Comparison Between Pediatricians and Physicians in Other Medical Specialties in Promoting Smoking Cessation in the Clinic.

BACKGROUND: Louisiana has one of the highest rates of smoking in the country, putting its children at high risk of secondhand and third-hand smoke exposure and subsequent morbidity. Pediatricians have an important role to play by including smoking cessation promotion (SCP) in their discussions with patient caregivers. The purpose of this study was to examine SCP trends at Ochsner Health System and to determine if pediatricians are less likely to express confidence in and performance of SCP activities than physicians in other specialties. METHODS: We distributed a survey to pediatricians and to physicians in the departments of obstetrics and gynecology, internal medicine, and psychiatry in the Ochsner Health System. The survey assessed physician confidence in and performance of several SCP behaviors. We analyzed pediatrician confidence in and performance of 3 behaviors (screening, counseling, and referring) and compared pediatrician responses to the responses of the physicians in the other specialties. RESULTS: Twenty-eight pediatrician and 33 other physician responses were included in the analysis. No significant correlation (P = 0.2785) was found between pediatrician confidence and performance in screening for smoking behavior. A significant correlation was found in counseling (P = 0.0159) and referring (P = 0.0214). In the comparison of pediatrician responses to other physician responses, the physicians in the other specialties had higher medians and/or quartiles for both confidence and performance of all 3 behaviors, and the differences were significant. CONCLUSION: The physicians in other specialties showed consistently higher rates of confidence and performance of SCP behaviors than the pediatricians. Intervention is necessary to encourage pediatricians at Ochsner Health System to promote smoking cessation in their practices.

Electronic Heath Record Prompts May Increase Screening for Secondhand Smoke Exposure.

INTRODUCTION: The American Academy of Pediatrics recommends that pediatricians promote smoking cessation among caregivers at every visit. Currently, there are inconsistencies between recommendations and clinical practice. This study aims to compare results generated from 3 intervention methods on the rate at which pediatricians screen for secondhand smoke exposure (SHSe). METHODS: Pediatricians were randomly assigned to 1 of 3 intervention groups: no lecture, changes in electronic health record (EHR) (G1); lecture, no changes in the EHR (G2); or a lecture and EHR changes (G3). Data between groups were compared using a 1-way analysis of variance. RESULTS: Documentation of SHSe was statistically significantly greater in G3, when compared with G1 and G2 ( P < .01). Documentation of SHSe was statistically significantly greater in G1, when compared with G2 ( P < .05). CONCLUSION: A brief lecture with EHR prompts may be a simple way to increase screening for SHSe in the pediatric primary care setting.

Are Pediatricians Diagnosing Obese Children?

BACKGROUND: Pediatric obesity is the most prevalent nutritional disorder in American children. The detrimental social, psychological, and physiological effects of obesity call for pediatricians to address this health concern. The literature demonstrates that clinicians are underreporting the diagnosis of obesity in the pediatric setting. The primary purpose of this study was to determine if pediatricians at one pediatrics clinic in the Ochsner Health System are documenting the presence of an overweight or obese body mass index (BMI) as a diagnosis in the medical record. A secondary purpose of this study was to determine the demographics of all pediatric patients in the Ochsner Health System to be used for program development. METHODS: A retrospective medical record review was conducted. Records from April 1, 2012 to April 1, 2016, were reviewed for the presence of the diagnosis of BMI classified as obese or overweight. RESULTS: We analyzed a total of 175,066 records in this study. Of these records, 1.32% documented a diagnosis of obesity, and 0.5% documented a BMI score indicating overweight. The percentages of patient visits that met the Centers for Disease Control and Prevention criteria to be classified as obese or overweight were 28.66% and 30.41%, respectively. The majority of our pediatric patients were male (51.76%), white (43.31%), and 5-12 years old (43.80%). CONCLUSION: This study demonstrates that pediatricians at Ochsner Health Center for Children are not diagnosing patients who have unhealthy BMI scores as overweight or obese. Interventions are needed to increase the identification of children who may benefit from receiving resources that encourage a healthy lifestyle and optimal weight maintenance.

A Tale of Smoking Cessation Promotion: The Utilization of a Children's Book to Increase Screening and Counseling in the Pediatric Clinic.

