467 - Promoting smoking cessation in the primary care of infants: Addressable Barriers

More than 50% of mothers stop smoking during pregnancy; however, over 80% resume within 1 year after delivery. Pediatric care of infants, with frequent well-child visits, provides an opportunity to intervene during this critical period.

Objective: To investigate current practices, barriers to and facilitators of implementation of core components of smoking cessation interventions for infant caregivers in a general pediatric practice.

Design/Methods: Cross-sectional study of pediatric providers (physicians (MD), registered nurses, behavioral health specialists and advanced practice providers (APP)) in a newborn nursery and a federally qualified health center who completed an online survey reporting demographic characteristics and clinical practices, training, and self-efficacy in provision of key components of smoking cessation support for caregivers of infants (screening, counseling, referring (to smoking cessation program or quitline (SCP)), and prescribing medication such as nicotine replacement therapy). We used chi-square tests to assess univariable associations.

Results: Among 186 eligible individuals, 28% responded (n=51; 88.2% prescribing providers (APP/MD), 54.9% age 25-34 years, 70.6% women, 33.3% in practice 6+ years). Respondents reported often/almost always screening (76.5%) and counseling (64.7%) caregivers about tobacco use; however, fewer often/almost always referred to an SCP (15.7%) or recommended or prescribed smoking cessation medication (21.6% and 13.7%, respectively). Regarding training, 82.4% reported training in screening, 66.7% in counseling, 52.9% in referring, 39.2% in recommending medication and 21.6% in prescribing medication. When asked about confidence in each domain, 92.2% somewhat/strongly agreed with having confidence in screening but only 29.4% somewhat/strongly agreed with having confidence in ability to refer to an SCP (29.4%), or to recommend (13.7%) or prescribe (7.8%) medication. Those who frequently prescribed smoking cessation medication were more likely to report training for prescribing smoking cessation medication (85.7% vs 11.4%, p< 0.001) and to report confidence in prescribing medication (75.0% vs 14.3%, p=0.004) compared to infrequent prescribers.

Conclusion(s): Although most pediatric providers received training in smoking cessation counseling, few are trained to refer to SCPs or to offer smoking cessation medications. Training in smoking cessation medications was associated with higher reported confidence and likelihood of prescribing smoking cessation medications for caregivers of infants.