Changing Pediatric Practice to Address Parental Smoking

描述（由申请人提供）：概述。 Jonathan P. Winickoff医学博士，公共卫生硕士，学术儿科医生，正在申请癌症预防，控制，行为和人口科学职业发展奖（K07），以发展和提高成为癌症预防和控制领域成功的独立调查员所需的技能。 他的长期目标是开发一个多学科的研究计划，致力于改善吸烟的父母和暴露于环境烟草烟雾的儿童的健康。 职业发展计划。 Winickoff博士职业发展的核心是他所组建的强大的机构承诺和指导团队。 他的多学科教育计划是建立在获得组织有效性理论，先进的生物统计学，生物伦理学，烟草控制和预防服务提供模式，以及政策研究的新技能。 除了正式的课程外，该计划还包括地方研讨会，国家科学会议和同行评审的结果出版物。 研究计划。 这项研究计划的目标是开发和测试一个办公系统，以加强提供循证烟草治疗服务的儿童在儿科实践中看到的父母。 研究计划分三个阶段，采用探索性、描述性和干预性设计来解决儿科门诊环境中父母的烟草控制问题。 研究的每个阶段都建立在前一阶段所学到的东西的基础上。 第1阶段是一项探索性研究，包括初步调整基于证据的烟草控制策略，以适应儿科门诊环境。 第一阶段以Solberg和瓦格纳的理论模型为基础，对门诊预防服务实施领域的几位领导者进行多次访谈，并根据这些关键访谈对拟议的烟草控制办公室系统进行迭代调整。 第2阶段是一项定性研究，使用来自8个儿科实践的焦点小组，以了解儿科医生和关键工作人员对实施拟议的烟草控制办公室系统的反应、障碍和解决方案。 第3阶段是干预研究，研究在儿科办公室环境中实施第1阶段开发并在第2阶段完善的烟草控制系统的可行性和有效性。 该设计是一个前后设计，其中一个实践作为对照。 主要结果是将已确定的父母吸烟者纳入美国各地越来越多的中央烟草控制基础设施。 结果应该证明在实践水平上进行更大规模的随机试验是合理的。 总之，该研究计划将提供有关儿科实践中循证烟草控制的关键信息，以及Winickoff博士在定性数据分析，调查方法，原始数据收集，数据库管理，统计分析和干预研究方面的重要经验。

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.