Improving Pediatric Tobacco Control in Primary Care

 预防青少年吸烟是公共卫生的优先事项，对实现我国的癌症预防目标至关重要。美国预防服务工作组最近得出结论，初级保健环境中的青少年烟草使用预防干预措施是这一努力的重要组成部分，但强调需要更多研究更聪明的方法将烟草使用预防纳入我们的医疗保健系统。本研究通过评估一种新的、基于系统的干预措施来解决这一需求，以改善儿科初级保健中的青少年烟草控制结果。我们将确定利用健康信息技术和基于行为的烟草控制资源的询问，建议，连接（AAC）干预模式是否可以改善人群和患者水平的结果。该模型依赖于有效的烟草使用史记录和儿科初级保健提供者的干预（例如，医疗助理、护士、医生），同时推荐使用可免费获取的循证在线烟草预防资源，以阻止和破坏烟草使用。通过分析儿科门诊工作流程，我们将评估如何无缝集成AAC干预策略，包括电子病历提示和简短的行为咨询策略，以激励患者依从性。我们将使用系统指标评估AAC干预对人群水平结果的影响，以记录提供者评估、患者教育和烟草使用避免指导以及反吸烟资源推荐。我们还将通过基于提供者推荐的资源使用的人口水平指标来检查AAC干预的范围，并前瞻性地检查其对个人水平结果的影响（例如，对烟草使用的敏感性，烟草使用相关的认知，避免烟草使用的技能）。这种AAC方法对于通过加强儿科初级保健系统的技术专长和劳动力能力来根除青少年烟草使用，促进更好和更可持续的青少年烟草控制至关重要。它与《患者保护和平价医疗法》和《家庭吸烟预防和烟草控制法》高度一致，因为它旨在减少烟草使用造成的发病率和死亡率的公共卫生和社会负担，并与国家癌症研究所在精确预防癌症风险方面的烟草控制目标完全一致。

 DESCRIPTION (provided by applicant): Preventing youth tobacco use is a public health priority and critical to achieving our nation's cancer prevention goals. The U.S. Preventive Services Task Force recently concluded that youth tobacco use prevention interventions in primary care settings are an important component of this effort, but highlighted a need for more research on smarter ways to integrate tobacco use prevention into our healthcare system. This study addresses this need by evaluating a novel, system-based intervention to improve youth tobacco control outcomes in pediatric primary care. We will determine if an Ask, Advise, Connect (AAC) intervention model that leverages health information technology and behaviorally-based tobacco control resources can improve population- and patient-level outcomes. The model relies on efficient tobacco use history-taking and intervention by pediatric primary care providers (e.g., medical assistants, nurses, physicians), paired with referral to freely accessible, evidence-based online tobacco prevention resources to deter and disrupt tobacco use uptake. By analyzing the pediatric outpatient workflow, we will evaluate how AAC intervention strategies can be seamlessly integrated, including electronic medical record prompts and brief behavioral counseling strategies to motivate patient adherence. We will assess the impact of the AAC intervention on population-level outcomes using system metrics to document provider assessment, patient education and guidance on tobacco use avoidance, and anti-smoking resource referral. We will also examine reach of the AAC intervention by capturing population-level metrics of resource use based on provider referral, and prospectively examine its effect on individual-level outcomes (e.g., susceptibility to tobacco use, tobacco use-related cognitions, skills to avoid tobacco use) among a subsample of patients. This AAC approach could be critical to promoting better and more sustainable youth tobacco control by strengthening the pediatric primary care system's technical expertise and workforce capacities to eradicate youth tobacco use. It is highly consistent with the Patient Protection and Affordable Care Act and the Family Smoking Prevention and Tobacco Control Act in that it seeks to reduce the public health and societal burden of morbidity and mortality caused by tobacco use, and is fully aligned with National Cancer Institute tobacco control objectives in precision prevention of cancer risk.