Secondhand smoke exposure affects more than 40% of the US pediatric population and exacerbates and/or increases the risk of disease morbidity and mortality. By helping parents quit smoking, pediatricians protect children and families from the harms of tobacco. Pediatricians are uniquely positioned to intervene but appropriate treatments are delivered to parent smokers less than 3% of the time. Major barriers to wider adoption include lack of understanding of effective pediatrician-parent communication regarding tobacco cessation treatment and mechanisms to systematize, consistently deliver, and scale effective interventions. A multi-disciplinary research approach incorporating decision science and clinical informatics could maximize intervention effectiveness while simplifying, standardizing, and systematizing parental treatment for tobacco use in pediatric clinical practice. To lead this research and establish my long-term career goal as a clinician- scientist dedicated to preventing cancer by protecting families and vulnerable populations from tobacco, my training objectives involve developing skills in critical theoretical and methodological areas including: 1) behavioral economics, 2) human factors engineering, and 3) clinical and pragmatic trial methodology. My career development will be fostered through my multidisciplinary mentoring team, including Alexander Fiks, MD, MSCE (primary mentor, expert in using health IT to improve clinical decision making), Robert Schnoll, PhD (co-mentor, expert in tobacco treatment trials), and David Asch, MD, MBA (co-mentor, expert in behavioral economics). My advisory committee will further guide my career development and will provide expertise in data analysis in clinical trials, human factors engineering, qualitative methods, and dissemination and health system integration. Building upon my preliminary work, this training will be leveraged to create and evaluate a novel intervention, a clinical decision support (CDS) tool embedded within the electronic health record (EHR), for tobacco treatment in the pediatric setting, grounded in behavioral economics and developed using rigorous informatics design methods, neither of which have been applied to this context. The research approach includes: developing theory-based messages that engage parents in tobacco cessation treatment (Aim 1), identifying effective methods for delivering these messages using CDS tools (Aim 2), and measuring the impact of these messages on parent quit rates (Aim 3). The results from these aims, which logically build towards the development of a testable, theory-driven intervention, will lead to future R01 grants that support the testing of CDS interventions optimized for effectively and systematically addressing parent smoking in pediatric settings.
Routinely delivered tobacco control to parents would provide a major health benefit in the US, as tobacco use leads to 480,000 preventable deaths, including almost one-third of all cancer deaths, and $300 billion in tobacco attributable costs annually. Conducting this research within the structure of a mentored, career development framework with additional training in behavioral economics, human factors engineering, and clinical and pragmatic trials will help establish my career as a clinician-scientist dedicated to cancer-prevention tobacco research, with a particular focus on developing scalable, health IT interventions to protect families and vulnerable populations from tobacco. These research efforts and associated training are aimed at the development of smoking cessation interventions ultimately targeted at vulnerable populations and could be scaled for broad population impact.
