Reducing Secondhand Smoke Exposure in Children

Transcription

1 THE CLINICAL EFFORT AGAINST SECONDHAND SMOKE EXPOSURE Reducing Secondhand Smoke Exposure in Children Presented by: Jyothi Marbin, MD CTTS FAAP Cindy Nelson Purdy, PNP MPH

2 Disclosure First 5 California provides major funding for CEASE California. No one involved in the planning or presentation of this activity has any relevant financial relationships with a commercial interest to disclose.

3 Overview Impact & Prevalence of Tobacco Use The CEASE Model CEASE Dissemination

4 Comparative Causes of Annual Preventable Deaths in the US Suicide Alcohol Motor Homicide Drugs Obesity Smoking Vehicle

5 HYDROGEN CYANIDE CARBON MONOXIDE ARSENIC LEAD AMMONIA CADMIUM AND MORE

6 SIDS RSV Asthma Cognitive Issues Otitis Media ADHD Absenteeism Nicotine Addiction Cardiac Disease Cancer COPD Low BW Stillborn Nicotine Addiction

7 No safe level of SHS exposure for children Young children at increased risk

8 Cotinine levels highest for kids: Under 12 African American Living below poverty level

9 Middle/HS students living with a smoker 25-30% Highest smoking prevalence in 25-34yo Higher smoking prevalence among some Asian subgroups Smoking rates fall with increasing income/education levels

10 Thirdhand Smoke The residue remaining after a cigarette has been extinguished

11 The 3 R s of Third Hand Smoke The 3 R s: Thirdhand Smoke Remains Re-emitted Latest Research Links THS to: -damage to human DNA -elevated lipid levels and non alcoholic fatty liver disease in mice Reacts -poor wound healing in mice -hyperactivity in mice

12 What is CEASE? C Clinical E Effort A Against S Second Hand Smoke E Exposure

13 CEASE: Three Easy Steps Ask: Universal screening Flag the provider! Assist: Prescribe NRT Connect: CA Smokers Helpline

14 Pediatric Visit Creates a Teachable Moment for Smoking Cessation Parents see their child s health care provider more often than their own

15 Step One: Ask Does Johnny live with anyone who smokes cigarettes? SHS exposure as a vital sign Ask at EVERY visit MA flags chart for provider

16 Documenting Tobacco History

17 Step Two: Assist Use motivational interviewing techniques Offer nicotine replacement therapy (NRT) You can bill for these services: Level 4, code

18 Why Prescribe NRT? Covered by insurance Helps with dosing Provider mandate to the parent

19 Pediatric Providers Can Prescribe NRT to Parents The American Academy of Pediatrics advises that all clinicians be familiar with pharmaceutical options for smoking cessation and offer them to parents if needed. The American Medical Association supports efforts by any appropriately licensed health care professional to identify and treat tobacco dependence in any individual, in the various clinical contexts in which they are encountered

20 Now, Pharmacists Can Prescribe NRT

21 How to Prescribe NRT Replace nicotine from cigarettes 1 cigarette = 1 mg nicotine Forms of NRT Patches: Baseline level of nicotine 21 mg, 14mg, 7mg Gum: breakthrough cravings 4 mg Wean down over 3-4 months

22 NRT: Things to Know Ask about: Heart attack within the last 2 weeks Worsening CP or worsening arrythmia Severe skin condition (for patch) Signs of too much nicotine Nausea, diarrhea, vomiting Rapid heart beat Cold sweats Blurred vision Dizziness Headaches Drooling Pregnancy/lactation - use gum only

23 Preprinted Prescriptions A way to get around EHR prescribing challenges Provided in training toolkit

24 Insurance Coverage Helpline provides the patch to: Anyone with Medi-Cal Anyone with kids 0-5yo - starts 12/14 Private insurance plans vary Most cover NRT at least partially Medi-Cal plans differ by county Check Encourage smokers to call Helpline

25 Step Three: Connect California Smokers Helpline Web referral OR gold card Free nicotine patches for Medi-Cal members AND caregivers of kids 0-5 $20 gift card for Medi-Cal members who ask for it!

26 Step Three: Connect INSPIRE Cessation Network Group/individual counseling Provides NRT

27 Combination Therapy Works! Follow-up 6 months post smoking cessation <5% quit on their own 20% quit with counseling 20% quit with medication 30-40% quit with combination meds & counseling

28 Expansion of CEASE Pilot program in Northern CA: 2013 Funded by Pfizer/AAP Statewide Expansion:

29 The CEASE Training Package 3 Meetings Initial meeting with champion Second meeting to train staff Follow up phone call after 6 months CEASE Toolbox MOC Part 4

30 Results so far 24 trainings in NorCal 63 trainings in SoCal 279 Providers & staff trained 400+ Helpline referrals 39% clients contacted 73% agreed to counseling/services

31 Lessons Learned Engage support staff Use data from Helpline for feedback to sites Barriers to implementation: Limited time Insurance issues

32 Summary SHS & THS - big impact on children s health CEASE helps protect children from SHS and THS Pediatric providers (YOU!) can and should offer behavior and pharmaceutical support to parents who smoke

33 Thank You! Interested in learning more?