ED Tapped for Second-Hand Smoke Exposure Program

The Emergency Department (ED) has been selected to participate in a pilot program focused on reducing second-hand smoke affects for children. For seven months starting in March, patients seen in the ED will be evaluated for possible exposure.

"As a primary care center for many of our patients, the ED was the ideal setting to implement this pilot because we will be able to evaluate a large, diverse population in a short amount of time," explained Diane Herrick, RRT-NPS, AC, program coordinator, second-hand smoke initiative and asthma management program. "Statistics show that 40% of children who appear in pediatric emergency departments have been exposed. We estimate that we will reach at least 400 children per week."

When Herrick and Keith Cavanaugh, MD, a Board-certified pediatric pulmonologist, began planning the program, they surveyed 2,000 physicians, registered nurses and respiratory therapists on their level of interest in addressing issue.

"We found that there's a discomfort; they were motivated, but not quite comfortable with providing intervention," explained Herrick. Both Herrick and Dr. Cavanaugh set out to develop ways to keep evaluation, intervention and referral as simple as possible.

In 2005, Dr. Cavanaugh, the program's principal investigator, received approval and a $97,000 grant from the State Tobacco Education Prevention Partnership to implement the pilot, which is based on a similar cessation program for adults. For the 2006-2007 year, Children's received an $188,000 continuation grant.

Moving forward, Dr. Cavanaugh and Herrick devised a brochure to help ED staff identify whether it was a caregiver or a parent who might be exposing the child to second-hand smoke.

"During triage, the adults accompanying the patient will be asked if anyone who cares for child smokes," explained Herrick. "After answering, the family takes the form to the exam room while staff determines the most consistent and effective provider to do the intervention."

The brochure's traffic light graphic presents to the recipient the question, "how ready and willing are you to stop smoking?"

"Intervention is then based on the feedback provided," explained Dr. Cavanaugh. "If they check red, we know they are not ready to quit, but we advise staff to emphasize exposure reduction. The message is simple: Prevent exposure by smoking outside the house or car. Simply doing so greatly reduces a child's exposure to second-hand smoke."

"However, if they check green, we jump on the cessation opportunity," added Herrick.

After the intervention, staff offers the recipient information about Quitline, a free and confidential smoking cessation counseling service. Recipients may also request that a Quitline representative contact them.

"Quitline is by far, the most evidence-based, successful program to date," added Herrick.

Throughout the pilot program, Herrick and Dr. Cavanaugh will track the volume of calls Quitline receives from Children's visitors. In addition, three weeks after the intervention, Children's will survey the recipients to evaluate their level of acceptance of the intervention, if they recall receiving the paperwork, and most importantly, if they changed their behavior.

"This is an opportunity for TCH to take the lead in both implementing and evaluating a system that emphasizes second-hand smoke exposure reduction," said Herrick. "What we hope is that this can then become policy throughout TCH and within other community settings."

For more about Quitline, log onto http://10.tobaccofreecolorado.com/