Changing Pediatric Practice to Address Parental Smoking

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DESCRIPTION (provided by applicant): Overview. Jonathan P. Winickoff MD, MPH, an academic pediatrician, is applying for a Cancer Prevention, Control, Behavioral and Population Sciences Career Development Award (K07) to develop and enhance the skills necessary to become a successful independent investigator in the field of cancer prevention and control. His long-term goal is to develop a multidisciplinary research program dedicated to improving the health of parents who smoke and the children exposed to their environmental tobacco smoke. Career Development Plan. Central to Dr. Winickoff's career development are the strong institutional commitments and mentoring team that he has assembled. His multidisciplinary education plan is built upon acquiring new skills in organizational effectiveness theory, advanced biostatistics, bioethics, models of tobacco control and preventive services delivery, and policy research. In addition to formal coursework, the plan includes local seminars, national scientific meetings, and peer-reviewed publication of results. Research Plan. The goal of this research plan is to develop and test an office system to enhance the delivery of evidence-based tobacco treatment services to parents of children seen in pediatric practice. In three phases, the research plan uses exploratory, descriptive, and intervention designs to address parental tobacco control in the pediatric outpatient setting. Each phase of the research builds on what has been learned in the prior phase. Phase 1 is an exploratory study consisting of the preliminary adaptation of an evidence-based tobacco control strategy to the pediatric outpatient setting. Phase 1 is grounded on the Solberg and Wagner theoretical models, multiple interviews with each of several leaders in the field of outpatient preventive services implementation, and iterative adaptation of the proposed tobacco control office system based on these key interviews. Phase 2 is a qualitative study using focus groups from 8 pediatric practices to elicit pediatrician and key staff responses, barriers, and solutions to implementing the proposed tobacco control office system. Phase 3, an intervention study, examines the feasibility and efficacy of implementing within the pediatric office setting the tobacco control system that was developed in Phase 1 and refined in Phase 2. The design is a before-after design with one practice serving as the control. The primary outcome is the enrollment of identified parental smokers into centralized tobacco control infrastructure increasingly available throughout the United States. Results should justify a larger trial with randomization at the practice level. In summary, the research plan will provide critical information about evidenced-based tobacco control within pediatric practice, and crucial experience for Dr. Winickoff in qualitative data analysis, survey methods, primary data collection, database management, statistical analysis, and intervention research.