1. Tobacco Screening, Brief Intervention and Referral for Parents

2. Why should the Pediatrician care about parental smoking? 40% of Children under 5 live with a smoker (data from NHANES III) 22% of adults smoke 21% of 12 th graders smoke regularly

3. What is the leading pediatric cause of death? Children’s exposure to smoking is linked to 5,900 deaths per year That’s 50% of all deaths occurring under 16 y.o.!!!!!!!!!!

4. The Toll of Parental Smoking Parents who smoke are the key predictor of teen smoking status Having a parent who smokes increases your chances of smoking by a factor of 4!

5. Why don’t we talk more about smoking? Letting ourselves of the hook – “I only smoke outside”……….Oh, OK……. Don’t want to be confrontational We don’t really know what to say after “Do you smoke?”

6. The Brief Intervention Here’s what to say after, “Do you smoke?”

7. Ask Smoking status Advise To quit Assess Willingness to quit Assist Aid in quitting Arrange Follow-up Tobacco use as a vital sign Strong, clear, personalized Assess importance, readiness, and confidence – weigh pros and cons – assess stage of readiness to quit Offer help: set quit date, analyze past attempts to quit, develop quit plan, provide pharmacotherapy The 5 “As”

8. Advise - An effective message is….. Brief Informative Clear Personalized “ Ms.Jones, I need to let you know any concerns I have about your child’s health. I’m really worried that his frequent respiratory and ear infections are aggravated by your smoking. I would really like to help you quit smoking.”

9. Assess Are you interested in quitting? Or, would you like your husband to quit smoking? How important is it for you to quit? How confident are you that you can quit? How many times have you tried to quit? Tell me about what motivated you to quit last time.

10. Suggested Brief Interview ELICIT CONCERNS –“What concerns do you have about smoking?” –“What else concerns you about your smoking?” CONSIDER BENEFITS –“What do you like about smoking” (“What does smoking do for you?) SUMMARIZE –“So on the one hand, you get some benefits from smoking, but at the same time you are concerned about…” OFFER HELP –“How can I help?”

11. Don’t worry! Help is available! State of Texas Quitline 1-877-YES-QUIT (937-7848) Free, trained tobacco cessation counselors and sometimes free nicotine replacement patches

12. Does all this really work? 5-7% of smokers spontaneously quit yearly 12+% of smokers quit after a brief message from a healthcare provider YOUR BRIEF INTERVENTION DOUBLES THE CHANCES THAT SOMEONE QUITS!

13. Never give up!