description): Position statements from the American Academy of Pediatrics and other leading health agencies call upon pediatricians to address environmental tobacco smoke (ETS), prevent smoking onset in youths, and encourage cessation of tobacco use by adolescents and their parents. Indeed, systematic intervention by pediatricians would serve to protect infants and young children from the harmful effects of ETS and save adolescents from a life time of addiction and premature morbidity and mortality from cancer, heart disease, chronic obstructive lung disease, and other forms of tobacco-related illness. Despite this, few practicing pediatricians adhere to these recommendations and pediatric residency training programs are not preparing residents to address the tobacco challenge. The proposed research addresses these deficits. The investigators propose to carry out a multi-site (n equals 16) randomized controlled study of the impact of residency training on tobacco on pediatric resident intervention on tobacco and ETS with patients and parents. The crux of this training program will be a hybrid CD-ROM/Web Site program on tobacco for pediatric residents developed and pilot tested with the support of the Foundation of the University of Medicine and Dentistry of New Jersey. The program will facilitate distant learning, allow residents to learn at their own pace, model appropriate assessment and interviewing techniques, and teach residents how to intervene on ETS and tobacco in parents and patients. Residents at the Special Training sites also will utilize companion materials to actively intervene on tobacco with patients and parents. Key endpoint measures for the study include reports from patients, parents, and residents about changes in resident intervention on tobacco, as well as changes in resident intervention skills as measured by use of standardized procedures. In addition, the investigators shall measure actual changes in patient and parent tobacco-related behaviors at the eight pediatric residency training sites which receive the Special Training Program and the eight other sites which receive Standard Training. They predict that residents in the Special Training sites will acquire greater knowledge about intervention on tobacco, will more actively intervene on tobacco in patients and parents, and will have a greater impact on tobacco modification than residents in the Standard Training sites. Equally important, it is hypothesized that residents who complete their training at the Special Training sites will be more likely to address tobacco when they enter clinical practice than residents from Standard Training sites. To the extent that these predictions are supported, the proposed training program may serve as a model for pediatric training on tobacco in the United States and elsewhere.
