Policy Objective: Support for Cessation Services
Setting: Practice
Below, you will see a list of goals for this policy objective. Click on the specific goal to read strategies you can use to achieve that goal in this setting.
Countering Industry Messaging
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Clinicians should be clear in their messages about tobacco use and secondhand smoke exposure with both children and families. Adult tobacco users should be advised to quit and given proper materials to do so, or at the very least, encouraged to work with the clinician to think of ways to protect the rest of the family from the toxins in secondhand smoke.
Helpful cessation materials may include the state quitline, websites, text-to-quit programs, apps, in-person programs and nicotine replacement therapy such as medication, patches, lozenges or gum. The adoption of smoke-free rules in homes and cars is one way a tobacco user who will not quit can still protect the rest of the family. Adolescent tobacco users should also be advised to quit, and given age-appropriate motivators to do so. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.
If the exposure to secondhand smoke is not under the parent’s control, the clinician should encourage the parents to consider having a discussion with the person causing the secondhand smoke exposure. If the parents seem anxious about facilitating this conversation, the clinician should suggest that they bring the smoker(s) to an appointment so that the dangers posed to the family from secondhand smoke can be discussed.
Clinicians should understand, and be prepared to discuss, that some patients and family members may be dual tobacco product users, or part of a demographic group which puts them at a higher risk for tobacco use.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 42, 48, 50
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 9 and 14
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Owners/Management Agents of Federally Assisted Public and Multi-family Housing
- U.S. Department of Housing and Urban Development– Smoke Free Housing- A Toolkit for Residents of Federally Assisted Public and Multi-family Housing
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Counseling Parents
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- Public Health Law Center– Vehicles
- Talk to your Patients.org– Don’t be Silent About Smoking
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Smokers and other tobacco users regularly state that the advice of a physician or health expert is important to them. In fact, one study found that the majority of parents would be more satisfied with their child’s pediatric office visit if the doctor discussed their tobacco use and how it could negatively impact their child. It is important to address cessation of tobacco use in all encounters with a tobacco user; otherwise it may appear as if the clinician condones the behavior. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 14
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- page 7
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Counseling Parents about Smoking Cessation
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control- Cessation
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- AAP State Government Affairs– Issue Brief: Tobacco-free Environments
- CEASE (Clinical Effort Against Secondhand Smoke Exposure)
Quitlines and Other Cessation Services
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Motivational interviewing is an effective technique to discuss tobacco use with a patient or family. Using this or similar methods, which have been proven to be successful, may double the chance of a tobacco user listening to and effectively acting on cessation recommendations.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 57-60
For more information:
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control- Working with Youth and Families
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- Motivational Interviewing.org
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Patients are more likely to accept advice from health care professionals who practice what they preach. Clinicians should not give patients or their families any excuses to dismiss the cessation advice of members of the health care team. Management should encourage all employees to stop using tobacco products, incentivize their cessation efforts by encouraging them to maintain a tobacco-free lifestyle, and provide cessation materials to staff whenever possible. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control- Community: Employer Support for Work-Based Smoking Cessation
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities
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Clinicians should adopt the practice of referring tobacco users to cessation resources, whether the user is their patient or not. There are both national and local resources available to assist in cessation efforts. Helpful cessation materials may include the state quitline, websites, text-to-quit programs, apps and in-person programs. Local resources, such as a state quitline, or a community organization, may be more culturally sensitive to a specific region or ethnic group than more generalized, national resources.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 42, 48
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendations 14, 16, 17, and 19
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- Surgeon General report– How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, 2010- page 648
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 2, 7-8
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– How to Quit
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control
- AAP Julius B Richmond Center– State-specific tobacco control resources
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- American Lung Association– Tobacco Cessation Coverage: Helping Smokers Quit
- Institute for Global Tobacco Control– The MPOWER framework and United Nations human rights treaties: An additional argument for the promotion of tobacco control goals
- North American Quitline Consortium– Find your state’s quitline information
- Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities
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Clinicians should make it as easy as possible for tobacco users to quit by providing access to cessation resources. Helpful cessation materials may include the state quitline, websites, text-to-quit programs, apps, in-person programs and nicotine replacement therapy such as medication, patches, lozenges or gum. Clinicians can also offer handouts to patients and families to educate and support them in their cessation efforts and can refer a tobacco user to national and state quitlines or prescribe pharmacotherapy, even if that person is not their patient. Electronic nicotine delivery systems (ENDS, or e-cigarettes), which are not approved by the US Food and Drug Administration as an approved cessation device, should not be recommended to help smokers quit.
