Original Publication
Open Access

Child Tobacco Smoke Exposure: Interventions for Busy Physicians

Published: February 8, 2016 | 10.15766/mep_2374-8265.10344

Included in this publication:

  • Child TSE Clinical Cases.pdf
  • Child TSE Presentation.pptx
  • Child TSE Speaker's Notes.pdf
  • Frequently Asked Questions.docx
  • Instructor's Guide.docx
  • Provider Assessment Survey.pdf
  • Suggested Readings & Resources.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: Smoking and tobacco smoke exposure (TSE) leads to 480,000 deaths and over $289 billion in medical costs and lost productivity annually. Among U.S. children, 44% are affected by TSE. TSE increases the frequency of low birth weight, sudden infant death syndrome, child ear infections, bronchiolitis, asthma, atherosclerosis, and neurobehavioral problems in children. Although parent motivation to quit smoking increases in healthcare settings, TSE interventions are delivered infrequently. Many pediatric residency programs provide no formal training in parent TSE interventions. With few exceptions, education resources for parent TSE interventions often omit participant-reported TSE intervention practice patterns, participant barriers, and physician workflow and are not peer reviewed. Methods: This module is designed to address these gaps and improve delivery of TSE interventions to parents who smoke. The training module uses small-group training sessions and the evidence-based Ask, Advise, Refer strategy for smoking cessation to: provide training in evidence-based screening for child TSE, provide parent smoking cessation advice, and use referrals to evidence-based smoking cessation resources. Results: The training module was implemented with 42 pediatricians at 10 pediatric practices in Utah. The included provider assessment tool was completed by 60% of participants prior to receiving the training module. Posttraining responses to the provider assessment tool indicated that implementation of the training module met the learning objectives for pediatrician knowledge and practice related to TSE and TSE interventions. Discussion: Following the training module, 47% of physicians reported a high level of interest in maintenance of certification for TSE interventions. Our results suggest that implementation of the training module may help improve TSE intervention practices that support parent smoking cessation. Posttraining improvements in participant-reported practice patterns suggest that this training module has significant potential for changing provider practices.

Educational Objectives

After completing the training module, participants will be able to:

  1. Understand the burden of tobacco smoke exposure (TSE) on child health and the impact of physician TSE interventions on parent smoking.
  2. Use evidence-based questions in routine clinical practice to screen for child TSE as a common, preventable risk factor for poor child health outcomes.
  3. Deliver brief, evidence-based TSE interventions using the Ask, Advise, Refer strategy in routine clinical practice to support parent smoking cessation by providing advice for smoking cessation, recommending nicotine replacement therapy, and referring to Quitline telephone counseling.
  4. Use motivational interviewing tools in routine clinical practice to deliver brief TSE interventions to support parent smoking cessation.

Author Information

  • Kevin Nelson, MD, PhD: University of Utah School of Medicine
  • Kasinda Goodwin: University of Utah School of Medicine
  • Rachel State, MD, MPH: University of Utah School of Medicine
  • Wendy Hobson-Rohrer, MD, MSPH, FAAP: University of Utah School of Medicine

None to report.

None to report.


  1. Cabana MD, Ebel BE, Cooper-Patrick L, Powe NR, Rubin HR, Rand CS. Barriers pediatricians face when using asthma practice guidelines. Arch Pediatr Adolesc Med. 2000;154(7):685-693.http://dx.doi.org/10.1001/archpedi.154.7.685
  2. Cabana MD, Rand C, Slish K, Nan B, Davis MM, Clark N. Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking. Pediatrics. 2004;113(1):78-81.
  3. Collins BN, Levin KP, Bryant-Stephens T. Pediatricians’ practices and attitudes about environmental tobacco smoke and parental smoking. J Pediatr. 2007;150(5):547-552.http://dx.doi.org/10.1016/j.jpeds.2007.01.006
  4. Davis D, O’Brien MA, Freemantle N, et al. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282(9):867-874.http://dx.doi.org/10.1001/jama.282.9.867
  5. Farber HJ, Groner J, Walley S, Nelson KE; Section on Tobacco Control. Protecting children from tobacco, nicotine, and tobacco smoke. Pediatrics. 2015;136(5):e1439-e1467. http://dx.doi.org/10.1542/peds.2015-3110
  6. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service; 2000.
  7. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service; 2008.
  8. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Dept. of Health and Human Services; 2014.
  9. Hymowitz N, Schwab JV. Pediatric Residency Training Director Tobacco Survey II. Pediatrics. 2012;130(4):712-716.http://dx.doi.org/10.1542/peds.2011-3570
  10. Jamal A, Agaku IT, O’Connor E, King BA, Kenemer JB, Neff L. Current cigarette smoking among adults—United States, 2005-2013. MMWR Morb Mortal Wkly Rep. 2014;63(47):1108-1112. 
  11. Kit BK, Simon AE, Brody DJ, Akinbami LJ. US prevalence and trends in tobacco smoke exposure among children and adolescents with asthma. Pediatrics. 2013;131(3):407-414. http://dx.doi.org/10.1542/peds.2012-2328
  12. Nelson KE, Hersh AL, Nkoy FL, Maselli JH, Srivastava R, Cabana MD. Primary care physician smoking screening and counseling for patients with chronic disease. Prev Med. 2015;71:77-82.http://dx.doi.org/10.1016/j.ypmed.2014.11.010
  13. Quinto KB, Kit BK, Lukacs SL, Akinbami LJ. Environmental tobacco smoke exposure in children aged 3-19 years with and without asthma in the United States, 1999-2010. NCHS Data Brief. 2013;126:1-8. 
  14. Ralston S, Grohman C, Word D, Williams J. A randomized trial of a brief intervention to promote smoking cessation for parents during child hospitalization. Pediatr Pulmonol. 2013;48(6):608-613.http://dx.doi.org/10.1002/ppul.22614
  15. Rosen LJ, Noach MB, Winickoff JP, Hovell MF. Parental smoking cessation to protect young children: a systematic review and meta-analysis. Pediatrics. 2012;129(1):141-152. http://dx.doi.org/10.1542/peds.2010-3209
  16. Singh GK, Siahpush M, Kogan MD. Disparities in children’s exposure to environmental tobacco smoke in the United States, 2007. Pediatrics. 2010;126(1):4-13. http://dx.doi.org/10.1542/peds.2009-2744
  17. Winickoff JP, Hillis VJ, Palfrey JS, Perrin JM, Rigotti NA. A smoking cessation intervention for parents of children who are hospitalized for respiratory illness: the Stop Tobacco Outreach Program. Pediatrics. 2003;111(1):140-145.http://dx.doi.org/10.1542/peds.111.1.140
  18. Winickoff JP, Nabi-Burza E, Chang Y, et al. Sustainability of a parental tobacco control intervention in pediatric practice. Pediatrics. 2014;134(5):933-941. http://dx.doi.org/10.1542/peds.2014-0639


Nelson K, Goodwin K, State R, Hobson-Rohrer W. Child tobacco smoke exposure: interventions for busy physicians. MedEdPORTAL. 2016;12:10344. https://doi.org/10.15766/mep_2374-8265.10344