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Factors Associated with Counseling Parents about Tobacco Smoke Exposure: A National Pediatrician Survey

Robert McMillen, 1,2 Karen O'Connor,3 Jonathan Winickoff,2,4 and Karen Wilson2,5

1MSU, Starkville, United States; 2RCE, AAP, Elk Grove, United States; 3AAP Dept of Research, Elk Grove Village, United States; 4MGHFC, Boston, United States and 5URochester, Rochester, United States.

Presented at the April 2012 Pediatric Academic Societies Annual Meeting

Background: Tobacco counseling to parents can reduce children's exposure to tobacco smoke. The 2009 AAP Policy Statement Tobacco Use: A Pediatric Disease advises pediatricians to ask, document, and counsel about tobacco smoke exposure.

Objective: To assess the rate of screening and counseling about tobacco smoke exposure among pediatricians and to explore associated factors.

Design/Methods: A national, random sample of non-retired US AAP members were mailed a Periodic Survey in 2010 (N=887, RR=55%). Bivariate analyses examined factors associated with counseling in well and sick-child visits, while multivariate analyses controlled for demographics. Analysis is limited to those who provide health supervision (n=549).

Results: Fewer than half of pediatricians report any tobacco counseling most or all of the time: 46% asked if anyone in the house smokes, 28% asked if smoking is allowed in the home, 35% asked if the child is exposed to secondhand smoke (SHS), 22% discussed the danger of SHS, and 20% advised the parent to enforce a no smoking rule in the house. In bivariate analysis, high counseling rates were found for those: in rural settings, nonwhite pediatricians, practices that routinely document exposure to SHS in a specific place within the patient chart, pediatricians with parent smoking rates >20%, and pediatricians who were very confident in their ability to provide guidance on the effects of SHS (P<.05 for each). Confidence in ability to provide guidance and chart documentation procedures persisted in multivariate analyses. 

Odds Ratios (P<.05 for each)
Asked if anyone in house smokes Asked if smoking is allowed in house Asked if child is
exposed to SHS
danger of SHS
Advised to have
smokefree home
Docu Specific
place in chart
4.5 5.1 4.8 1.9 2.8
Very Confident 2.4 2.7 2.1 2.3 2.5

Conclusions: Fewer than half of pediatricians report asking and counseling about tobacco smoke exposure most or all of the time. These data also suggest that increasing confidence in ability to provide counseling and changing chart documentation practices could increase counseling. Educational and quality improvement activities to improve screening and counseling for tobacco use are needed. Appropriate electronic medical records implementation may also improve rates of screening and counseling.
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