HMN 2025: How Automated smoking interventions are offered to parents may curb their tobacco habits

Researchers from Children’s Hospital of Philadelphia (CHOP) and Mass General Brigham have found that integrating an automated smoking cessation intervention for parents into pediatric primary care demonstrated increased treatment received and reduced the number of cigarettes smoked. While additional interventions are needed to improve quit rates, the study indicates the benefits of pediatric primary care support in reducing parental smoking.

The findings are published in JAMA Network Open.

Prior studies have shown a variety of benefits for parents who quit smoking, including elimination of future tobacco-related poor pregnancy outcomes, reducing the likelihood of their children becoming smokers and decreasing childhood exposure to tobacco smoke, as well as less risk of developmental delays and increased financial resources. While some parents who smoke may not have their own primary care health physician, they will seek primary care for their children multiple times a year.

To take advantage of when and where parents interact with the health care system, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was developed prior to this study to address parental smoking by providing routine access to cessation resources. However, this approach has not been used broadly, in part because of difficulties in scaling the intervention in busy primary care settings.

To address this gap in knowledge, this study aimed to automate adult smoking cessation support in pediatric primary care using electronic health care records to consistently screen parents and connect them to treatment.

In this cluster-randomized clinical trial, 817 parents who smoked were enrolled across 12 pediatric primary care practices in the Philadelphia area between July 2021 and August 2023. Household members completed questionnaires about tobacco use before their child’s visit, and parents in intervention practices were proactively offered automated home delivery of nicotine replacement therapy and enrollment in a quitline and/or SmokefreeTXT, a text messaging program to help people quit smoking. They were also offered health navigator support at the time of enrollment.

Among parents who completed the follow-up, 48.2% of participants reported using nicotine replacement therapy compared with 16% in the control arm, and 22.8% of the intervention arm utilized a quitline or SmokefreeTXT compared with only 2.2% in the control arm. Just over 80% of parents in the intervention group had attempted to quit in the most recent three months, compared with just over 70% in the control group, with intervention practices leading to a greater reduction in the average number of cigarettes smoked daily as well as the percentage of daily smokers.

However, the 7-day biochemically confirmed abstinence rate was only 8.3% in the intervention arm of the study compared with 6.4% in the control arm.

“The significantly increased treatment engagement and reductions in cigarette use are particularly encouraging and suggest that additional strategies, integrated with automated intervention, may work even better to reduce smoking among parents,” said co-senior study author Alexander Fiks, MD, a pediatrician and the Director of Clinical Futures and the Possibilities Project: Innovation in Pediatric Primary Care at CHOP.

“We were surprised to see how effectively our approach identified parents who smoke and automatically engaged them in treatment,” said co-senior author Jonathan P. Winickoff, MD, MPH, a pediatrician and researcher in the Department of Pediatrics at Massachusetts General Hospital.

“Now, any health system in the country can routinely help parents with tobacco use and will likely be able to improve the quit rates seen in this study by offering additional FDA-approved medications, not just the nicotine replacement therapies offered in this trial.”

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