Reducing second hand tobacco smoke exposure through inpatient interventions.
Karen Wilson, MD, MPH, PI.
University of Rochester/Golisano Children's Hospital at Strong

The specific aims are to 1) determine the validity of the current standard admission secondhand tobacco smoke exposure assessment compared to a structured assessment and cotinine levels, 2) determine the effectiveness of the inpatient parent smoking cessation initiative on quit rates of secondhand tobacco smoke reduction efforts, and 3) determine whether caregivers of children admitted for "smoking exacerbated" illnesses are more likely to quit smoking following and inpatient intervention, compared with those admitted for other conditions.

The Role of Biomarker Feedback in Reducing Children's Exposure to Environmental Tobacco Smoke.
Stephen Wilson, MD, MSc, PI.
University of Cincinnati

This is a pilot study to test whether providing feedback to parents on their child's biomarkers of tobacco susceptibility (using DNA adduct levels) impacts smoking behaviors, leading to a reduction in their child's exposure to environmental tobacco smoke. The primary outcome is the child's environmental tobacco smoke exposure, measured by serum cotinine at 3 and 6 months.

Using Pediatric ED Visits at "Teachable Moments" for Maternal Smoking Cessation.
Melanie Prusakowski, MD, PI.
Children's Hospital of Philadelphia

Two brief motivational interventions (BMIs) will target smoking mothers of children less than 6 years who present to EDs with high and low motivation to quit. Interventions will be piloted with a follow up phone call and resource card; a control group will receives general advice and a resource card. The primary outcome is change in self-reported number of cigarettes smoked daily at 1 month.

The Effect of Using a Structured Tobacco Cessation Education Program in Resident Training on Reducing Secondhand Smoke Exposure in Young Children.
Roopa Shankar, MD, PI.
SUNY Upstate Medical University, Syracuse, NY

This randomized controlled trial will evaluate the effectiveness of a structured tobacco cessation education program (NY-CEASE), delivered by pediatric residents in the outpatient continuity clinic of a pediatric residency program in reducing the exposure of infants to SHS, and will evaluate the efficacy of using cotinine measurement and feedback as an adjunct to counseling vs. usual care.

Kristen Andersen, MD
Cardinal Glennon Children's Hospital, St. Louis, MO

Overall goals and objectives of the program.
While SHS is a leading cause of pediatric morbidity and mortality, surveys of practicing pediatricians found that pediatricians are less likely than other primary care physicians to address and intervene on reducing tobacco exposure. Reasons stated by pediatricians for not addressing tobacco include lack of confidence, lack of time, competing priorities, and concerns about efficacy and reimbursement. In fact, a recent survey revealed that almost all pediatric residents receive less than two hours of smoking cessation training during residency. Pediatric residency training is an ideal time to train future pediatricians to improve physician self-efficacy for smoking screening and cessation counseling.

We wish to invite a speaker to increase awareness of children's tobacco exposure, develop a curriculum for medical students and residents on tobacco prevention, and improve clinicians' skills on tobacco control and cessation. In addition, with wide audiences including medical students, residents, faculty, and community pediatricians in the St. Louis area, it is our goal to educate child healthcare providers about the dangers of second hand smoke and enhance their tobacco counseling for patients and parents in both office and hospital settings. Finally, with the cooperation of our program directors and dean of medical education at both St. Louis University and Washington University, we plan to integrate tobacco counseling and intervention into the curriculum for medical students and pediatric residents.

Corrie Stofcho, DO, MD
Naval Medical Center San Diego- Department of Pediatrics San Diego, CA

Overall goals and objectives of the program.
We aim to educate residents and staff regarding the dangers of second hand smoke exposure and the most effective techniques in counseling parents regarding smoking cessation. By affiliating with AAP Uniformed Services Chapter West, and AAP District 3 California, we hope to not only target the three teaching institutions (NMCSD, UCSD, and Camp Pendleton), but also community pediatricians.

