PRIMARY CARE AND SELF HELP INTERVENTION FOR TEEN SMOKERS

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ABSTRACT(provided by applicant) Approximately 2,145 adolescents begin smoking each day in the US; an evidence base for effective cessation interventions for this population is just beginning to emerge. Brief primary care interventions for smoking with referral to appropriate adjuncts have been shown to be effective with adults; current clinical guidelines recommend extending this intervention to adolescent patients. Although there have been recent calls to action, tobacco cessation interventions by adolescent primary care providers remain low. The current trial is a randomized controlled trial to examine the effectiveness of a brief primary care provider intervention with referral to adjuncts for adolescent smoking cessation. Preliminary data indicate greater adoption of specific smoking screening and counseling behaviors by providers in intervention conditions relative to usual care control, although adoption of the systems and clinical interventions was not universal. To the extent that this health care delivery system can serve as a structure for providing evidence-based tobacco cessation interventions to adolescents, evidence based health care provider office systems interventions need to be identified and the infrastructure for intervention needs to be disseminated. The current project has 100 pediatric and family practices engaged, half of whom are now experienced in working with the brief intervention system. Using the evidence base generated from the current trial, lessons learned in the field, and specific collaborative feedback from practices, the proposed project would identify a set of recommended best practices for primary care office implementation of adolescent smoking cessation intervention using academic detailing. (Note that other models for implementing practice-based interventions exist and similar processes are needed for each; the current project will identify and package for the field best practices for the academic detailing model which is the one with which our team has had considerable experience). The development of such a "best practices" tool kit will provide critical infrastructure for dissemination of evidence-based cessation interventions as they emerge from the current trial and other adolescent trials underway.