Since 2006, the American Academy of Pediatrics (AAP) Julius B. Richmond Center of Excellence has conducted research on tobacco use and secondhand smoke (SHS) exposure, with emphasis on the effects on children and families. The Flight Attendant Medical Research Institute (FAMRI) has funded the AAP Richmond Center to do the majority of this research comes from other funding sources, including the federal government and the AAP Pediatric Research in Office Settings (PROS) practice-based research network. Read about the different research efforts through the AAP Richmond Center, as well as attitudes towards tobacco-related topics through surveys of AAP members.
Karen Wilson, MD, MPH, FAAP
Ana Rule, PhD
The goals of the Measurement Core are to assure that consistency in protocol use of shared methodologies are maintained across the projects within the AAP Richmond Center and to specifically evaluate measures to determine those that are most valid in predicting SHS exposure in order to help advance the field of SHS research. A core set of survey measures and biological and environmental measures of exposure will be used in several individual projects. The Measurement Core will continually evaluate the most up-to-date evidence in measuring tobacco exposure and its physiological and environmental effects, and make recommendations to the AAP Richmond Center study teams about additional or alternative measures that may be useful for particular research projects.
Data and Datasets
Robert McMillen, PhD
The AAP Richmond Center Data and Datasets Project provides ongoing surveillance of the social climate of SHS exposure and clinical counseling about tobacco, while also examining contextual policy and social factors that relate to SHS exposure. The dataset project serves as a resource for AAP Richmond Center investigators, young scholars, and others to identify predictors of healthy, smoke-free environments, inform clinical practices, and to support policy initiatives. The principal surveillance instrument of the Data and Dataset Project is the Social Climate Survey of Tobacco Control, an annual cross-sectional survey representative of the US adult population.
Building the Field
Jonathan Klein, MD, MPH, FAAP
This project will help develop the pediatric workforce, clinical services, and policies essential to protecting the nation's children. It will focus its efforts on the development of a research workforce, and of broad-based awareness, commitment, and skills within the pediatric community of research efforts to reduce children's exposure to SHS. This project is designed to help the AAP Richmond Center raise awareness among pediatricians about SHS service delivery in clinical practice and to educate clinicians and future researchers about research findings and evidence that can prevent or reduce SHS exposure of children.
Evaluation of Nanotechnology-based Personal Sensors for Detection and Quantification of Secondhand Tobacco Smoke Exposure
Susanne Tanski, MD, MPH, FAAP
The primary aim of this project is to validate two nanotechnology-based personal sensors, measuring ambient nicotine or urine cotinine (a metabolite of nicotine), to measure SHS exposure. Nanotechnology sensing allows for detection of substances at the molecular level, increasing the sensitivity and specificity of testing while decreasing the limit of detection and size of the instrument. These two devices will each have a different application — the ambient sensor assessing time-varying exposure to SHS, and the cotinine sensor providing a point-in-time measure of SHS exposure. The ultimate goal is to use these devices to motivate parents to establish 100% smoke-free homes and cars by revealing the levels of SHS to which non-smokers are exposed when sharing the smoker's environment.
Secondhand Smoke and Vascular Endothelial Status in Toddlers
Judith Groner, MD, FAAP
This study will, for the first time, determine the cardiovascular effects of SHS exposure on children during a period of potential critical vulnerability. This work has importance in terms of increasing the understanding of the nature of cardiovascular disease emergence during childhood, specifically in vulnerable populations of young children. The effects of SHS on the respiratory system of children is well-defined and understood by both the public and policy makers, but the impact of SHS exposure on the emerging cardiovascular system is not. The ultimate goal is to improve the health of children and adults, by defining the important and earliest effects of SHS on the cardiovascular system during childhood.
Pilot study for Respiratory Illness and Secondhand Smoke Exposure in Kids — The RISSK Study Pilot
Karen Wilson, MD, MPH, FAAP
This project assists in eliminating children's exposure to tobacco and SHS. The study will allow for easier identification of children at high risk for complications, and test potential interventions. Knowing which specific biomarkers are involved will help to identify therapeutic targets for anti-inflammatory or anti-oxidant medication, and enable improved outcomes among children hospitalized for respiratory illness, and reduce their risk of developing asthma. The physiological information obtained will help to develop smoking cessation interventions and SHS exposure elimination interventions for families.
