An Electronic Health Record-Based Tobacco Treatment System for Parents in Pediatric Primary Care

Parental smoking is a leading source of secondhand smoke exposure for children, increasing risks of respiratory illness and future smoking. Cessation treatment delivery for parents remains rare in pediatrics. This study evaluates the population-level impact of an automated tobacco treatment system integrated into the electronic health record (EHR) in pediatric primary care.

We conducted a retrospective observational study of parents whose children received care at 12 pediatric practices in a cluster-randomized trial (June 2021-August 2024). Six practices implemented an automated EHR-linked parent tobacco treatment system (screening, motivational messaging, automatic treatment connection including nicotine replacement therapy, SmokefreeTXT, and quitline referral through a previsit questionnaire); 6 implemented screening only. This analysis included all parents who completed questionnaires during routine care, excluding parents enrolled in the trial. We analyzed self-reported cessation rates among parents who reported smoking during the study period.

Among 55 567 parents with follow-up data (49 595 mothers; 5972 fathers), smoking rates were 4.3% vs 5.5% for mothers and 6.5% vs 8.3% for fathers receiving care with vs without the system. Among mothers who reported smoking during the study, cessation rates were significantly higher for those receiving care with the system (37.4% vs 33.5%, P = .044), representing a 3.9% improvement. Among fathers who smoked, there was no difference in cessation rates (29.6% vs 29.6%).

An automated tobacco treatment system was associated with significantly increased maternal smoking cessation in pediatric settings while showing no effect for fathers. This scalable approach could enhance pediatric preventive care by reducing household tobacco use.