P3.Q322: Refer2Quit: A Proactive, Tailored, Population Health Approach for Tobacco Treatment for Parent Smokers through a Pediatric Care Network

Background: Pediatricians are uniquely positioned to reduce exposure to secondhand smoke by helping parents who smoke quit. However, appropriate tobacco treatments are rarely provided to parents who smoke and are almost never provided to household members who smoke and who are not present at the child’s healthcare visit. We evaluated a clinical decision support (CDS) system that leverages the pediatric preventive visit to identify household members who smoke and remotely engage them in tobacco use treatment.

Methods: We conducted a single-arm prospective study with parents/caregivers who smoke, recruited through 1 high-volume (~30,000 patients) pediatric primary care practice serving a patient population with high rates of adult smoking (25-30%) and medically underserved (81% children with Medicaid insurance). We created a CDS system that, as part of routine preventive visits, screens parents for individual tobacco use, automates connection to treatment, and prompts these parents to refer other household members who smoke to our study team. Within 1-2 weeks of the referral, the study team reached out to consent referred household members and connect them with evidence-based tobacco treatments: nicotine replacement therapy (NRT), quitline (counseling via phone), and/or smokefreeTXT (counseling via text). Participants completed a demographic and system improvement survey (questions about satisfaction with this approach, barriers to treatment, and suggested improvements) at baseline. Primary outcomes included feasibility (percentage of identified household members who smoke who are referred for tobacco treatment), acceptability and clinical impact (percentage of referred individuals who accept treatment). Tobacco treatments used and smoking cessation (reporting no combustible tobacco use in the past 7 days) were assessed via 1-month follow-up survey (collected via phone or text).

Results: From April 2022-March 2024, 3109 pediatric patients had additional household members who smoke. For feasibility, 289 (9.3%) were referred to treatment, and 283 were successfully contacted by the team. Of those referred (n=289), 83 (29%) accepted treatment and enrolled. Of participants enrolled, the majority were male (60%), a parent to the child (71%), had a high school education or less (58%), had Medicaid or no health insurance (73%), and exhibited very low (54%) to low (37%) nicotine dependence (via the Fagerstrom Test for Nicotine Dependence, see Table 1 for demographics). All participants found this referral to treatment approach acceptable. For treatment accepted, 77 out of 83 accepted NRT (93%), 58 (70%) accepted the quitline, and 53 (64%) accepted SmokefreeTXT. For 1-month follow-up, 54 (65%) completed the survey; 42 reported using their accepted tobacco treatment, and 12 reported smoking cessation.

Conclusion: A pilot approach combining population health and clinical informatics that systematically identifies all household tobacco users and engages them in evidence-based care is feasible, acceptable, and potentially impacts clinical care. An R01-level clinical trial is underway to evaluate this novel approach to promote smoking cessation.