Acceptability of tobacco cessation interventions in the pediatric emergency department

To assess the acceptability to parents and staff of providing a brief tobacco cessation intervention incorporating the first 2 A's of the Clinical Practice Guideline on Treating Tobacco Use and Dependence (Ask and Advise) + fax referral to a state tobacco quitline from the emergency department (ED) of a large children's hospital.

Data were collected from a written survey of (1) parental smokers accompanying their children to a pediatric ED who consented and were randomized to participate in a tobacco cessation intervention and (2) medical doctors (MDs) or nurse practitioners (NPs) caring for their child. Acceptability of the intervention was measured on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree."

Of the 1643 parental subjects that were screened to participate in this study, 557 (33.9%) were smokers, 240 of whom were enrolled in the intervention group and a total of 215 (90%) completed the survey. A total of 230 (100%) of the MDs/NPs approached completed the survey. Of the 215 parental subjects in the intervention group, 212 (98.6%) and 208 (96.7%) agreed that the intervention provided them with "useful information" and "easy to understand" advice, respectively. Most parental subjects agreed that the advice given was sufficient and met their needs (n = 208, 96.7%) and that the study length was "just right" (n = 206, 95.8%). On a rating scale of 1 to 10, the mean (SD) rating of the study was 9.1 (1.3). Of the MDs/NPs participating in this survey, 224 (97.4%) and 206 (89.6%) agreed that the "ED is a good place to screen parents for tobacco use" and that the "ED is a good place to give advice about tobacco cessation," respectively. In addition, 202 (87.8%) and 196 (85.2%) reported that they felt comfortable giving tobacco cessation advice to parents or referring parents to the national quitline, respectively. Only 7 (3%) felt that the study interfered with patient care.

An ED tobacco cessation intervention using the 2 A's + Quitline referral had excellent acceptability in this study of parents and staff of pediatric patients. The use of the pediatric ED as a venue to providing tobacco cessation counseling to a population with a high prevalence of parental smokers warrants further consideration.