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

项目摘要 在美国，烟草使用是可预防的死亡、残疾和疾病的唯一主要原因。 青春期是进行干预的关键发育期，90%的成年吸烟者是在青春期开始进行干预的 句号。使用电子尼古丁输送系统(END)，这是不可燃烟草产品(例如， 电子烟)，在年轻人中急剧增加，并与许多有害健康有关 结果以及酒精和其他非法物质的使用。国家指南建议对 在每一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这样做 参加初级保健。每年有150多万青少年住院治疗，其中许多 患者吸烟和与烟草相关的不良健康结局的风险增加，因为潜在的 共病(例如，精神健康障碍、物质使用障碍、哮喘)。尽管有证据支持 在成人住院期间的烟草使用治疗方面，还没有制定或测试干预措施 儿科医院环境。基于来自初级保健和医院的有前景的理论证据 环境，我们建议设计、迭代地改进和评估一种新型烟草和最终用途的实施 对住院青少年和青壮年(AYA)的干预。我们将发展介入治疗 利用5A的框架和激励性访谈，在住院的AYA中使用烟草和终端使用， 药物治疗和电脑化决策支持工具。我们将根据以下条件反复细化干预措施 关键利益攸关方反馈，包括AYA、父母/监护人和医院提供者。我们将进行一项 随机对照试验研究(n=144)，随访3个月以评估初步疗效以及 实施成果(即可接受性、可行性、忠诚度)。通过开展这些形成性研究 活动I将获得设计和初步评估行为的关键技能和专业知识 在复杂卫生保健系统的背景下进行干预。我们预计这些发现将直接 告知未来的干预混合实施试验计划，以确定短期和长期效果- 任期结束了禁欲。这项工作意义重大，因为它有可能增加筛查和治疗 年度协定中的烟草和终端使用导致使用率下降和相关的不良健康后果。

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.