The goal of this renewal application is to transform routine pediatric outpatient practice to assist parents quitting smoking in order to help eliminate tobacco use in families. In our Phase I RCT (R01-CA127127), framing the intervention from the practice perspective using the Chronic Care Model (Wagner) and the Prevention System (Solberg), we demonstrated dramatic office systems changes without additional resource added to practices, showing 14-fold increased rates of delivering tobacco control assistance in a practice-based research network, and justifying significant investment to disseminate nationally. The intervention included three key implementation steps to address parental smoking in the child healthcare setting: (1) motivational messaging;(2) proactive referral to quitlines;and (3) pharmacologic management of tobacco dependence. The intervention was recently named an "innovation in medicine" by AHRQ. In the proposed Phase II trial, in close collaboration with the American Academy of Pediatrics (AAP), the largest pediatrics professional organization in the United States, we will perform a two-arm RCT to address the critical unanswered questions of generalizability, sustainability, and cost- effectiveness of the intervention using a national 20-ste sample of pediatric practices. The Phase II intervention will be augmented to address key barriers identified in Phase 1 and to enhance generalizability and sustainability by: (1) including facilitated nicotine replacement delivery-compliant with new national Medicaid coverage standards and (2) including an innovative additional dissemination and sustainability component, developed with a separate NCI ARRA grant--an online, tailored, self-paced module where clinicians work on a full practice implementation over the course of several months of self study and hands-on improvement cycles. The module satisfies the new American Board of Pediatrics Maintenance of Certification Performance in Practice requirement creating a natural "pull" for the training.
The Specific Aims i nclude: " Aim 1. to implement and sustain adherence to evidence-based guidelines at the clinical level; " Aim 2. to facilitate behavior change among parents and evaluate cost per quit among parents who smoke; " Aim 3. to study systems changes and the processes that affect them at the practice level. Building on the success of Phase 1, the generalizable training systems to be studied in this application will enhance the adoption, implementation, and sustainability of the intervention, making it widely transportable throughout pediatric practice nationally and providing a critical return on decades of NIH investment in developing the evidence base for tobacco control. The project will have significant impact by yielding an effective, theoretically-based, rapidly disseminable, and sustainable strategy to address tobacco use in families through child healthcare settings in the United States.

Public Health Relevance

The goal of this research is to transform routine pediatric outpatient practice by implementing and sustaining an intervention to assist parents quitting smoking in order to help eliminate tobacco use in families. In the proposed trial, in close collaboration with the American Academy of Pediatrics (AAP), the largest pediatrics professional organization in the United States, we will perform a two-arm RCT to address the critical unanswered questions of generalizability, sustainability, and cost-effectiveness of the intervention using a national 20-site sample of pediatric practices. The generalizable training systems to be studied in this application will enhance the intervention, making it widely transportable throughout pediatric practice nationally and providing a critical return on decades of NIH investment in developing the evidence base for tobacco control.

Agency
National Institute of Health (NIH)
Type
Research Project (R01)
Project #
5R01CA127127-08
Application #
8678867
Study Section
Community-Level Health Promotion Study Section (CLHP)
Program Officer
Land, Stephanie R
Project Start
Project End
Budget Start
Budget End
Support Year
8
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02199
Winickoff, Jonathan P; Nabi-Burza, Emara; Chang, Yuchiao et al. (2014) Sustainability of a parental tobacco control intervention in pediatric practice. Pediatrics 134:933-41
Drehmer, Jeremy E; Ossip, Deborah J; Nabi-Burza, Emara et al. (2014) Thirdhand smoke beliefs of parents. Pediatrics 133:e850-6
Winickoff, Jonathan P; Hartman, Lester; Chen, Minghua L et al. (2014) Retail impact of raising tobacco sales age to 21 years. Am J Public Health 104:e18-21
Friebely, Joan; Rigotti, Nancy A; Chang, Yuchiao et al. (2013) Parent smoker role conflict and planning to quit smoking: a cross-sectional study. BMC Public Health 13:164
Ossip, Deborah J; Chang, Yuchiao; Nabi-Burza, Emara et al. (2013) Strict smoke-free home policies among smoking parents in pediatric settings. Acad Pediatr 13:517-23
Nabi-Burza, Emara; Winickoff, Jonathan P; Finch, Stacia et al. (2013) Triple tobacco screen: opportunity to help families become smokefree. Am J Prev Med 45:728-31
Winickoff, Jonathan P; Nabi-Burza, Emara; Chang, Yuchiao et al. (2013) Implementation of a parental tobacco control intervention in pediatric practice. Pediatrics 132:109-17
Winickoff, Jonathan P; Tanski, Susanne E; McMillen, Robert C et al. (2011) Acceptability of testing children for tobacco-smoke exposure: a national parent survey. Pediatrics 127:628-34
Winickoff, Jonathan P; Gottlieb, Mark; Mello, Michelle M (2010) Regulation of smoking in public housing. N Engl J Med 362:2319-25
Hall, Nicole; Hipple, Bethany; Friebely, Joan et al. (2009) Addressing Family Smoking in Child Health Care Settings. J Clin Outcomes Manag 16:367-373