Refer2Quit: A pilot referral approach to promote treatment for parents who smoke tobacco through pediatric primary care.

Objective: Evidence-based tobacco treatments are rarely provided to household members who smoke but do not attend a child's pediatric visit. This pilot study evaluated an electronic health record (EHR)-linked intervention leveraging pediatric visits to identify and engage household members who smoke tobacco in treatment remotely. Methods: We conducted a single-arm prospective study with household members who smoke at a high-volume pediatric primary care practice. During preventive visits, the EHR system screened parents for tobacco use, automated treatment connections, and prompted referrals for household members who smoke. Referred household members were contacted, consented, and offered nicotine replacement therapy (NRT), quitline counseling, and/or SmokefreeTXT. Outcomes included feasibility (referral rate), effectiveness (treatment acceptance), and acceptability (satisfaction). A 1-month follow-up survey assessed treatment use and smoking cessation (7-day abstinence from combustible tobacco). Results: Between April 2022 and August 2024, 3478 pediatric patients had additional household members who smoke. Of 352 (10.1 %) referred individuals, 350 were contacted; 91 (25.9 %) accepted treatment. Among these, 82 (90 %) chose NRT, 58 (64 %) chose quitline, and 64 (70 %) chose SmokefreeTXT. All participants found the referral approach acceptable. At follow-up, 54 (59 %) completed the survey; 42 (46 %) reported treatment use, and 12 (13 %) reported smoking cessation. Conclusions: This EHR-linked intervention effectively identifies and engages household members who use tobacco in treatment, demonstrating feasibility, acceptability, and promising outcomes. These findings warrant more rigorous evaluation.