Assessment of the Smoke Free Families Tobacco Screening, Counseling, and Referral Program in Pediatric Primary Care Practices.

OBJECTIVES: The Smoke Free Families (SFF) program trained pediatric providers to use a SFF tool during well-child visits (WCVs) of infants ≤12 months to "Ask" caregivers about tobacco use, "Advise" smokers to quit, and "Refer" smokers to cessation services (AAR). The primary objectives were to assess the prevalence and changes in caregiver tobacco use after being screened and counseled by providers using the SFF tool. A secondary objective was to examine providers' AAR behavior facilitated by using the SFF tool.

METHODS: Pediatric practices participated in one of three 6-9-month SFF program waves. Over the three waves, all initial SFF tools completed on caregivers during their infant's WCV were evaluated for caregiver and household tobacco use and providers' AAR rates. An infant's first and next WCV were matched to determine changes in caregiver tobacco product use.

RESULTS: In total, the SFF tool was completed at 19,976 WCVs; 2081 (18.8%) infants were exposed to tobacco smoke. A total of 834 (74.1%) caregivers who smoked received counseling: 786 (69.9%) were advised to quit, 700(62.2%) were given cessation resources, and 198 (17.6%) were referred to the Quitline. In total, 230 (27.6%) of caregivers who smoked had a second visit; 58 (25.2%) self-reported that they quit using tobacco. Among cigarette users (n=183), 89 (48.6%) reported that they used fewer cigarettes or quit at their infants' second WCV.

CONCLUSIONS: Systematic use of the SFF AAR tool during infants' WCVs could improve the health of caregivers and children, resulting in decreases in tobacco-related morbidity.

WHAT'S NEW: Pediatric providers incorporated a tool into primary care visits which prompted them to "Ask" about tobacco use, "Advise" caregivers to quit, and "Refer" and provide cessation services/resources (AAR). Routine implementation of AAR could decrease tobacco-related morbidity in caregivers and children.