Addressing Parental Smoking by Changing Pediatric Office Systems

说明(申请人提供)：戒烟使父母平均多活七年，改善配偶的健康，消除孩子接触二手烟(SHS)的大部分，减少与烟草有关的不良妊娠结局，消除导致房屋火灾死亡的最大原因，并改善家庭的经济来源。已经进行了大量研究，开发技术，以加强成人初级保健实践环境中循证烟草控制的提供，但父母可能没有初级保健临床医生，即使他们有，也经常比他们自己的医生更频繁地去看孩子的医生。我们开发了一种干预措施，以解决儿童保健环境中的父母吸烟问题，该干预结合使用了基于证据的戒烟技术，包括5A(询问、建议、评估、协助、安排)、主动转诊到地区和国家的“戒烟热线”，以及烟草依赖的药物管理。我们将测试这一以前开发的、经过试点测试和基于理论的干预措施，旨在提高临床医生层面对循证指南的遵从性，促进父母行为层面的改变，并导致实践层面的系统改变的实施。我们将把我们的干预比作“注意”控制，包括分发当前最佳实践的烟草控制小册子。这项拟议的研究将是一项关于有效性的60个地点的分组随机对照试验(RCT)，建立在由国家癌症研究所、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)办公室环境中的儿科研究(PROS)基于实践的研究网络中进行，该网络是美国最大的儿科实践研究网络。调查结果将被广泛复制，并通过700多个专业实践(为全国300多万儿童提供护理)以及其他实践网络和实践在全国范围内传播。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开发和应用基于证据的干预措施预防癌症的战略计划完全一致。这项试验将通过“加快癌症预防的进展”，帮助美国“抓住一切机会抢占癌症的先机”，并将重点放在年轻人和儿童身上，他们构成了一个没有癌症的美国人口的未来。

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.