Secondhand Smoke and Asthma in Premature Infants
J. Michael Collaco, MD, MBA, MPH, FAAP
Sharon McGrath-Morrow, MD, MBA
Little is known regarding the impact of secondhand smoke on the development of respiratory symptoms in premature infants. This project hopes to identify how SHS leads to worse lung disease in premature infants. Respiratory outcomes and effects of SHS exposure at home will be examined in consented premature infants followed in the bronchopulmonary dysplasia (BPD) outpatient clinic. The second facet of this project utilizes a mouse model to replicate some of the features of BPD. In this model, newborn mice will be exposed to oxygen for several days to simulate lung injury similar to BPD in human premature infants. The mice will then be placed in a smoke chamber to simulate a smoke-filled environment at home. With this model researchers will study the effects of neonatal oxygen lung injury and SHS on lung development and function. This project will lead to a better understanding of the negative effects of SHS on these vulnerable infants, and lessons learned from this study may be applicable to vulnerable children in general.
Adolescent Health in Pediatric Practice (AHIPP)
PI: Jonathan Klein, MD, MPH, FAAP
Awardee Organization: AAP
Funded by: the National Cancer Institute (NCI); Project Number: 1R01CA140576-05
Background Information: Smoking is a critical health issue for adolescents, with 88% of smokers starting the habit before age 18. Each day in the United States, 3000 adolescents try their first cigarette, and 700 become daily smokers. Most adolescent smokers know they are addicted and have tried to quit unsuccessfully. The evidence for adolescent smoking cessation counseling is limited, because teenagers rarely think of quitting with assistance.
Study Description: The AHIPP study is a randomized, controlled trial to examine the effectiveness of an office-based smoking cessation intervention for adolescents. This study aims to enroll up to 16,000 adolescents aged 14 years or older and up to 320 clinicians working in community-based settings. Participating pediatric practices are randomized into either a smoking cessation intervention group or a control group focused on assessment and brief counseling related to media use. Participating clinicians complete a baseline survey, undergo study training, enroll 100 adolescents from their practice, and complete a follow-up survey. Participating adolescents are asked to complete a baseline survey during a regularly-scheduled well or sick visit to their doctor's office; a sample of participating teens are asked to participate in three follow-up telephone surveys. The project's long-term goal is to improve clinical preventive services for adolescent tobacco cessation, which has positive implications for adolescent health.
Specific Aims: Our specific aims are to demonstrate providers' fidelity to guidelines for tobacco counseling and delivery of cessation interventions, including systematic screening using charting tools and linkages to adjunct materials, including web resources. The study will also assess the impact of primary care provider counseling interventions on adolescent smoking cessation.
Study Status: AHIPP completed data collection in 2015, with a final cohort of 155 pediatric practices and 10,967 teens across the United States. Data analysis has begun and will continue through Spring 2016.
AHIPP is a collaboration between the Richmond Center and the AAP Pediatric Research in Office Settings (PROS) practice-based research network. To learn more about PROS, please visit http://www2.aap.org/pros/.
CEASE: Changing Pediatric Office Systems Nationally to Address Parental Tobacco Use
PI: Jonathan P. Winickoff, MD, MPH, FAAP
Awardee Organization: Massachusetts General Hospital
Funded by: the National Cancer Institute (NCI); Project Number: 5R01CA127127-07
Background Information: Quitting smoking adds an average of seven years to a parent's life, improves the health of the spouse, eliminates the majority of secondhand smoke (SHS) exposure to children, reduces tobacco-related poor pregnancy outcomes, eliminates the greatest cause of house fire mortality, and improves the financial resources of the family. Much research has been done developing techniques to enhance the provision of evidence-based tobacco control in the adult primary care practice setting, but parents may not have a primary care clinician and even when they do, often visit their child's doctor more frequently than their own. The CEASE team has developed an intervention to address parental smoking in the child health care setting that employs, in combination, evidence-based smoking cessation techniques including the Ask-Assist-Refer counseling method, proactive referral to regional and national "quitlines," and pharmacologic management of tobacco dependence.
