Clinical Effort Against Secondhand Smoke Exposure (CEASE)
|Program Title||Clinical Effort Against Secondhand Smoke Exposure (CEASE)|
|Purpose||Designed to promote delivery of tobacco control assistance by pediatric practices to reduce second-hand smoke exposure in the home. (2013)|
|Program Focus||Awareness Building for Healthcare Providers, Awareness of impact of second-hand smoke exposure in the home, Behavioral Modification for Healthcare Providers and Smoking Cessation|
|Age||Adults (40-65 years), Young Adults (19-39 years)|
|Race/Ethnicity||Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, White, not of Hispanic or Latino origin|
|Funded by||NCI (Grant number(s): R01-CA127127), HRSA (Grant number(s): HRSA 5-UA6-10-001)|
|User Reviews||(Be the first to write a review for this program)|
The first step, delivered by front desk staff, takes place before the child and parent(s) enter the exam room. Upon arrival for the child’s visit, the parent receives a screening intake survey (on paper or an iPad) to screen for household tobacco use. If the parent indicates that he or she is a smoker, he or she receives the CEASE Action Sheet, which asks the parent if he or she is interested in getting information on a free telephone quitline or receiving nicotine replacement therapy (NRT). If the parent expresses interest in the tobacco cessation quitline, the front desk staff give the parent a quitline fax referral form, help the parent complete it, and fax the form to the free tobacco cessation quitline. During the visit, the clinician reviews the CEASE Action Sheet, gives brief counseling to encourage the parent to quit smoking, helps the parent to set a quit date, supports the parent in establishing rules for a tobacco-free home and car, and provides the parent with a prescription for nicotine replacement therapy (gum and patch).
Health care practices interested in receiving CEASE training identify a practice leader to receive training on integrating the three steps into routine practice. The practice leader training is conducted by telephone and is also accessible as a self-guided video on the CEASE website. A second training is conducted 1‒2 weeks later by conference call with the practice leader and all other office staff to participate in role-playing activities and address any barriers or concerns regarding implementation. A sustainability training is conducted 6‒9 months after implementation.
-- 60 minutes for individual training for the practice leader
-- Group training for all practice staff: 60 minutes of training to provide an overview and 60‒90 minutes of training using videos and role playing to focus on the Ask, Assist, and Refer process
-- 120 minutes monthly for ongoing telephone support to sustain program implementation
-- Email support as needed, including when practice materials (such as quitline forms) have changed
-- 60 minutes for sustainability training for practice staff 6‒9 months after initial implementation
-- Online eQIPP training through the American Academy of Pediatrics’ PediaLink training platform
-- CEASE Action Sheet
-- CEASE Training Manual
-- CEASE Implementation Guide
-- CEASE Training DVD/Video
-- Clinician NRT Frequently Asked Questions
-- CEASE website
-- Asthma Poster
-- Third-hand Smoking Poster
-- No Smoking Sign Poster
-- Medical Records Review Sheet
-- Quick Training Manual
-- CEASE At A Glance
Program products developed after study completion
-- Electronic cigarette information
-- eQIPP course
-- Sample Disease Registry Report
-- Sample Intake Survey Report
-- Tobacco Disease Registry Guide
-- CEASE Comic Strip
-- Clinician Training Manual for the iPad
For costs associated with this program, please contact the developer, Jonathan Winickoff. (See products page on the RTIPs website for developer contact information.)
About the Study
Each study site aimed to recruit a sample of 100 parents exiting their child’s pediatrics office to result in a total of 2,000 study participants. Parents aged 18 years and older who smoked within the past 7 days and who had a child under age 18 were eligible to participate. A 14-item screening questionnaire was given to parents to collect data on demographics, reason for the visit, parent smoking rules in the home and car, and parent smoking behavior. Parents were also asked about the tobacco control assistance they received during the visit. Follow-up data were collected from the parents through a telephone survey 12 months after their exit interview. During the call, parents were asked about their current tobacco use behavior, smoking rules in the home and car, and any visits to their child’s pediatrics office in the past 12 months. Parents who reported that they had at least one office visit in the past 12 months were asked about the tobacco control assistance they received during the visit. A saliva sample was requested from parents who reported cessation of tobacco use.
