Solving The Puzzle — Clinicians

This kit is designed to educate clinicians about the unique concerns facing children and families within the larger realm of tobacco control. These presentations can be used for Grand Rounds or noon hour presentations, and include notes and references with the slides.

• Secondhand Smoke Exposure — The Pediatrician's Role
  • Slides 4 and 12 offer the opportunity to fill in local statistics and information
• Promoting Smoke-free Families
  • Note: Slides 4 and 36 offer the opportunity to fill in local statistics and information
• Systems Change: From a “Good Idea” to a Practice Culture
  • Note: To view an example of a program discussed in this presentation, view the Systems Change section below
• Special populations: Tobacco Use

These videos and Web sites may assist you and your staff in gaining more education in tobacco control or earning Continuing Medical Education (CME) credits.

Videos

• Creating a Smoke-free Household (mpg, 78.7 MB)
• Motivational Interviewing (mpg, 57.4MB)
• Prevention and Adolescents (mpg, 46.8MB)
• Ready to Quit (mpg, 97.2MB)

Web Sites

• AAP Richmond Center CME Opportunities
• AAP PediaLink CME Module — Help Every Family Quit Smoking
• AAP Education in Quality Improvement for Pediatric Practice (EQIPP) Module — Eliminate Tobacco Use and Exposure
• Johns Hopkins University Global Tobacco Control
• University of Wisconsin Center for Tobacco Research and Intervention
• Tobacco CME

Find useful resources to assist in research or in formulating presentations.

• AAP Tobacco Policy Statement
  In November 2009, the AAP released a policy statement titled "Tobacco Use: A Pediatric Disease." This policy statement is a comprehensive, straightforward approach to changing the current climate surrounding tobacco use and smoke exposure in children.
• Technical Report — Secondhand and Prenatal Tobacco Smoke Exposure
• Technical Report — Tobacco as a Substance of Abuse
• Appendix — Diseases and Other Adverse Health Events with Which Secondhand or Prenatal Tobacco Smoke Exposure Has Been Associated
• Appendix — General Tobacco Resources by Category
• Appendix — Resources for Smoke Free Multi-unit Housing
• American Medical Association Policy H-490.917: Physician Responsibilities for Tobacco Cessation
  The American Medical Association takes a strong stand against smoking and favors aggressively pursuing all avenues of educating the general public on the hazards of using tobacco products, as well as the continuing high costs of this serious but preventable problem.

• Beliefs About the Health Effects of "Thirdhand" Smoke and Home Smoking Bans
  This article, written by AAP Richmond Center researchers, discusses thirdhand tobacco smoke and how this impacts home smoking bans.
• Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction. Institute of Medicine Report, 2001
  This report looks at the types of products that could reduce harm from the effects of tobacco and reviews the available evidence for their impact on various forms of cancer and other major ailments. It also recommends approaches to governing these products and tracking their public health effects.
• Public Health Service Guidelines Treating Tobacco Use and Dependence 2008 Update
  This evidence-based, updated guideline provides specific recommendations regarding brief and intensive tobacco cessation interventions as well as system-level changes designed to promote the assessment and treatment of tobacco use.

• Surgeon General Reports on Tobacco from 1994-2010
  Topics covered in these reports cover different populations at risk for tobacco use, prevention, and health effects.
  • 2012: Preventing Tobacco Use among Youth and Young Adults
  • 2010: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease
  • 2006: The Health Consequences of Involuntary Exposure to Tobacco Smoke; Children and Secondhand Smoke Exposure
  • 2004: The Health Consequences of Smoking
  • 2001: Women and Smoking
  • 2000: Reducing Tobacco Use
  • 1998: Tobacco Use Among U.S. Racial/Ethnic Minority Groups
  • 1994: Preventing Tobacco Use Among Young People

For Surgeon General reports from 1964-1992, please visit the Reports of the Surgeon General Web site.

There are a number of ways to integrate a true systems change. Listed below are resources that offer tips and strategies to incorporate a consistent way to address tobacco control during patient visits.

• CEASE
  The Clinical Effort Against Secondhand Smoke Exposure (CEASE) program was developed to help child health care clinicians adjust their office setting to address parental tobacco use in an Ask, Advise, Refer approach. Below are items that will help your practice learn how to implement the program, collect patient information, identify staff responsibilities, and promote your cause.
  • CEASE Training Manual
  • CEASE Action Sheet
  • CEASE Implementation Guide
  • CEASE materials
  • CEASE State-specific materials
• Addressing Family Smoking in Child Health Care Settings
  This article discusses the utilization of the CEASE program to implement evidence-based tobacco control practices with family members into pediatric office visits.
• Systems Change: Treating Tobacco Use and Dependence, US Department of Health and Human Services
  The 2008 Update to the Clinical Practice Guideline offers this evidenced-based guideline for clinicians to use when treating patients who use tobacco.
• Treating Tobacco Use and Dependence—A Systems Approach
  The University of Arkansas Medical School released this guide to systems change, as well as approaches to implementing changes, and strategies for action.

When a clinician spends time discussing tobacco with a patient or family, it is important to get paid for the time spent by coding correctly. Below are some tools that can help.

• AAP Tobacco Coding Fact Sheet
  This resource is a helpful tool for pediatric health care providers and staff to ensure appropriate coding for their work in tobacco prevention and control counseling. Created by American Academy of Pediatrics coding experts, this fact sheet offers CPT codes for inpatient and outpatient settings, as well as ICD-9-CM codes for medical diagnoses, comorbid diseases, and related supplemental codes. At the end of the coding section are six short scenarios with applicable codes and diagnoses.
• How to get Paid for Smoking Cessation Counseling
  From the February 2012 edition of AAP News, this article discusses coding procedures for pediatric patients as well as their family members.
• Coding Corner — CPT Codes
  This edition of the AAP News Coding Corner discusses behavioral change intervention codes, as covered in the 2008 Current Procedural Terminology (CPT) manual.
• Coding Corner — Q&A
  In this edition of Coding Corner in the January 2010 issue of AAP News, covers different scenarios commonly found in pediatric practice, and provides clarification on which codes should be used in which situations.
• Reimbursement for Smoking Cessation Therapy
  In this guide created by Physician Assisted Cessation Therapy (PACT), information is given to clinicians on how to obtain reimbursement for smoking cessation treatments and counseling. The guide also assists in navigating around coverage deficiencies.
• The Power of Paperwork: How Philip Morris Neutralized the Medical Code for Secondhand Smoke
  This article gives background to smoking cessation coding by taking a closer look at the code created in 1994 for smoking cessation therapy. The code became invalid as a result of a two million dollar campaign by Phillip Morris that included lobbying, Paperwork Reduction Act challenges, and the strong support for other, less comprehensive codes.