Study Description: The CEASE study is a 15-site, randomized controlled trial (RCT) of the sustainability of the CEASE intervention in practice. The team will test the sustainability of the CEASE intervention, which is designed to improve adherence to evidence-based guidelines at the clinician level, facilitate change at the parent behavior level, and lead to implementation of systems changes at the practice level. Participating practices will be randomized into the “Intervention” Arm (trained in the CEASE intervention) and a regular-care “Control” Arm. Researchers will collect data from parents seen in Intervention and Control practices over a two year period, in order to compare parental receipt of cessation services. The current study will be conducted in the AAP Richmond Center, and findings will be widely reproducible and transportable to AAP members.
Specific Aims: Our specific aims are to implement and sustain adherence to tobacco-control guidelines at the clinical level; to facilitate behavior change among parents and evaluate cost-per-quit among parents who smoke, and to study systems changes and the processes that affect them at the practice level.
Study Status: Study implementation, physician training, and data collection began in fall 2014.
Previous work: This study is the newest iteration of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) study: a collaboration between AAP and Massachusetts General Hospital. The research builds on years of pilot work and an RCT that demonstrated effectiveness. Previous work was supported by the NCI, FAMRI, the Robert Wood Johnson Foundation, and the AAP Pediatric Research in Office Settings (PROS) practice-based research network.
Connecting Adolescents and Young Adults to Preventive Health Care Services
PI: Jonathan Klein, MD, MPH, FAAP
Awardee Organization: AAP
Funded by: The Merck Foundation
Background Information: Adolescence and young adulthood are characterized by significant physical, emotional and intellectual growth as well as increased vulnerability and risk taking. While preventive services have proven effective in reducing harm to adolescents and young adults, most do not receive the recommended preventive clinical care services. Even fewer young adults report private, one-on-one discussions with their clinician.
Specific Aims: Our specific aims are to improve parental as well as adolescent and young adult awareness of the importance and value of preventive health care services for youth, in addition to increase the number of adolescents and young adults who receive appropriate preventive health care services, including private, one-on-one time with their clinician.
Study Description: The “Connecting Adolescents and Young Adults to Preventive Health Care Services” project is a consortium of four national medical societies who will help inform all stages of the project. The consortium partner organizations are: the American Academy of Pediatrics (AAP), the Society of Adolescent Health and Medicine (SAHM), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). The project is co-led by the AAP Julius B. Richmond Center of Excellence (PI: Jonathan Klein, MD, MPH, FAAP) and Columbia University Mailman School of Public Health (PI: John Santelli, MD, MPH, FAAP)This study aims to formulate a set of communication strategies, messages and tools that share information about the value of preventive health care services for adolescents and young adults ages 13-26 from across the United States. Each of the Consortium partners will lead communication activities within their respective organizations. Such efforts will include incorporating key messages into education and outreach activities for adolescents, young adults and parents and using these materials to develop education and practice-change interventions created specifically for their memberships.
Study Status: In Fall 2015, study staff conducted focus groups with adolescents, young adults, parents and clinicians in order to assess knowledge and attitudes related to clinical preventive services and private time during the adolescent clinical visit. A final cohort of 299 youth, parents and clinicians participated in 36 focus groups across 4 cities in the United States. These findings will inform the development and implementation of a national internet survey for youth and parents, which will be implemented Spring 2016.
The Periodic Survey of Fellows routinely gathers data from AAP members on current topics in pediatrics and pediatricians' practice characteristics.
Below is a list of Periodic Surveys regarding tobacco, and findings for each:
- Periodic Survey 78 (Field period June – November 2010) — Tobacco Counseling
- Trends in Tobacco Counseling: Results from the AAP Periodic Survey of Fellows, Presented at the Pediatric Academic Societies Conference, May 2012
- Factors Associated with Counseling Parents about Tobacco Smoke Exposure: A National Pediatrician Study, Presented at the Pediatric Academic Societies Conference, May 2012
- Periodic Survey 61 (Field period June – November 2004) — Attitudes and practices regarding tobacco cessation counseling of patients and parents (funded by the Agency for Healthcare Research and Quality)
- Pediatricians Cite Barriers to Tobacco Cessation Counseling, AAP News, December 2006
- Periodic Survey 42 (Field period September 1998 – February 1999) — Counseling on environmental hazards
- Cigarette smoke tops list of environmental hazards: AAP survey, AAP News, September 1999
- Pediatricians' Practices Regarding Patients' Exposure to Environmental Tobacco Smoke (ETS), Presented at the American Public Health Association National Conference, November 2000