O3249: Automated Treatment Support for Parental Tobacco Use: The eCEASE RCT

Background: Delivering tobacco use treatment routinely to parents in pediatric settings is critical for improving the nation's overall health. We aimed to automate household tobacco use intervention in child healthcare delivery via the electronic health record (EHR).

Methods: An NIH-funded cluster-randomized controlled trial, conducted from July 2021 to August 2023.Twelve pediatric primary care practices in Children’s Hospital of Philadelphia network were grouped into pairs by Medicaid rate and practice size. Six pairs were chosen at random, and within each pair the intervention and usual-care control practices were randomly assigned. This study was designed to have 80% power to detect a between-arm difference in quit rates, at 0.05 two-tailed significance level. Parents or legal guardians who used combusted tobacco products, even a puff in the past 7 days and were present at the child’s pediatric visit were eligible to be enrolled in the study. The intervention was a custom-programmed, scalable EHR-integrated platform that screens households for tobacco-use and offers automated Nicotine replacement treatment (NRT) home delivery, enrollment in the state Quitline and SmokefreeTXT programs, as well as a prompt to the clinician to reinforce messaging and treatment. The intervention also offered the parent an opportunity to opt-in for navigator cessation support. We assessed receipt of treatment in the two arms. We also measured the intervention’s effect on tobacco-use behavior by comparing change in smoking quantity, frequency and quit attempts from baseline to one-year follow-up using difference in difference analyses. Parental combusted tobacco quit rate at 1-year (Primary outcome) was defined as parents reporting no combustible tobacco use in the past 7 days, confirmed by salivary cotinine and/or carbon monoxide breath test.

Results: Of the 817 smoking parents enrolled (Table 1), 367 (89.7%) in the intervention arm and 368 (90.2%) in the control arm completed the 12-month follow-up survey. Among those who completed the follow-up, 193 (52.6%) vs. 44 (12%) reported receiving NRT at a CHOP practice in the intervention and control arm respectively. Additionally, 66 (17.9%) vs. 6 (1.6%) reported talking to someone at the quitline and 46 (12.5%) vs. ( < 1%) reported using SmokefreeTXT in the intervention and control arm respectively. The average number of cigarettes smoked per day reduced more in the intervention arm (1.91 cigarettes/day) compared to the control arm (0.27 cigarettes/day). We also observed significant benefits of the intervention on the number of daily smokers and quit attempts (Table 2). Biochemically confirmed quit rate was 34 (8.33%) and 26 (6.36%) in the intervention and control arm respectively (OR: 1.34 (95% CI: 0.79, 2.29, P=0.28).

Conclusion: Automated parental tobacco use intervention in pediatric primary care practices significantly increased treatment delivery and reduced cigarette consumption. The quit rate in the intervention arm compared to the control arm was slightly, but not significantly, higher.