Open Access Open Badges Research article

Distance-based training in two community health centers to address tobacco smoke exposure of children

Bethany Hipple13, Emara Nabi-Burza13, Nicole Hall13, Susan Regan3 and Jonathan P Winickoff123*

Author Affiliations

1 Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, 50 Staniford Street Suite 901, Boston, MA 02144, USA

2 AAP Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, IL, USA

3 Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA

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BMC Pediatrics 2013, 13:56  doi:10.1186/1471-2431-13-56

Published: 17 April 2013



The CEASE (Clinical Effort Against Secondhand Smoke Exposure) intervention was developed to help pediatricians routinely and effectively address the harms of family smoking behaviors. Based on paper versions of CEASE, we partnered with the American Academy of Pediatrics’ online education department and developed a completely distance-based training, including an online CME training, handouts and education materials for families, and phone and email support.


The pediatric offices of two low income health clinics with primarily Medicaid populations were selected for the study. Pre and post intervention data by survey of the parents was collected in both practices (Practice 1 n = 470; Practice 2 n = 177). The primary outcome for this study was a comparison of rates of clinician’s asking and advising parents about smoking and smoke-free home and cars.


Exit surveys of parents revealed statistically significant increases in rates of clinicians asking about parental smoking (22% vs. 41%), smoke-free rules (25% vs. 44%), and asking about other smoking household members (26% vs. 48%).


Through a completely distance based intervention, we were able to train pediatricians who see low income children to ask parents about smoking, smoke-free home and car rules, and whether other household members smoke. Implementing a system to routinely ask about family tobacco use and smoke-free home and car rules is a first step to effectively addressing tobacco in a pediatric office setting. By knowing which family members use tobacco, pediatricians can take the next steps to help families become completely tobacco-free.

Trial registration

Clinical trials number: NCT01087177

Tobacco smoke exposure; Secondhand smoke; Tobacco control; Online education; Community health centers; Parental smoking; Tobacco cessation