Smoking cessation services Five minutes of brief smoking cessation advice by physicians could increase quit rates from about 5% at baseline to about 15% at follow-up (Folsom & Grimm, 1987; Janz et al., 1987; Russell, Wilson, Taylor, & Baker, 1979). The current U.S. policies promote the ��five A’s�� (ask, advise, assess, assist, and arrange) and encouraging physicians to ask and advise their patients figure 2 not to smoke. While more physicians are delivering brief advice, more research is needed to learn how to promote such advice from all health care providers. If all providers employed brief advice, the cumulative effects might be significant. The most affordable interventions are likely to be brief advice, but they tend to be the least powerful.

A subset of clinicians��for example, preventive medicine specialists��might offer more intensive interventions. This might include medications such as nicotine replacement therapy and Zyban for assisting with cessation. Some services are a good fit for this type of care. Families returning regularly for well-baby visits might be provided intensive clinical services by the pediatrician or assistants using tailored counseling, feedback, and incentives. Interventions could also provide financial and social contingencies to motivate cessation. Financial contingencies include vouchers��for example, $50/month to pregnant women for quitting smoking (Donatelle, Prows, Champeau, & Hudson, 2000), or $100 to employees for completing a smoking cessation program (Volpp et al., 2009).

Social contingencies include social support provided by a nonsmoker who has a close relationship with the smoker (Donatelle et al.). More research is needed in these promising areas. ��Minimal interventions�� for SHSe Minimal interventions for SHSe have not yet been tested. In a randomized trial with more than 2,000 families, Wall, Severson, Andrews, Lichtenstein, and Zoref (1995) provided minimal counseling and video materials for maternal smokers and explained that quitting would protect their child from SHSe and its health consequences. Parents were shown a video at the first well-baby visit and were provided written materials and brief advice from the pediatrician at well-baby visits at 2 weeks and 2, 4, and 6 months. This resulted in 7-day abstinence of 2.7% in control families and 5.9% in experimental families at 6 months.

However, the study focused on smoking cessation outcomes. No SHSe measures were obtained to determine whether changes in SHSe were obtained in homes, or whether parents smoked outside. Had this study included measures of SHSe, it might have demonstrated a direct effect on SHSe. Future studies should determine the likely effect of brief and low-intensity interventions for SHSe that could be distributed across many Carfilzomib clinical services.