Changing Pediatric Practice to Address Parental Smoking

描述(申请人提供)：概述。乔纳森·P·维尼科夫医学博士，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研究员所需的技能。他的长期目标是开发一项多学科研究计划，致力于改善吸烟父母和暴露在环境烟草烟雾中的儿童的健康。职业发展计划。维尼科夫博士职业发展的核心是他组建的强大的机构承诺和指导团队。他的多学科教育计划建立在获得组织有效性理论、高级生物统计学、生物伦理学、烟草控制和预防服务交付模式以及政策研究方面的新技能的基础上。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议的成果出版。研究计划。这项研究计划的目标是开发和测试一个办公室系统，以加强向在儿科实践中看到的儿童的父母提供循证烟草治疗服务。在三个阶段中，研究计划使用探索性、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。研究的每一阶段都建立在前一阶段所学知识的基础上。第一阶段是一项探索性研究，包括初步调整循证烟草控制策略以适应儿科门诊环境。第一阶段以索尔伯格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分别进行多次访谈，并根据这些关键访谈反复调整拟议的烟草控制办公室系统。第二阶段是一项定性研究，使用来自8个儿科诊所的焦点小组，以获得儿科医生和主要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。第三阶段是一项干预研究，研究在儿科办公室内实施在第一阶段开发并在第二阶段改进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，以一个实践为对照。主要结果是将确定的父母吸烟者登记到中央烟草控制基础设施中，这些基础设施在全美越来越多地可用。结果应该证明在实践水平上进行随机化的更大规模的试验是合理的。总而言之，该研究计划将提供有关儿科实践中基于证据的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、主要数据收集、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.