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Clinicians' Perspectives on Implementing Contingency Management to Promote Parental Smoking Cessation in Routine

Julie D Flom1, Deepa R Camenga1, Veronika Shabanova1

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PubMed
Summary

Pediatric clinicians support contingency management (CM) for infant parent smoking cessation. Barriers to implementing CM in pediatric primary care can be addressed through multifaceted strategies and partnerships.

Keywords:
clinician attitudescontingency managementgeneral pediatricsimplementation scienceincentive-based interventionsinfantparents/caregiverspediatric primary caresmokingsmoking cessationtobacco use

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Area of Science:

  • Pediatric primary care
  • Public health
  • Behavioral science

Background:

  • Secondhand smoke exposure in infancy is a critical period for caregiver behavior change.
  • Pediatric clinicians are well-positioned to support caregivers in smoking cessation.
  • Contingency management (CM) is an evidence-based intervention not yet widely used in pediatric primary care for parents/caregivers who smoke.

Purpose of the Study:

  • To explore pediatric clinician perspectives on using contingency management (CM) for smoking cessation among infant parents/caregivers.
  • To identify potential barriers and facilitators to implementing CM in pediatric primary care settings.

Main Methods:

  • Sequential mixed-methods approach using surveys and qualitative interviews with clinicians/staff at a federally qualified health center and nursery.
  • Linear regression assessed factors associated with CM beliefs.
  • Framework analysis of interview transcripts identified implementation barriers mapped to the Consolidated Framework for Implementation Research.

Main Results:

  • Most survey respondents (72 clinicians) were familiar with CM and held positive sentiments towards its use.
  • Favorable CM sentiment was associated with attending physician status, CM awareness, personal smoking history, and positive views of caregivers who smoke.
  • Key barriers identified included poor outcome expectancy, caregiver/clinician burden, and perceived complexity, which mapped to strategies like promoting adaptability, clinician education, and partnerships.

Conclusions:

  • Pediatric clinicians generally support the use of CM to aid smoking cessation in infant parents/caregivers.
  • Overcoming implementation barriers requires a multifaceted strategy involving comprehensive training and leveraging patient, community, and academic partnerships.