Refer 2 Quit: Proactive Promotion of Tobacco Use Treatment for Household Members Who Smoke through Pediatric Primary Care

Tobacco use remains the leading preventable cause of disease and death in the US, and 40% of children are regularly exposed to the harms of secondhand smoke (SHS), most often from a household member who smokes. Pediatricians are uniquely positioned to help families to address smoking and protect children from SHS exposure, but appropriate treatments are rarely delivered to parents who smoke. Emerging clinical decision support (CDS) systems within electronic health records (EHRs), including those developed by this team, help pediatricians screen for SHS exposure, motivate parent treatment engagement, and prescribe and/or connect caregivers to tobacco interventions. Office-based approaches, however, focus only on caregivers attending clinic visits with their children, failing to reach additional household members who smoke, leaving many adults without access to evidence-based treatments and children continually exposed to detrimental effects of SHS. Thus, a major barrier to protecting children from SHS exposure and extending tobacco use treatment to adults who smoke is identifying an efficient and scalable method to engage all household members who smoke, not just parents who present to the pediatric clinic with the child. This proposal uses an innovative, multi-disciplinary research approach incorporating both population health and clinical informatics implementation strategies to overcome this barrier and systematically expand the reach of tobacco use treatment through pediatric healthcare settings. EHR-based informatics tools can efficiently identify additional household members who smoke and proactively offer tobacco treatment. Using a rigorous, 2-arm pragmatic randomized control trial within a large pediatric network comprising practices with high rates of Medicaid-insured children, we will compare a novel intervention using population health and clinical informatics implementation strategies vs. usual care to increase the reach and effectiveness of tobacco use treatments. We will use a Type 2 hybrid effectiveness-implementation design, measuring the clinical intervention's impact on priority outcomes and testing an implementation strategy. The specific aims are: Aim 1) To compare the reach of Refer2Quit - a proactive, population health and clinical informatics implementation intervention on tobacco use treatment engagement for household members who smoke vs. usual care; Aim 2) To compare the effectiveness of the Refer2Quit intervention for increasing quit rates among household members who smoke vs. usual care; and Aim 3) To study household member and pediatric patient characteristics that are associated with reach and effectiveness of Refer2Quit. This addresses a significant practice gap in the utilization of evidence-based treatments for tobacco. Leveraging the pediatric setting can increase access and use of evidence-based tobacco treatments. This proposal will yield a scalable strategy to address the impacts of tobacco use and SHS in families.