Clinicians should understand, and be prepared to discuss, that some patients and family members may be dual tobacco product users, or part of a demographic group which puts them at a higher risk for tobacco use.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- AAP policy statement– Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- pages 42, 48
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 14
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- Surgeon General report– How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease, 2010- page 648
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 7-8
- World Health Organization (WHO)– WHO Report on the Global Tobacco Epidemic 2008: The MPOWER Package- Intervention O
For more information:
- AAP Julius B Richmond Center– Counseling Parents about Smoking Cessation
- AAP Julius B Richmond Center– Quit Resources for Smokers (available as a handout; contact the AAP Richmond Center)
- AAP Julius B Richmond Center– Quit Resources for Adolescents (available as a handout; contact the AAP Richmond Center)
- AAP Julius B Richmond Center– Solving the Puzzle: A Guide to Pediatric Tobacco Control- Cessation
- AAP Julius B Richmond Center– Tobacco Control and Specific Populations
- AAP Issue Brief– Tobacco Cessation and Treatment Programs
- Smoking Cessation Leadership Center– Tobacco-Free Toolkit for Community Health Facilities
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Clinicians are under constant time constraints. It may be difficult to address tobacco use and exposure with a patient or patient’s family if there is no time, or no benefit to the clinician. Clinicians should be sure to code properly for the valuable time spent on counseling a patient or family about tobacco use and exposure. Also consider using tobacco exposure as a risk factor when justifying other potentially related illnesses, such as asthma and other respiratory problems.
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- pages 134, 231-40
For more information:
- AAP Julius B Richmond Center– How to Get Paid for Smoking Cessation Counseling
- AAP Julius B Richmond Center– CPT Codes for Tobacco Counseling
- AAP Julius B Richmond Center– Tobacco Coding Fact Sheet
- AAP Julius B Richmond Center– Coding Corner: Tobacco use and exposure Q&A
- AAP Julius B Richmond Center– Reimbursement for Smoking Cessation Therapy: A Healthcare Practitioner’s Guide
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Each time a clinician discusses tobacco use with a patient or family member, it should be documented. Even if a family member reports that they smoke outside and away from the children in the family, it should be documented in the child’s chart. Living with a smoker does pose a risk to a child’s health, no matter where the smoking occurs.
It is important that clinicians ask the right questions of their patients and families. Asking “you don’t smoke, do you?” may sound judgmental and may not get at the right information. Someone who uses a product other than cigarettes (smokeless tobacco, cigars, hookah, electronic nicotine delivery systems) may not answer yes to this question. Try asking broad questions, but give specific examples- “Do you use any form of tobacco like cigarettes, cigars, dip, or hookah? Do you use any type of electronic smoking device like an e-cigarette or vaping device?”
Recommended by:
- AAP policy statement– Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke
- AAP policy statement– Electronic Nicotine Delivery Systems
- Centers for Disease Control and Prevention (CDC)– Best Practices for Comprehensive Tobacco Control Programs, 2014- page 42
- CDC– Health Equity in Tobacco Prevention and Control
- National Academy of Medicine report– Ending the Tobacco Problem: A Blueprint for the Nation, 2007- Recommendation 14
- Surgeon General report– The Health Consequences of Smoking— 50 Years of Progress, 2014- page 875
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- page 7
For more information:
- AAP Julius B Richmond Center– Clinicians and Clinical Practice
- CEASE (Clinical Effort Against Secondhand Smoke Exposure)
- U.S. Department of Health and Human Services– Treating Tobacco Use and Dependence: 2008 Update- Clinical Practice Guidelines- Systems Change Resources
Last Updated
03/24/2021
Source
American Academy of Pediatrics