PRIMARY CARE AND SELF HELP INTERVENTION FOR TEEN SMOKERS

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DESCRIPTION: (Applicant's Description) Over 3 million adolescents smoke cigarettes, with 3,000 starting each day. Most will continue to smoke, and an estimated 5 million people ages 0-17 in 1995 will ultimately die from a smoking-related disease. Although research efforts have focused on methods for preventing adolescent smoking, there are little data available on how to help the one-third of adolescents who smoke. Effective cessation interventions are key to reducing smoking prevalence in this population. Both clinician- and self-help interventions are particularly appropriate to this population, as they allow for targeting large and geographically diverse populations, while maintaining confidential contact that is developmentally important to this age group. The proposed study will examine the effectiveness of a health care provider-based intervention with self help adjuncts for adolescent smokers ages 14-18. Ninety pediatric and adolescent practices will be recruited in a 6 county area, with 20 adolescents/practice for a total of 1800 subjects. Practices will be blocked on key variables and randomized to: 1) Intervention - physician, nurse practitioner, and physician assistant training in smoking intervention (following NCI and AHCPR guidelines), and self-help adjuncts (self-help manual, hotline, proactive calls, Internet resources) or 2) Usual care. Interventions and practice level implementation will be guided by focus group feedback in year 1. Subjects will be followed by telephone at 3 and 12 months for determination of smoking status, use of self-help resources, and other smoking/health variables. Health care providers will be surveyed pre- and post training and at 12 month follow-up to regarding self-reported smoking screening and intervention with adolescents; adolescent subjects will also be queried regarding receipt of these services. This study will provide evidence for effective smoking cessation interventions for adolescents, and will assist in planning future intervention efforts with this population.