Addressing Parental Smoking by Changing Pediatric Office Systems

戒烟可以使父母的寿命平均增加7年，改善配偶的健康，消除大多数儿童接触二手烟（SHS），减少与烟草相关的不良妊娠结局，消除房屋火灾死亡的最大原因，并改善家庭的经济资源。已经做了大量的研究开发技术，以加强在成人初级保健实践环境中提供基于证据的烟草控制，但父母可能没有初级保健医生，即使他们这样做，也经常比自己更频繁地去看孩子的医生。我们开发了一种干预措施，以解决父母吸烟的儿童医疗保健设置，采用相结合的循证戒烟技术，包括5A的（问，建议，评估，协助，安排），积极转介到区域和国家的“戒烟热线”，烟草依赖的药理学管理。我们将测试这种先前开发的、经过试点测试的、以理论为基础的干预措施，旨在提高临床医生对循证指南的依从性，促进父母行为水平的改变，并导致实践水平的系统改变。我们将把我们的干预措施比作一种“注意力”控制，即分发一本当前最佳烟草控制做法的小册子。拟议的研究将是一项60个地点的有效性分组随机对照试验（RCT），该试验建立在国家癌症研究所、空乘医学研究所和罗伯特·伍德约翰逊基金会支持的焦点小组、可行性和有效性工作的基础上。它将在美国儿科学会（AAP）儿科研究办公室设置（PROS）基于实践的研究网络中进行，这是美国最大的儿科实践研究网络。调查结果将通过700多个PROS实践（为全国300多万儿童提供护理）和全国其他实践网络和实践广泛复制和传播。这项研究将有助于NCI通过国家癌症计划战胜癌症的努力，并与NCI的战略计划完全一致，以制定和应用循证干预措施来预防癌症。这项试验将通过“加速癌症预防的进展”帮助国家“抓住一切机会预防癌症”，并将努力集中在构成美国无癌症人口未来的年轻人和儿童身上。

DESCRIPTION (provided by applicant): Quitting smoking adds an average of seven years to a parent's life, improves the health of the spouse, eliminates the majority of secondhand smoke (SHS) exposure of the children, reduces tobacco-related poor pregnancy outcomes, eliminates the greatest cause of house fire mortality, and improves the financial resources of the family. Much research has been done developing techniques to enhance the provision of evidence-based tobacco control in the adult primary care practice setting, but parents may not have a primary care clinician and even when they do, often visit their child's doctor more frequently than their own. We developed an intervention to address parental smoking in the child healthcare setting that employs, in combination, evidence-based smoking cessation techniques including the 5 A's (Ask, Advise, Assess, Assist, Arrange), proactive referral to regional and national "quitlines," and pharmacologic management of tobacco dependence. We will be testing this previously developed, pilot tested, and theoretically-based intervention designed to improve adherence to evidence-based guidelines at the clinician level, facilitate change at the parent behavior level, and lead to implementation of systems changes at the practice level. We will compare our intervention to an "attention" control consisting of handing out a current best practice tobacco control pamphlet. The proposed study will be a 60-site, group randomized controlled trial (RCT) of effectiveness that builds on focus group, feasibility, and efficacy work supported by the National Cancer Institute, the Flight Attendant Medical Research Institute, and the Robert Wood Johnson Foundation. It will be conducted in the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings (PROS) practice-based research network, the largest research network of pediatric practices in the United States. Findings will be widely reproducible and transportable through the more than 700 PROS practices (which provide care to over 3 million of the nation's children) and to other practice networks and practices nationally. This research will contribute to the NCI's efforts to defeat cancer through the National Cancer Program and is in exact alignment with NCI's Strategic Plan to develop and apply evidence-based interventions for preventing cancer. This trial will help the nation to "preempt cancer at every opportunity" by "accelerating progress in cancer prevention" and to focus efforts on the young adults and children who form the future of a cancer-free U.S. population.