OBJECTIVES: The rate at which pediatricians promote smoking cessation in clinical settings is low. The literature demonstrates that interventions paired with tangible health promotion materials may significantly increase screening rates to the pediatric office. The aim of this study was to investigate whether the addition of a children's book in the pediatric clinic could result in an increase in the rate in which pediatricians screened for secondhand smoke exposure (SHSe) and counseled caregivers to stop smoking. STUDY DESIGN: This randomized controlled study was performed at 7 pediatric clinics. METHODS: Seven pediatric clinic sites were randomly assigned to either an intervention or control group. Pediatricians in the intervention group were given children's books about SHSe to distribute to their patients while the control group did not receive any materials. RESULTS: At baseline, there was no difference between the control group and intervention group in rates at which pediatricians screened for SHSe ( P = .8728) and counseled caregivers to stop smoking ( P = .29). After the intervention, screening for SHSe and counseling caregivers to stop smoking were statistically significantly greater in the intervention group, when compared to controls ( P < .01 and P < .001, respectively). CONCLUSIONS: The use of a health promotion children's book in the pediatric setting can increase the rate at which pediatricians screen for SHSe and counsel caregivers to stop smoking. Future research should examine the effect of the storybook on various parameters of smoking cessation and future smoking behaviors.

Increasing Pediatricians' Smoking Cessation Promotion and Knowledge of the Smoking Cessation Trust.

The link between second hand smoke exposure (SHSe) and health issues in children has been well established. The objective of this study was to determine if a short intervention implemented among pediatricians promotes improvement in the promotion of smoking cessation to caregivers and increase pediatricians' awareness of the Smoking Cessation Trust (SCT). Pediatricians from 6 clinics were randomly assigned to the control or intervention group. All pediatricians received a survey to assess baseline knowledge, confidence and behaviors in smoking cessation promotion and utilization of the SCT. Pediatricians in intervention group received an educational lecture delivered by a physician. Two months post intervention, pediatricians in the control and intervention group received a survey to assess changes from baseline. Out of 36 general pediatricians, 27 completed the surveys for use in the analysis of this study (75%). Intervention group made more referrals to the SCT, compared to controls (p=0.048) and to baseline (p=0.0065). Pediatricians in the intervention group were more confident in recommending the use of NRT (0.040) and schedule a follow up to discuss smoking cessation (p=0.029) after the intervention. The intervention group was more likely to refer caregivers to smoking cessation programs (p=0.027), discuss a child's health risk from SHSe (0.031) and recommending the use of NRT to help quit (p=0.047) post intervention. The results from this study indicate that a short intervention can increase confidence and behavior in various parameters of smoking cessation promotion and significantly improve the rate in which pediatricians refer smoking caregivers to the SCT.

Pediatricians' Confidence and Behaviors in Smoking Cessation Promotion and Knowledge of the Smoking Cessation Trust.

BACKGROUND: Secondhand smoke exposure increases morbidity and mortality in children. Thirty-one percent of caregivers who accompany their children to the Ochsner Health Center for Children smoke, and none uses the services of the Smoking Cessation Trust (SCT), a free smoking cessation program for eligible Louisiana residents who began smoking before 1988. The objective of this study was 2-fold: first, to assess and compare pediatricians' confidence and behaviors in regard to smoking cessation promotion with caregivers, and second, to determine pediatricians' knowledge and comfort level with the SCT. METHODS: Pediatricians were given a questionnaire to assess 12 parameters regarding their confidence and practice when screening, counseling, and referring caregivers to smoking cessation programs. RESULTS: Thirty-six questionnaires were administered, of which 27 were completed (75%). Only 7.41% of respondents had formal training in smoking cessation, 18.52% had never heard of the SCT, and 92.59% do not refer to the SCT. All the pediatrician respondents stated that they were confident in their ability to screen for secondhand smoke exposure, 62.96% were confident in providing counseling, and 44.44% were confident in offering referrals. Most pediatricians very often or always screened for secondhand smoke exposure (77.78%); however, only 25.93% counseled smoking caregivers to quit, and only 11.11% provided a smoking cessation referral. Pediatricians stated that they were confident to screen, counsel, and refer caregivers; however, they were significantly less likely to report actually screening for secondhand smoke exposure (P<0.05), counseling (P<0.05), and referring caregivers (P<0.05). CONCLUSION: Efforts should be made to increase the rate by which pediatricians provide smoking cessation, counseling, and referrals to the SCT through education and training.

