Clinical effort against secondhand smoke exposure: development of framework and intervention.
OBJECTIVE
The purpose of this work was to describe a novel process and present results of formative research to develop a pediatric office intervention that uses available systems of care for addressing parental smoking.


METHODS
The scientific development of the intervention occurred in 3 stages. In stage 1, we designed an office system for parental tobacco control in the pediatric outpatient setting on the basis of complementary conceptual frameworks of preventive services delivery, conceptualized for the child health care setting through a process of key interviews with leaders in the field of implementing practice change; existing Public Health Service guidelines that had been shown effective in adult practices; and adaptation of an evidence-based adult office system for tobacco control. This was an iterative process that yielded a theoretically framed intervention prototype. In stage 2, we performed focus-group testing in pediatric practices with pediatricians, nurses, clinical assistants, and key office staff. Using qualitative methods, we adapted the intervention prototype on the basis of this feedback to include 5 key implementation steps for the child health care setting. In stage 3, we presented the intervention to breakout groups at 2 national meetings of pediatric practitioners for additional refinements.


RESULTS
The main result was a theoretically grounded intervention that was responsive to the barriers and suggestions raised in the focus groups and at the national meetings. The Clinical Effort Against Secondhand Smoke Exposure intervention was designed to be flexible and adaptable to the particular practices' staffing, resources, and physical configuration. Practice staff can choose materials relevant to their own particular systems of care (www.ceasetobacco.org).


CONCLUSIONS
Conceptually grounded and focus-group-tested strategies for parental tobacco control are now available for implementation in the pediatric outpatient setting. The tobacco-control intervention-development process might have particular relevance for other chronic pediatric conditions that have a strong evidence base and have available treatments or resources that are underused.
Winickoff
Jonathan P
JP
Center for Child and Adolescent Health Policy, 50 Staniford St, Suite 901, Boston, MA 02114, USA. jwinickoff@partners.org
Park
Elyse R
ER
Hipple
Bethany J
BJ
Berkowitz
Anna
A
Vieira
Cecilia
C
Friebely
Joan
J
Healey
Erica A
EA
Rigotti
Nancy A
NA
D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002669:Child Welfare; D005260:Female; D017144:Focus Groups; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D010372:Pediatrics / Q000379:methods; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services / Q000458:organization & administration; D011322:Primary Prevention / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000517:prevention & control*; D014481:United States
D014028:Tobacco Smoke Pollution