Engaging in secondhand smoke reduction discussions with parents of hospitalized pediatric patients: A national survey of pediatric nurses in the United States Kevin Blaine a, ⁎, Jayne Rogers b , Jonathan P. Winickoff c , Sarah C. Oppenheimer a , Alison Timm d , Al Ozonoff b , Alan C. Geller a a Harvard School of Public Health, USA b Boston Children's Hospital, USA c Massachusetts General Hospital, USA d Boston University, USA abstract article info Available online 4 February 2014 Keywords: Tobacco smoke exposure Hospitalized child Nursing education Nursing pediatric Pediatric hospitals Objective: To identify individual- and system-level predictors and barriers associated with US pediatric nurses' routine counseling about child secondhand smoke exposure for parents of hospitalized children. Methods: In 2008, members of the Society of Pediatric Nurses completed a questionnaire assessing demo- graphic, hospital systems, and work attitudes related to the following outcomes: asking about child secondhand smoke exposure, informing about sources of secondhand smoke exposure, counseling about the dangers of secondhand smoke exposure, and advising a smoke-free home policy. Results: Of 1475 eligible nurses, 888 completed the survey. We found that 39% asked, 43% informed, 29% counseled, and 25% advised parents. Nurses working in hospitals with mandatory prompts in the medical record to assess child secondhand smoke exposure, the availability of written materials for parent smokers, and regular secondhand smoke counseling training for nurses had increased odds of routinely engaging parents in second- hand smoke reduction best practices. Nurses reported parents' resistance to discussions about smoking, short hospital stays, and non-standardized care as the most common barriers to counseling parents. Conclusion: System supports in hospitals significantly increases the odds of nurses engaging in child second- hand smoke reduction practices. Strengthening existing systems and introducing new policies are critical for nurses' engagement of parents in discussions about reducing child secondhand smoke exposure. © 2014 Elsevier Inc. All rights reserved. Introduction Secondhand smoke (SHS) causes excess morbidity and mortality in non-smokers, and there is no safe level of exposure (Office of Smoking and Health, 2006). Children who are exposed to SHS are at increased risk for developing asthma, Sudden Infant Death Syndrome, ear infec- tions, and respiratory infections (Office of Smoking and Health, 2006). Furthermore, children exposed to tobacco smoke are more likely to be hospitalized and absent from school (Stapleton et al., 2011). The American Academy of Pediatrics recommends that pediatricians assess patients' SHS exposure, and the Society of Pediatric Nurses (SPN), the largest organization of pediatric nurses, endorses a comprehensive SHS reduction plan that includes identifying and counseling parent smokers in hospitals that treat children. A child's hospitalization may represent a “teachable moment” given the parent's enhanced motivation to limit their child's exposure to SHS, helping to improve the health of their sick child (Winickoff et al., 2003). Policies and support systems in hospitals that capitalize on the teachable moment might provide a unique opportunity for parents to learn about the dangerous effects of SHS and receive free or low-cost resources to make a behavioral change that will significantly impact their child's health (Dohnke et al., 2012; McBride et al., 2003; Ralston and Roohi, 2008; Winickoff et al., 2003). Because many hospitals that treat children encourage family-centered care, nurses are in a unique position to offer counseling to parents during the child's hospitalization, which can help to support a child's overall health well after discharge. Based on the more than 6 million pediatric hospitalizations each year and a conserva- tive smoking rate of 20% for at least one smoking parent, changes in hos- pital systems have the potential to enable the easy identification and rapid triage of hundreds of thousands of parent smokers to SHS counsel- ing services, thus protecting the most vulnerable children from being exposed to tobacco smoke (Charles et al., 2012; Yu et al., 2011). Earlier, we reported the smoking cessation counseling practices of hospital-based pediatric nurses (Geller et al., 2011). Though cessation Preventive Medicine 62 (2014) 83–88 Abbreviations: NAA, nursing admission assessment; SHS, secondhand smoke; SPN, Society of Pediatric Nurses. ⁎ Corresponding author at: Division of General Pediatrics, Boston Children's Hospital, 21 Autumn St., 2 FL, 222, Boston, MA 02115, USA. E-mail address: kevin.blaine@childrens.harvard.edu (K. Blaine). 0091-7435/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ypmed.2014.01.021 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed