Curbing Tobacco Use in Suburban and Rural Schools

描述（由申请人提供）：青少年吸烟仍然是一个主要的公共卫生问题。在过去的20 - 30年里，在制定以戒烟为导向的烟草控制计划方面取得了相当大的进展。现在通过互联网提供几个方案。然而，许多这些程序未能充分利用现有的现代技术，如交互性，动画，视频片段，视频游戏组件，以及其他功能，拥有巨大的吸引力，当代，计算机精明的青年。我们的长期目标是制定以青少年为导向的烟草控制计划，这些计划在说服年轻人避免使用烟草产品或（如果他们已经使用此类产品）戒烟方面非常成功。我们最近完成了由国家癌症研究所资助的研究，“通过光盘预防和戒烟青少年”（ASPIRE项目），采用了对吸烟者友好的现代技术，并显示出重大的有益影响，特别是在预防吸烟方面。拟议的项目是ASPIRE项目的延续，将以ASPIRE项目的优势为基础，并在重要方面加以扩大。新的干预措施与以前以光盘为基础的干预措施不同，将以互联网为基础。虽然最初的方案是为市中心，主要是少数民族青少年（6%白人）设计和测试，新的方案将针对一组郊区和农村高中学生有很大不同的种族构成（约50%白人）和社会经济地位的特点。最初的ASPIRE项目干预措施将在认真考虑新的目标人群和干预措施设置的情况下进行重大重新设计。由于非城市青少年烟草使用者中吐出烟草消费的流行率很高（根据我们的初步研究为35%），新方案也将解决吐出烟草问题。最后，在新的计划中，课堂课程将加强一个强大的，二维的社会支持组件：（1）通过互联网公告板和聊天室在家里的虚拟支持和（2）通过训练有素的学校人员（教师，教练，辅导员和护士）的人力支持。我们的具体目标是确定新的干预措施是否会导致（1）吸烟开始减少，（2）戒烟增加，（3）对吐出烟草使用产生积极影响，（4）通过跨理论模型的吸烟和吐出烟草使用变化阶段的积极进展，和（5）与标准护理条件相比，已知介导烟草使用的关键变量的积极变化。这项研究将是一项分组随机对照试验，有2000名年龄在14-16岁之间的参与者，他们来自德克萨斯州东南部郊区和农村的16所高中。将在6周和6、12和18个月时进行随访评估。

DESCRIPTION (provided by applicant): Tobacco use among adolescents remains a major public health problem. Over the past 2-3 decades, considerable progress has been made in developing adolescent-oriented tobacco control programs. Several programs are now being offered via the Internet. However, many of these program fail to take full advantage of available modern technology such as interactivity, animations, video segments, video-game components, and other features that hold tremendous appeal for contemporary, computer-savvy youth. Our long-term goal is to develop adolescent-oriented tobacco control programs that are extremely successful in convincing young people to avoid using tobacco products or, if they are already using such products, to quit. Our recently completed NCI-funded study, "Teen Smoking Prevention and Cessation via CD-ROM" (Project ASPIRE), incorporated adolescent-friendly modern technology and demonstrated a significant beneficial impact, particularly in smoking prevention. The proposed project is a continuation of Project ASPIRE and will build on the strengths of Project ASPIRE and expand it in important ways. The new intervention, unlike its CD-ROM-based predecessor, will be Internet-based. While the original program was designed for and tested among inner-city, predominantly minority adolescents (6% whites), the new program will be targeted at a group of suburban and rural high school students with a substantially different ethnic make-up (approximately 50% whites) and socio-economic status characteristics. The original Project ASPIRE intervention will be substantially redesigned with careful consideration of the new target population and intervention setting. Because of the high prevalence of spit tobacco consumption among non-urban teenage tobacco users (35% according to our preliminary study), spit tobacco will also be addressed in the new program. Finally, in the new program, the classroom curriculum will be fortified with a strong, two-dimensional social support component: (1) virtual support at home via Internet bulletin boards and chat rooms and (2) human support via trained school personnel (teachers, coaches, counselors, and nurses). Our specific aims are to determine whether the new intervention results in (1) a reduction in smoking initiation, (2) an increase in smoking cessation, (3) a positive impact on spit tobacco use, (4) positive progression through the Transtheoretical model's stages of change in both smoking and spit tobacco use, and (5) positive change in key variables known to mediate tobacco use compared to a standard care condition. The study will be a group-randomized, controlled trial with 2000 participants aged 14-16 years from 16 high schools in suburban and rural southeast Texas. Follow-up assessments will be conducted at 6 weeks and at 6, 12, and 18 months.