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Utilization of a Clinical Decision Support Tool to Reduce Child Tobacco Smoke Exposure in the Urgent Care Setting

Mahabee-Gittens, Esther Melinda MD, MS*; Merianos, Ashley L. PhD, CHES; Dexheimer, Judith W. PhD*‡; Meyers, Gabe T. MSW*; Stone, Lara MA*; Tabangin, Meredith MPH§; Khoury, Jane C. PhD§; Gordon, Judith S. PhD

doi: 10.1097/PEC.0000000000001646
Original Article: PDF Only

Background Clinical decision support systems (CDSS) may facilitate caregiver tobacco screening and counseling by pediatric urgent care (UC) nurses.

Objective This study aimed to assess the feasibility of a CDSS to address caregivers' tobacco use and child tobacco smoke exposure (TSE).

Methods We conducted a 3-month prospective study on caregivers screened using a CDSS. Nurses used the CDSS to advise, assess, and assist caregivers to quit. We assessed caregiver sociodemographics, smoking habits, and child TSE.

Results We screened 185 caregivers whose children were exposed to TSE for study inclusion; 155 (84%) met the eligibility criteria, and 149 (80.5%) were included in the study. Study nurses advised 35.2% of the caregivers to quit, assessed 35.9% for readiness to quit, and assisted 32.4%. Of the 149 participants, 83.1% were female; 47.0% were white and 45.6% African American; 84.6% had public insurance or were self-pay; 71.1% were highly nicotine dependent; 50.0% and 50.7% allowed smoking in the home and car, respectively; and 81.3% of children were biochemically confirmed to be exposed to tobacco smoke. At follow-up (86.6% retention), 58.9% reported quit attempts at 3 months. There was a significant decrease in nicotine dependence and a significant increase in motivation to quit. Self-reported quit rate was 7.8% at 3 months.

Conclusions An electronic health record–embedded CDSS was feasible to incorporate into busy UC nurses' workloads and was associated with encouraging changes in the smoking behavior of caregivers. More research on the use of CDSS to screen and counsel caregivers who smoke in the UC and other acute care settings is warranted.

From the *Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center;

School of Human Services, University of Cincinnati; Divisions of

Biomedical Informatics and

§Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and

College of Nursing, University of Arizona, Tucson, AZ.

Funding Source: This study was funded by the National Institutes of Health National Cancer Institute (grant no. R21CA184337).

Disclosure: The authors declare no conflict of interest.

Clinical Trial Registration: NCT02489708; registration date: May 28, 2015.

Reprints: E. Melinda Mahabee-Gittens, MD, MS, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH 45229 (e-mail:

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