicotine Tob Res. 2012; 14: 674-681
- An electronic health record-based strategy to address child tobacco smoke exposure.Am J Prev Med. 2018; 54: 64-71
- Design and implementation of decision support for tobacco dependence treatment in an inpatient electronic medical record: a randomized trial.Transl Behav Med. 2017; 7: 185-195
- A content analysis of electronic health record (EHR) functionality to support tobacco treatment.Transl Behav Med. 2017; 7: 148-156
- Implementation of an inpatient electronic referral system (Opt-to-Quit) from the electronic health record to the New York State Smokers’ Quitline: first steps.Hosp Pediatr. 2016; 6: 545-551
- Pediatric residency training on tobacco: training director tobacco survey.Prev Med. 2001; 33: 688-698
- Changes and factors associated with tobacco counseling: results from the AAP Periodic Survey.Acad Pediatr. 2017; 17: 504-514
- Integrating education and service in pediatric residency training: results of a national survey.Acad Pediatr. 2017; 17: 907-914
- Do pediatric residents prefer interactive learning? Educational challenges in the duty hours era.Med Teach. 2011; 33: 494-496
- Using motivational interviewing to address tobacco cessation: two standardized patient cases for pediatric residents.MedEdPORTAL. 2019; 15: 10807
- Motivational interviewing: a high-yield interactive session for medical trainees and professionals to help tobacco users quit.MedEdPORTAL. 2019; 15: 10831
Buenger LE, Webber EC. Clinical decision support in the electronic medical record to increase rates of influenza vaccination in a pediatric emergency department. Pediatr Emerg Care. In press. Online January 6, 2020. https://doi.org/10.1097/PEC.0000000000001998.
- Physician advice for smoking cessation.Cochrane Database Syst Rev. 2013; CD000165
- Clinical decision support tool for parental tobacco treatment in hospitalized children.Appl Clin Inform. 2016; 7: 399-411
- Electronic decision support for treatment of hospitalized smokers: a qualitative analysis of physicians’ knowledge, attitudes, and practices.Drug Alcohol Depend. 2019; 194: 296-301
- Training health professionals in smoking cessation.Cochrane Database Syst Rev. 2000;; CD000214
Smoking & tobacco use: outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention.https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Updated February 25, 2020. Accessed June 23, 2020.
- Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults.Prev Med. 2017; 105: 32-36
- Tobacco-related counseling and documentation in adolescent primary care practice: challenges and opportunities.Nicotine Tob Res. 2020; 22: 1023-1029
- Section on Tobacco Control. Clinical practice policy to protect children from tobacco, nicotine, and tobacco smoke.Pediatrics. 2015; 136: 1008-1017
Article Info
Publication History
Published online: October 29, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