A total of 1,980 parents participated in the study (999 parents in the CEASE group and 981 parents in the usual care group). The average age of parents was 30 years, and 78% of parents in the study were mothers. In the CEASE group, the participants were 73% White, 11% African American, 8% Hispanic, 4% Native Hawaiian or other, 3% more than one race, and <1% Asian. In the usual care group, the participants were 62% White, 20% African American, 14% Hispanic, 3% more than one race, 1% Native Hawaiian or other, and <1% Asian. Among the 1,355 parents who completed the 12-month telephone survey, the average age was 31 years, and 81% were mothers.
The outcome assessed was the percentage of parents who received tobacco control assistance, first at the initial visit and second during the following 12-month period. Parents were considered to have received tobacco control assistance if they said “yes” to any of the following questions: Did your provider “discuss medicine to help you quit smoking (e.g., nicotine replacement gum, patch, lozenge, or other medicine),” “discuss methods and strategies (other than medicine) to help you quit smoking,” or “suggest you use a telephone quitline or other program to help you quit smoking”?
- At the exit interview, 42.5% of parents in the intervention group reported receiving at least one form of tobacco control assistance during the initial office visit compared with 3.5% of parents in the usual care group (p<.001).
- At the 12-month follow-up, among parents who reported having at least one subsequent office visit over the 12-month period, 54.7% of parents in the intervention group reported receiving at least one form of tobacco control assistance compared with 19.2% of parents in the usual care group (p<.001).
- At the 12-month follow-up, parents who received any tobacco control assistance (in the intervention group) were more likely to have quit smoking than parents who did not receive any assistance (in the intervention and usual care groups) (p=.016). However, no statistically significant difference in quit rates were found between the CEASE and usual care groups.
Winickoff JP, Nabi-Burza E, Chang Y, Finch S, Regan S, Wasserman R, Ossip D, Woo H, Klein J, Dempsey J, Drehmer J, Hipple B, Weiley V, Murphy S, Rigotti NA. (2013). Implementation of a parental tobacco control intervention in pediatric practice. Pediatrics, 132 (1), 109-117.
Winickoff JP, Nabi-Burza E, Chang Y, Regan S, Drehmer J, Finch S, Wasserman R, Ossip D, Hipple B, Woo H, Klein J, Rigotti NA. (2014). Sustainability of a parental tobacco control intervention in pediatric practice. Pediatrics, 134 (5), 933-941.
Winickoff JP, Park ER, Hipple BJ, Berkowitz A, Vieira C, Friebely J, Healey EA, Rigotti NA. (2008). Clinical effort against secondhand smoke exposure: development of framework and intervention. Pediatrics, 122 (2), e363-e375.
Drehmer JE, Hipple B, Ossip DJ, Nabi-Burza E, Winickoff JP. (2015). A cross-sectional study of happiness and smoking cessation among parents. Journal of Smoking Cessation, 1-9.
Winickoff JP, Hipple B, Drehmer J, Nabi E, Hall N, Ossip DJ, Friebely J. (2012). The Clinical Effort Against Secondhand Smoke Exposure (CEASE) Intervention: A Decade of Lessons Learned. Journal of Clinical Outcomes Management: JCOM, 19 (9), 414-419.
Winickoff JP, Healey EA, Regan S, Park ER, Cole C, Friebely J, Rigotti NA. (2010). Using the postpartum hospital stay to address mothers' and fathers' smoking: the NEWS study. Pediatrics, 125 (3), 518-525.
Winickoff JP, Berkowitz AB, Brooks K, Tanski SE, Geller A, Thomson C, Lando HA, Curry S, Muramoto M, Prokhorov AV, Best D, Weitzman M, Pbert L; Tobacco Consortium, Center for Child Health Research of the American Academy of Pediatrics. (2005). State-of-the-art interventions for office-based parental tobacco control. Pediatrics, 115 (3), 750-760.
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