Pediatric Residency Training On Tobacco

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. Systematic intervention on
tobacco by pediatricians would protect infants and young children from the harmful effects
of ETS and save adolescents from a lifetime of addiction and tobacco-related disease.
Despite this, few pediatricians address tobacco use, and pediatric residency training
programs are not preparing residents to play a leadership role in the anti-tobacco arena.

The Pediatric Residency Training on Tobacco project is a four-year randomized controlled
study of the efficacy of a specialized tobacco intervention program for pediatric residents.
Eight participating pediatric training sites were randomly assigned to a Special Training
condition featuring "Solutions for Smoking", a hybrid CD-ROM/Website training program. Six
sites were randomly assigned to a control condition that provided standard print literature.
Key features of "Solutions for Smoking" include a website containing background material on
tobacco, interviewing, behavioral and pharmacological aspects of intervention, and a series
of CD-ROMs containing audio-visual vignettes that model state-of-the-art interviewing and
tobacco intervention skills. Residents are expected to practice the interventions with
patients in their Continuity Clinics, and all sites are provided with brochures and other
intervention materials for this purpose. Study investigators meet with residents at all
sites three times per year to discuss the program and the residents’ efforts to intervene on
tobacco with their patients. Annually, second and third-year residents participate in
Objective Structured Clinical Examinations (OSCEs) and a Resident Tobacco Survey. Patients
and parents attending each of the Continuity Clinics complete Patient and Parent Tobacco
Surveys at baseline and end of study.

Primary endpoints include changes over time in pediatric residents’ tobacco intervention
knowledge, skills, and activities as reported on the Tobacco Surveys and measured by
performance on the OSCEs at baseline and follow-up. Secondary endpoints include changes in
smoking, other tobacco use, and control of ETS by patients and parents. The study
hypothesizes that pediatric residents in both arms of the study will be similar in knowledge
and skills at baseline; that residents in the specialized training program will acquire more
knowledge and greater skills for tobacco intervention during the course of the study
compared to residents in the control condition; and residents in each condition will
increase the frequency in which they address tobacco in patients and parents.

The training program will include all residents enrolled in the 14 participating residency
training programs.

The Baseline and Follow-up Resident Tobacco Surveys and OSCEs will include all second and
third year residents enrolled in the residency training programs at baseline and years 1,
2, and 3 of follow-up.

The Baseline and Follow-up Patient Tobacco Survey will include 30 patients, ages 12-21,
who were present in the waiting areas of the Continuity Clinic when the surveys were
administered. All patients present in the clinic will be approached and invited to
participate. Partcipants must be able to read English or Spanish, and patients who are
attending the clinic for the very first time will not be eligible to participate in the
survey.

The Baseline and Follow-up Parent Tobacco Surveys will be administered to 100 parents (one
per family) who are present in the clinic when the surveys are administered. Parents who
cannot read English or Spanish and who are bringing their child to the clinic for the very
first time will not be able to participate.