Overview: I am applying for a 5-year Career Development Award (CDA) to support my overarching goal of increasing smoking cessation among patients with respiratory diseases. This will be accomplished through the completion of mentored research activities and formal training designed to provide the skills necessary to become an independent investigator. During the course of my award, I will develop and test a program of proactive tobacco treatment for smokers with chronic obstructive pulmonary disease (COPD), delivered electronically and designed to increase participation in evidence-based tobacco treatments. Significance: COPD is one of the most common conditions cared for by the Veterans Health Administration and 90% of cases are directly attributable to smoking. Though the VA has made great strides in tobacco control, patients with COPD continue to smoke at rates double the overall VA average. Treatment for tobacco use disorder is the most impactful intervention for smokers with COPD. Unfortunately, smokers with COPD remain undertreated for tobacco use. Proactive tobacco treatment programs, where smokers are systematically identified outside of a routine visit, engaged in a cessation attempt, and connected to evidence- based treatment, have been found to be effective for increasing smoking cessation and use of quit support, and may be particularly beneficial for smokers with COPD. Proactive programs are rarely implemented, possibly due to high associated workload. Using electronic communication such as secure messaging to deliver this care may be effective without the cost and workload associated with previously tested telephone outreach programs. The intervention developed in this CDA proposal has the potential for wide-reaching impact, leveraging existing VA resources more efficiently to increase cessation in this high-risk population. Career Plan: My primary area of research has focused on identifying gaps in care quality for patients with COPD, particularly in tobacco cessation treatment. To successfully achieve my goals of improving utilization of tobacco treatment for smokers with COPD, I need further mentored training in implementation science including: qualitative and mixed methods, design and testing of behavioral tobacco interventions with a focus on mobile health, and cost analysis. I will achieve these objectives through formal coursework, seminars, and mentored research activities under the guidance of Steven Fu, MD MSCE (primary mentor, Minneapolis VA Health Care System [MVAHCS]), Hildi Hagedorn, PhD (MVAHCS) and David Au, MD MS (VA Puget Sound). Research Plan: My primary research objective is to develop and test an electronic proactive tobacco treatment program for smokers with COPD. To execute this goal, I will complete the following projects: 1) a mixed methods (survey and interview) assessment of current use of health information technology among smokers with COPD to (A) inform the creation of a proactive tobacco treatment pro...