Improving Parent/Adolescent Communication about Tobacco

说明(由申请人提供)：低社会经济地位的市中心儿童在青春期开始吸烟并在成年后继续吸烟的风险很高。青少年对非紧急健康问题的急性护理服务利用率很高，这表明急诊科(ED)为预防烟草使用提供了一个有前途的创新环境。此外，由于寻求紧急护理的青少年患者通常由父母陪同，因此在急诊室提供的干预可以同时接触到儿童和家长。儿童/父母一致干预的理由来自于青少年吸烟与父母对吸烟的宽大感受有很强的关联。K23奖将为候选人提供时间、资源和指导，将她在烟草预防方面的研究兴趣与她在急诊医学方面的临床经验结合起来。她的长期目标是制定量身定做的干预措施，帮助父母防止青少年开始和使用烟草。为颁奖期提出的研究计划集中于一项名为改善父母/青少年对烟草的沟通(IMPACT)的烟草预防战略的试点测试、修订、实施和评估。该策略是由研究团队开发的，基于计划行为理论。干预措施包括：父母可以向11-14岁的青少年子女传达的有关烟草使用的文化上适当的口头和书面信息；模拟有效的亲子讨论这些信息的录像带；以及测试干预措施有效性的调查工具。重点访谈、定量评估和影响专家审查将导致对材料进行修订，然后使用为期六个月的纵向随机设计评估影响的影响。这项拟议的研究试图探索影响对青少年吸烟意图和意愿的有效测量的影响，以及影响影响的潜在中介和调节因素。假设的中介因素包括青少年对烟草风险的了解；青少年对父母态度、社会接受程度和烟草使用普及率的看法；以及青少年应避免的自我效能和父母应预防的使用自我效能。假设的调节因素包括青少年种族/民族、青少年性别和父母吸烟行为。为获奖期提出的职业发展计划包括先进的定性和定量方法、健康行为理论、青少年成瘾以及对现有烟草预防方案的实地观察。在获奖期结束时，候选人希望提交一份R01拨款申请，用于一项旨在评估影响青少年实验、开始和持续使用烟草的影响的纵向研究。

DESCRIPTION (provided by applicant): Inner-city children of low socioeconomic status are at high risk for initiating tobacco use during adolescence and continuing its use throughout adulthood. The high utilization of acute-care services for non-emergent health problems by adolescents suggests that the emergency department (ED) offers a promising and innovative setting for the prevention of tobacco use. Furthermore, because adolescent patients seeking urgent care typically are accompanied by parents, an intervention delivered in the ED can reach child and parent simultaneously. The rationale for coincident child/parent intervention derives from the strong association of adolescent smoking with perceived parental leniency toward smoking. The K23 award will provide the time, resources, and mentorship for the Candidate to integrate her research interest in tobacco prevention with her clinical experience in emergency medicine. Her long-term goal is to develop tailored interventions that will help parents prevent tobacco initiation and use by their adolescent children. The research plan proposed for the Award period centers on the pilot testing, revision, implementation, and evaluation of a tobacco prevention strategy entitled Improving Parent/Adolescent Communication about Tobacco (IMPACT). The strategy was developed by the research team and is based on the Theory of Planned Behavior. The intervention consists of: culturally appropriate verbal and written messages about tobacco use that can be conveyed by parents to their adolescent children aged 11-14 years; a videotape that models effective parent-adolescent discussion of these messages, and; a survey instrument to test the effectiveness of the intervention. Focused interviews, quantitative evaluation, and expert review of IMPACT will result in revision of the materials, followed by evaluation of the effects of IMPACT using a six-month longitudinal, randomized design. The proposed research seeks to explore the effect of IMPACT on validated measures of adolescent intention and willingness to smoke, as well as potential mediators and moderators of the effect. Hypothesized mediators include adolescent knowledge of tobacco risk; adolescent perceptions of parental attitudes, social acceptance, and prevalence of tobacco use; and the self-efficacy of adolescents to avoid, and parents to prevent, use. Hypothesized moderators include adolescent race/ethnicity, adolescent gender, and parent smoking behavior. The career development plan proposed for the Award period incorporates coursework in advanced qualitative and quantitative methods, health behavior theory, adolescent addiction, as well as field observation of existing tobacco prevention programs. By the end of the Award period, the Candidate expects to submit an R01 grant application for a longitudinal study designed to assess the effect of IMPACT on adolescent experimentation, initiation, and ongoing use of tobacco.