O1037 Oct.4: 5:05pm - Multi-Center Medical Education Curriculum for Training Pediatric Residents on Tobacco Cessation

BACKGROUND
The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is an evidence-based framework that increases pediatric providers’ ability to address secondhand smoke exposure (SHSE) through three effective techniques to curb caregiver smoking: screening for SHSE, assisting with quitting through motivational interviewing and prescribing nicotine replacement therapy (NRT), and referring those who smoke to a quitline.

Despite the adverse health outcomes for children exposed to SHSE, resident training programs do not require training in smoking cessation. The purpose of this project was to evaluate whether a curriculum for teaching pediatric residents CEASE resulted in self-reported behavior change, increased knowledge, and improved self-efficacy with the subject matter.

METHODS
Physician champions at four University of California sites conducted regular one-hour didactic trainings on CEASE principles. At the end of the academic year in June 2019, pediatric residents were asked to complete a voluntary, online, retrospective Qualtrics survey to assess their behavior, knowledge, and self-efficacy around helping caregivers quit smoking.

To assess behavior, residents were asked to indicate the number of caregivers whom they had counseled to quit smoking, prescribed NRT for, and referred to the California Smokers’ Helpline. SHSE knowledge and self-efficacy at performing quitting interventions were separately assessed using Likert and numeric scales.

Trainee characteristics were described using counts, percentages, means, medians, standard deviations, and interquartile ranges. Groups were compared using the chi‐square and Wilcoxon rank‐sum tests. To determine if CEASE training was associated with increased likelihood of prescribing and counseling behaviors, we utilized logistic regression models that were adjusted for trainee postgraduate (PGY) year and clinical site.

RESULTS
111 of 284 total pediatric residents (39%) completed the survey; of the respondents, 53% recalled receiving CEASE training. Per self-report, CEASE-trained residents had significantly higher rates than untrained residents of: (1) counseling on smoking cessation, (2) referring to the smokers’ quitline, and (3) offering NRT prescriptions to 50% or more of their patients’ caregivers who smoked (Table 1a). The effect persisted after controlling for PGY year and clinical site for counseling patient caregivers who smoke (OR=4.5, p=0.009) and referring them to the smokers’ quitline (OR 3.60, p=0.007) in half or more of their encounters (Table 1b).

Among residents who indicated they had received CEASE training, there were significant increases in post-training knowledge and self-efficacy items, including knowledge of the health effects of second- and third-hand smoke exposure and comfort with talking to patient caregivers who smoke, using motivational interviewing with them, referring to the smokers’ quitline, and providing NRT prescriptions (Table 2).

CONCLUSION
CEASE-trained residents reported higher comfort levels in performing secondhand smoke screening, prescribing NRT, and referring caregivers who smoke to the quitline; trained residents also self-reported higher frequencies of these behaviors compared to the untrained residents.