Development and Implementation of a Tobacco and ENDS Use Intervention for Adolescents and Young Adults in the Pediatric Hospital

项目摘要 烟草使用是美国可预防的死亡、残疾和疾病的唯一主要原因。 青少年是一个关键的发展时期，因为90%的成年烟草使用者在此期间开始吸烟。 期使用电子尼古丁输送系统（ENDS），这是不可燃的烟草产品（例如， 电子烟），在年轻人中急剧增加，并与许多不利的健康状况有关 结果以及使用酒精和其他非法物质。国家指导方针建议咨询， 在每次青少年临床就诊时解决烟草使用问题;然而，许多高危青少年并不经常 参加初级保健。每年有超过150万青少年住院，其中许多人 患者吸烟和烟草相关不良健康结果的风险增加， 合并症（例如，精神健康障碍、物质使用障碍、哮喘）。尽管有证据表明 治疗成人住院期间的烟草使用，没有干预措施已经制定或测试， 儿科医院环境。基于来自初级保健和医院的有希望的理论证据 我们建议设计，反复完善和评估一种新的烟草和ENDS使用的实施， 对住院青少年和年轻人（AYAs）的干预。我们将开发干预治疗 利用5A的框架与动机访谈， 药物治疗和计算机决策支持工具。我们将根据以下方面反复完善干预措施： 关键利益相关者的反馈，包括AYAs，父母/监护人和医院提供者。我们将进行 随机对照初步研究（n=144），随访3个月，以评价初步疗效以及 执行成果（即，可接受性、可行性、保真度）。通过开展这些形成性研究， 活动我将获得关键技能和专业知识的设计和初步评估的行为 在复杂的卫生保健系统中进行干预。我们预计这些发现将直接 告知未来计划进行干预的混合实施试验，以确定短期和长期的有效性- 结束禁欲。这项工作是重要的，因为它有可能增加筛查和治疗 烟草和ENDS在AYA的使用导致使用率下降和相关的不良健康结果。

Project Summary Tobacco use is the single leading cause of preventable death, disability and disease in the United States. Adolescence is a critical developmental period to intervene as 90% of adult tobacco users initiate during this period. Use of electronic nicotine delivery system (ENDS), which are noncombustible tobacco products (e.g., e-cigarettes), has increased dramatically among youth and is associated with numerous adverse health outcomes as well as use of alcohol and other illicit substances. National guidelines recommend counseling to address tobacco use at every adolescent clinical visit; however, many at-risk adolescents do not routinely attend primary care. There are more than 1.5 million adolescent hospitalizations annually and many of these patients are at increased risk for tobacco use and tobacco-related poor health outcomes due to underlying comorbidities (e.g., mental health disorders, substance use disorders, asthma). Although evidence supports treatment of tobacco use during an adult hospitalization, no interventions have been developed or tested in the pediatric hospital setting. Based on promising theoretically-based evidence from the primary care and hospital settings, we propose to design, iteratively refine and assess implementation of a novel tobacco and ENDS use intervention for hospitalized adolescents and young adults (AYAs). We will develop the intervention to treat tobacco and ENDS use in hospitalized AYAs utilizing the 5A’s framework with motivational interviewing, pharmacotherapy and computerized decision support tools. We will iteratively refine the intervention based on key stakeholder feedback, including AYAs, parents/guardians and hospital providers. We will conduct a randomized controlled pilot study (n=144) with 3-month follow up to evaluate preliminary efficacy as well as implementation outcomes (i.e., acceptability, feasibility, fidelity). Through conduct of these formative research activities I will gain critical skills and expertise in the design and preliminary evaluation of behavioral interventions within the context of complex health care systems. We anticipate these findings will directly inform future plans for a hybrid implementation trial of the intervention to determine efficacy for short and long- term ENDS abstinence. This work is significant as it has the potential to increase screening and treatment of tobacco and ENDS use in AYAs leading to decreased rates of use and related poor health outcomes.