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March 2003

Caring for Parents vs Caring for Children: Is There a Difference?

Arch Pediatr Adolesc Med. 2003;157(3):221-222. doi:10.1001/archpedi.157.3.221

IN THIS ISSUE OF THE ARCHIVES, Curry et al1 present the results of a maternal smoking cessation randomized trial carried out in 4 Seattle, Wash, pediatric clinics that serve low-income children. The intervention included a motivational message by the pediatrician, a 10-minute motivational interview conducted by the clinic nurse or a research associate, a self-help guide to quitting smoking given to the mother, and as many as 3 telephone counseling calls during the following 3 months. In follow-up surveys conducted 12 months after enrollment, 13.5% of mothers in the intervention group reported not smoking during the previous 7 days compared with 6.9% of mothers in the control group. The authors state that "The results strengthen the evidence for expanding implementation of evidence-based clinical guidelines for smoking cessation into pediatric practice." Does this study provide sufficient evidence to support integrating maternal smoking cessation programs into pediatric practice? Does increasing the proportion of mothers who claim to have stopped smoking by 6.6% justify the widespread implementation of maternal smoking cessation programs involving the additional contact time during an office visit and as many as 3 telephone counseling calls during the following 3 months? Perhaps more importantly, how much time and effort should pediatricians be spending screening and counseling for parental conditions, such as smoking and depression? In considering these questions, we must understand the goals of pediatric preventive care and the boundary between caring for the child and the parents, have a prioritization process to determine which topics should be covered during a health supervision visit, establish the feasibility of integrating the intervention into the pediatric office setting in a cost-effective and beneficial manner, and realistically assess ways that pediatricians will be fairly paid for these activities.