Cheryl Courtlandt, MD
Levine Children's Hospital Carolinas Medical Center Charlotte, NC

Overall goals and objectives of the program.
The Richmond Visiting professorship presents a unique opportunity for our entire community in Charlotte to host a national tobacco control expert to aid in the elimination of secondhand smoke (SHS) and to encourage smoking cessation. North Carolina has a long history of tobacco production and both adult and youth smoking rates are higher than the national average. The 2005 Youth Tobacco Survey for North Carolina noted almost 6% percent of middle schoolers and 20% of high schoolers were current users of tobacco products.

According to the most recent US Surgeon General Report, there is no safe level of exposure to SHS. It is critical that all caretakers of children understand the health implications of SHS exposure. The proposal addresses recently published concerns regarding the lack of pediatric resident and community clinician confidence and knowledge in approaching SHS exposure and smoking cessation. The program outlined will provide resident education and community clinician training on this critical issue. By teaching clinicians to address these issues and incorporate them into their clinical practice, the standard of care is improved for all. Programs like this one enhance resident confidence and knowledge and impact positively on their clinical practice.

The proposed program has the additional benefit of providing information and a consistent message concerning smoke cessation and SHS exposure to other agencies in the city that provide services to children. Day care directors and child care administrators often have the difficult task of balancing the need for limiting smoke exposure of children from staff and parents with the risk of aliening staff and intrusion in parents' personal affairs. Many are concerned for children's welfare but lack the information to mount a credible case to staff and parents.

School nurses represent a medical liaison for all health providers in the community, of doing frontline screening and detection of serious illness. The school nurse has the role of health provider, educator and advocate for children at school. Nurses are confronted with tobacco related illness in their students and often feel unable to effectively counsel a student or a parent about smoking cessation. The program will give them the necessary tools to educate with confidence.

A two-pronged approach, coupling education to prevent initiation and encouraging smoking cessation are the only effective strategies in combating this public health crisis. To promote smoking cessation and reduction of SHS exposure, it is essential to utilize as many community resources as possible. A consistent message through a network of community stakeholders will have the maximal impact. Many of these providers interface with smoke exposed children and their parents on a daily basis and therefore can be powerful agents of change.

Ryan H. Pasternak, MD, MPH
Louisiana Public Health Institute, New Orleans, LA

Goals

1. Enhance tobacco control curriculum for pediatric training program, school health program and community health providers and develop provider knowledge of public health impacts from smoking and secondhand smoke exposure in children and adolescents.
2. Increase student and provider self-efficacy in delivery of tobacco control messages and cessation planning.
3. Promote awareness of careers and career development in pediatric tobacco control for students, residents, and community providers and community members.
4. Develop productive relationships between pediatric training programs, area public health institutions and programs, local AAP chapters, and community health groups to address tobacco control and exposure in children.

Objectives

1. Through large group lectures and workshop discussion attendees will be able to describe public health impacts of smoking and secondhand smoke exposure in children and adolescents.
2. Through workshops conducted by local public health tobacco control programs and visiting presenters, provider self-efficacy in delivery of tobacco control messages and cessation planning for smoking mothers, caretakers, adolescents and children will be increased. Changes in self-efficacy will be measured through pre/post-workshop evaluations.
   http://www.tobaccofreeliving.org/home/section/15/1213
   http://www.tobaccofreeliving.org/home/
3. Lectures/workshops from physicians and health care providers with careers in tobacco-control will provide students, residents and practicing providers with models for integrating tobacco control into their careers.
4. Multi-disciplinary curriculum including physicians and public health experts as presenters, and discussion/workshop groups that include:
   Pediatric residents, medical students, community health providers and administrators, State Office of Public Health program administrators, School Based Health Center providers and program administrators, and local AAP members and leadership; will facilitate development of productive relationships between various institutions and programs and bolster support for additional tobacco control education and clinical care within the State/region.