Opportunistic Provision of Smoking Cessation Support at Children’s Emergency Department, Starship, Auckland City Hospital.

Abstract

Aims: To investigate if the Children’s Emergency Department (CED) represents an acceptable venue to offer opportunistic cessation advice and support to parents who smoke. Methods: A cross-sectional survey was conducted using a semi-structured, face-to-face interview and questionnaire. Between July and August, 2013, a purposive sample of parents who smoke, presenting to CED with a child aged between 1 and 5 years were recruited at Starship CED, a large urban tertiary children’s hospital in Auckland, New Zealand. Parents were asked if CED was an appropriate setting to offer cessation advice and support when they presented with their sick child. Information was also sought about the child’s secondhand smoke (SHS) exposure, the parent’s previous experiences with cessation support, and what a preferred intervention would be, if one was offered at CED. Findings: Of 166 parents approached, 33 parents smoked and 30 agreed to participate in the survey. Of these, 16 accompanied children presenting with a breathing-related illness. Most parents (83%, n = 25) believe CED is an acceptable site for opportunistic cessation support. Irrespective of their intention to stop smoking, parents are interested in understanding ways they can reduce their child’s exposure to SHS when they come to CED. Parents widely acknowledged tobacco smoke is harmful to their child’s health (97%, n = 29) but only 30%, (n = 9), believed SHS played a role in their child’s visit to CED. Pacific parents were overrepresented (47%, n = 14) and had the most children (63%, n = 10) presenting for a breathing-related illness across ethnic groups. Conclusions: Using CED as an intervention point to provide advice and support is acceptable to parents who present with their sick child. Parents expect to have a dialogue with clinicians about this and are open to receiving opportunistic support. Children with acute respiratory illness (ARI) are especially at risk of the adverse effects of SHS exposure and reducing their exposure needs particular focus. Recommendations: Practical strategies to assist parents to stop smoking when they present at CED include immediate access to nicotine replacement therapy (NRT). Clinicians may need support to confidently engage in discussions in CED to assist parents to stop smoking but this is vital as many parents may not understand the link between SHS and ARI. Specific focus may be required for Pacific parents who were over-represented in this study.