Improving Pediatric Tobacco Control in Primary Care

? DESCRIPTION (provided by applicant): Preventing youth tobacco use is a public health priority and critical to achieving our nation's cancer prevention goals. The U.S. Preventive Services Task Force recently concluded that youth tobacco use prevention interventions in primary care settings are an important component of this effort, but highlighted a need for more research on smarter ways to integrate tobacco use prevention into our healthcare system. This study addresses this need by evaluating a novel, system-based intervention to improve youth tobacco control outcomes in pediatric primary care. We will determine if an Ask, Advise, Connect (AAC) intervention model that leverages health information technology and behaviorally-based tobacco control resources can improve population- and patient-level outcomes. The model relies on efficient tobacco use history-taking and intervention by pediatric primary care providers (e.g., medical assistants, nurses, physicians), paired with referral to freely accessible, evidence-based online tobacco prevention resources to deter and disrupt tobacco use uptake. By analyzing the pediatric outpatient workflow, we will evaluate how AAC intervention strategies can be seamlessly integrated, including electronic medical record prompts and brief behavioral counseling strategies to motivate patient adherence. We will assess the impact of the AAC intervention on population-level outcomes using system metrics to document provider assessment, patient education and guidance on tobacco use avoidance, and anti-smoking resource referral. We will also examine reach of the AAC intervention by capturing population-level metrics of resource use based on provider referral, and prospectively examine its effect on individual-level outcomes (e.g., susceptibility to tobacco use, tobacco use-related cognitions, skills to avoid tobacco use) among a subsample of patients. This AAC approach could be critical to promoting better and more sustainable youth tobacco control by strengthening the pediatric primary care system's technical expertise and workforce capacities to eradicate youth tobacco use. It is highly consistent with the Patient Protection and Affordable Care Act and the Family Smoking Prevention and Tobacco Control Act in that it seeks to reduce the public health and societal burden of morbidity and mortality caused by tobacco use, and is fully aligned with National Cancer Institute tobacco control objectives in precision prevention of cancer risk.