ABSTRACT. Objective. Pediatricians have a unique role to play in the antismoking arena. However, few pediatric residency training programs prepare residents to meet the tobacco challenge. This study evaluates the effects of a comprehensive pediatric residency training program on tobacco on resident tobacco intervention behaviors, as well as on changes in the behavior of patients and their parents/guardians.Methods. Pediatric residents were exposed to a comprehensive training program on tobacco. Baseline and follow-up surveys of residents, parents/guardians, and patients were used to assess the effects of the training program. A quasi-experimental design permitted unambiguous evaluation of the program's effects on resident intervention behaviors.Results. The comprehensive training program on tobacco led to marked and significant changes in resident intervention on tobacco. Many of these changes were supported by parents' and patients' reports. In turn, resident intervention on tobacco led to a significant increase in the likelihood that parents would maintain a "smokefree household." Significant changes in the prevalence of parental smoking were not found, although the trend during 3 years of follow-up was in the desired direction. A high proportion of residents reported that they intervened on tobacco in patients at baseline and follow-up, but too few patients were sampled to permit analysis of the impact on changes in smoking.Conclusions. Comprehensive training on tobacco had a positive and powerful effect on the tobacco intervention behavior of pediatric residents. In turn, intervention on tobacco by pediatric residents may have a significant impact on patients and their parents. These findings underscore the efficacy of pediatric residency training on tobacco, and it is hoped that they will serve as an impetus for other pediatric residency programs to introduce training on tobacco. Pediatrics 2001;108(1). URL: http://www. pediatrics.org/cgi/content/full/108/1/e8; tobacco control and prevention, cigarette smoking, environmental tobacco smoke, residency training.

The results support the efficacy of the special training program and underscore the importance of preparing pediatric residents to address tobacco.

ABSTRACT. Objective. Pediatricians have a unique and important role to play in the prevention and treatment of childhood and adolescent tobacco use, the protection of patients from the harmful effects of environmental tobacco smoke, and the encouragement of smoking cessation among parents. However, because recent research indicates that physician training in tobacco dependence is woefully weak and lacks a model for training, this article constructs a useful approach to this problem.Methodology. A comprehensive review of the literature served as the basis for the development of a new model for pediatrician training in tobacco dependence.Results. A comprehensive model is presented for training pediatricians in the areas of reducing infant and child exposure to environmental tobacco smoke, preventing youth smoking initiation, and providing smoking cessation assistance for adolescents and parents.Conclusions. Pediatricians have been called on to play an active role in the antitobacco arena. Because of their unique opportunity to interact with children, adolescents, and parents, pediatricians can and should be antitobacco interventionists. For this to occur, however, additional guidance should be provided to pediatricians during their training to better prepare them to carry out effective assessment and intervention practices. Pediatrics 2000;106(5). URL: http://www.pediatrics.org/ cgi/content/full/106/5/e66; smoking initiation, smoking prevention, smoking cessation, environmental tobacco smoke, pediatricians.

Objective-To evaluate the efficacy of a special program for training pediatric residents to address tobacco.Method-In a study conducted at the New Jersey Medical School, sixteen pediatric residencytraining programs in the New York/New Jersey metropolitan area were assigned randomly to either special or standard training conditions. All of the residents were invited to take part in the training. Only second and third-year residents participated in data collection activities (baseline and followup tobacco surveys and objective structured clinical examinations [OSCEs]). Baseline data were collected in the spring of 2001, and follow-up data were collected annually through the spring of 2005.Special training consisted of a hybrid website/CD-ROM training program on tobacco, a seminar series, companion intervention material, and clinic mobilization. Standard training residents participated in the seminar series and utilized standard educational and self-help material Results-The percent of residents in special training, but of not those in standard training, who provided assistance for modifying environmental tobacco smoke, preventing use, and helping patients and parents stop smoking increased significantly from baseline to year 4 of training, as did the percent who felt prepared to address tobacco. Performance on the OSCEs was consistent with survey outcomes, as special training residents revealed mastery of key interviewing and intervention skills. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access

Environmental tobacco smoke (ETS) is detrimental to the health of children. It is important for families to implement rules that limit the exposure of children both within the home and in the community. The current study used a diverse sample of participants from pediatric clinics in a large metropolitan area to explore what restrictions families place on tobacco use in their home and in the community (e.g., restaurants, trains). In general, minority ethnic groups were less likely than their Caucasian peers to limit exposure to ETS outside of the home, even when income and education were taken into account. Income and education had a consistent inverse relationship to the endorsement of home smoking rules. It was not surprising that smoking status of the parents and the presence of smokers in the home were related to fewer home smoking rules. Implications for communitybased interventions on the dangers of ETS are discussed.