The Smoking Cessation Trust Program of Louisiana: The Pediatrician's Role in Identifying and Referring Eligible Caregivers.

BACKGROUND: A pilot study was conducted to determine whether the caregivers of children being seen at the Ochsner for Children health center were eligible for and using services provided by the Smoking Cessation Trust (SCT). METHODS: The study population consisted of pediatric patients' caregivers who visit the Ochsner for Children health center. Caregivers were offered a questionnaire to assess their age, sex, relationship to the child, medical insurance, smoking status, and prior cessation attempts and aids. Data about 3 other caregivers were also requested from the visiting caregiver. RESULTS: Of the 84 caregivers assessed, 26 (30.95%) smoked, of whom 12 (46.15%) began smoking prior to 1988 and were eligible for SCT services. The cohort of eligible caregivers included 4 grandmothers (33.33%), 2 grandfathers (16.67%), and 3 fathers (25.00%). Smoking prevalence in our cohort was higher than the national average (31% vs 18%). During the previous 12 months, 3 of 12 (25.00%) SCT-eligible caregivers had tried to quit smoking. Four (33.33%) SCT-eligible caregivers were interested in smoking cessation. CONCLUSION: Pediatricians are in a unique position to screen, counsel, and refer caregivers who smoke to the SCT.

Evaluation of pediatricians' adherence to tobacco prevention, control, and treatment guidelines before and after an educational outreach program.

BACKGROUND: Tobacco use is the world's leading single preventable cause of death. Because children exposed to second- and third-hand smoke are at risk for smoke-related morbidity, pediatricians have an obligation to address tobacco use in their practices. The purpose of this study was to measure physician adherence to the American Academy of Pediatrics' guidelines on tobacco prevention, control, and treatment before and after the implementation of an educational outreach program. METHODS: Charts were randomly selected from pediatric clinics before and after the educational outreach. The intervention consisted of a review of the guidelines and available tools physicians could implement into their practices. We measured the rates of adherence to the guidelines before and after the educational outreach. RESULTS: We analyzed 213 charts (116 pre- and 97 posteducation). The proportion of families screened for tobacco smoke exposure was comparable between the pre- and postintervention groups (67.2% vs 59.8%, P=0.317). The postintervention group had a higher proportion of counseling compared to the preintervention group (51.5% vs 31.9%, P<0.05). We found no statistically significant change in the rate of screening or referral to smoking cessation services. CONCLUSION: Current guidelines to reduce tobacco use are underutilized. Educational outreach may increase the rate of counseling. Physician acceptance of guidelines is urgently needed to affect the tobacco epidemic.

Combined effects of chronic nicotine and acute virus exposure on neurotrophin expression in rat lung.

Strong epidemiologic evidence indicates that tobacco smoke influences frequency and severity of respiratory infections. Previously, we have shown that infection with respiratory syncytial virus upregulates expression of neurotrophic factors and receptors in the lungs, but the effect of tobacco exposure on neurotrophins is unknown. Therefore, we first sought to determine the expression of neurotrophic pathways in lungs of rats chronically exposed to nicotine, and then we studied the interactions between pollution and infection by inoculating virus after nicotine exposure. Expression of the neurotrophins nerve growth factor (NGF) and brain-derived neurotrophic factor, of their high-affinity tyrosine kinase receptors (trkA and trkB, respectively), and of the low-affinity receptor p75(NTR) was measured in the lungs of nicotine-exposed rats both at the mRNA level by reverse-transcription polymerase chain reaction and at the protein level by enzyme-linked immunoassay. Nicotine increased NGF expression both at the mRNA and protein level and also created a receptor imbalance deriving from increased expression of the pro-inflammatory p75(NTR) receptor without any concomitant change in the high-affinity trkA receptor. Viral infection after chronic nicotine exposure exerted an additive effect on NGF expression, and resulted in exaggerated neurogenic airway inflammation that was abolished by selective inhibition. In conclusion, nicotine levels comparable to those found in smokers are per se able to upregulate the expression of critical neurotrophic molecules in the respiratory tract, and combination of an acute infection following chronic nicotine exposure produces more severe neurotrophic dysregulation and neurogenic-mediated inflammation compared to either infection or nicotine alone.