title: Involving stakeholders to optimize a study protocol on secondhand tobacco smoke and chronic rhinosinusitis in adults.
abstract: BACKGROUND
  Epidemiological evidence evaluating the association between secondhand smoke exposure and diseases of the upper airway in adults is limited by a small number of studies and a lack of established protocols. This study was designed to optimize a research protocol on secondhand tobacco smoke exposure and chronic rhinosinusitis for a future population-based case-control study in Washington County, Maryland, using a participatory research model.
  
  
  METHODS
  We conducted three focus groups with health professionals, community members, and research practitioners for protocol development; 10 one-on-one cognitive testings with community members for protocol refinement; and a pilot testing of the full study protocol (10 cases and 10 controls) for full evaluation of the study protocol.
  
  
  RESULTS
  Health professionals recommended, among other themes, enrolling patients with confirmed chronic rhinosinusitis (minimum 12-week symptom duration and objective inflammation). Community members and research practitioners discussed optimal strategies for participant recruitment and interviewing. The protocol, revised with the focus group's feedback, was further evaluated in one-on-one sessions with 10 Washington County residents (3 with chronic rhinosinusitis). In the pilot study, 10 nonsmoking chronic rhinosinusitis cases (5 clinic based and 5 community based) and their community-based age, sex, and former/never smoking-matched controls were recruited. Sinonasal symptoms scores were higher in cases than controls but similar for clinic versus community-based cases.
  
  
  CONCLUSIONS
  This protocol development framework involving stakeholders resulted in a comprehensive questionnaire that was successfully evaluated during a pilot study and is now ready to be used in population-based and clinical epidemiological studies of chronic rhinosinusitis in adults.
authors.affiliation: Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Laili
authors.initials: L
authors.lastname: Irani
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Lin
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Clipp
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.forename: Ana
authors.initials: A
authors.lastname: Navas-Acien
mesh_terms: D000328:Adult; D002908:Chronic Disease; D055812:Community-Based Participatory Research; D017144:Focus Groups; D006801:Humans; D012107:Research Design / Q000592:standards*; D012220:Rhinitis / Q000453:epidemiology* / Q000503:physiopathology; D012307:Risk Factors; D012852:Sinusitis / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires / Q000592:standards*; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution