Smoke Free for Families: A Three-year QI Experience to Reduce Infant Tobacco Smoke Exposure After Counseling from Their Primary Care Provider

Purpose/Objectives: Although many pregnant mothers quit smoking, 70-80% relapse in the postpartum period. Pediatricians have an opportunity to decrease child tobacco smoke exposure (TSE) by counseling caregivers. The Smoke Free Families Quality Improvement (QI) program works with pediatric providers to facilitate TSE screening and provide smoking cessation resources to caregivers with children ≤1 year of age during well-child visits (WCVs). Following families at subsequent WCVs enables providers to determine self-reported changes caregivers have made.

Design/Methods: Pediatric practices, recruited from the Ohio Chapter of the American Academy of Pediatrics’ database self-selected to participate in one of three 6–9-month QI sessions between 2018-2020. A TSE screening tool with smoking cessation talking points and resources was to be used by providers at every WCV for children ≤ 1 year old. The tool assessed caregiver demographics, tobacco use, and child TSE exposure and whether the provider delivered counseling. An infant’s first and next WCV (at least 7 days later) with the same caregiver were matched to determine changes in child TSE patterns after provider counseling.

Results: During the three project waves, 48 practices (184 providers) participated. A total of 20,413 screens (Wave 1–7703, 2–4640, 3 – 8070) were completed with 11,052 infants (Wave 1–3964, 2–2769, 3–4319). Most caregivers self-identified their baby’s race/ethnicity as white (Wave 1–2685 (67.7%); Wave 2–1902 (68.7%); Wave 3–3312 (76.7%)) and had public insurance (Wave 1–1701 (42.9%); Wave 2–1171 (42.3%); Wave 3–2078 (48.1%)). The mean age (SD) of infants per wave was 4.1 (4.1), 4.5 (4.0), and 4.3 (4.0) months at the initial WCV.
Caregiver tobacco use and child TSE was reported in 1124 (10.2%) of the initial WCVs (Wave 1–322 (8.1%); Wave 2–271 (9.8%); Wave 3–531 (12.3%)), and practices reported providing counseling to 829 (73.8%) of caregivers during initial WCVs (Wave 1–261 (81.1%); Wave 2–190 (70.1%); Wave 3–378 (71.2%)).
Among caregivers who reported smoking at the initial visit, had follow-up and received counseling, 90 (50.6%) self-reported reduced infant TSE by smoking fewer cigarettes and/or vaping less or by quitting at follow-up (Wave 1–37 (54.4%); Wave 2–14 (48.3%); Wave 3–39 (48.1%)). In particular, 44 (24.7%) of caregivers who received counseling self-reported quitting at follow-up (Wave 1–19 (27.9%); Wave 2–9 (31.0%); Wave 3–16 (19.8%).

Conclusion/Discussion: Pediatric providers were able to incorporate a TSE screening and smoking cessation tool into WCVs. Many caregivers reported a reduction in TSE exposure and/or quit smoking after counseling at their next WCV. We expect that continued implementation of this QI will reduce TSE in infants.