A Multilevel Analysis of Predictors of Successful Teen Smoking Cessation in the N

描述(由申请者提供)：项目摘要/摘要毫无疑问，吸烟仍然是美国最重要和最紧迫的公共健康问题之一。吸烟不仅每年在公共和私人医疗保健上花费超过960亿美元，而且每年还导致近50万人死亡。此外，每一个与烟草有关的死亡中，就有20个人患有与烟草有关的疾病。然而，尽管开展了预防和戒烟方面的研究以及财政和政策努力，但吸烟率在过去几年中保持稳定。然而，特别是对于青少年吸烟者来说，仍然存在对有效戒烟方案的重大需求和巨大需求。然而，不幸的是，关于成功的青少年戒烟计划的证据有限。由于成功的戒烟计划很少，因此对那些接受结构化戒烟计划的青少年的社会人口统计、心理和背景特征以及这些特征如何结合起来影响戒烟成功或失败的了解相对较少。缺乏这样的知识很重要，因为为了使干预措施与最有可能从此类计划中受益的人相匹配，并为那些在既定干预措施中失败的人修改现有治疗方法，我们必须首先了解那些成功和失败的个人和计划的特征。本研究试图通过对最大的青少年吸烟者数据库进行结构方程建模和分层线性建模来解决这些问题，这些数据库是在一个单一的、经验支持的干预措施-美国肺脏协会的不吸烟(NOT)计划-中接受戒烟治疗的青少年吸烟者。 通过认识和关注青少年吸烟和青少年戒烟的嵌套性质，我们希望将影响戒烟的不同生态和个人层面的变量联系起来，从而阐明个人吸烟者与其近端和远端社会生态之间的复杂相互作用。本研究的贡献将是重大的，因为它将第一次评估寻求通过单一经验支持的结构化干预措施戒烟的青少年的大型数据库。拟议的研究结果将有助于确定个人因素(例如吸烟史、尼古丁依赖)以及几个嵌套因素的作用，包括同伴吸烟环境、戒烟团体动态以及学校、社区和州一级的因素。这些知识对于确定治疗失败的风险青年以及在个人、地方和州一级确定可能与戒烟成功或失败有关的关键背景和政策因素至关重要。项目简介这项拟议的研究是对青少年戒烟的多个层面的影响的广泛分析。最先进的统计分析，包括结构方程建模和分层线性建模，将有助于阐明个人因素、父母和同伴的影响以及学校、县和州因素如何结合在一起，影响寻求通过经验支持的戒烟计划戒烟的青少年的结果。这项拟议的研究与公共卫生和癌症控制相关，因为这项研究有可能指导戒烟招募、计划修改以及学校、县和州范围内有关吸烟的政策。

DESCRIPTION (provided by applicant): Project Summary / Abstract There is little question that cigarette smoking remains one of the nation's most significant and pressing public health concerns. Not only does smoking cost over $96 billion in public and private health care dollars annually, it is responsible for nearly half a million deaths each year. Moreover, for every tobacco related death, there are 20 individuals who are suffering with a tobacco-related disease. Nevertheless, despite research as well as financial and policy efforts geared towards tobacco prevention and cessation, the rates of smoking have remained stable for the last several years. Nevertheless, especially with regard to youth smokers, there continues to be both a significant need and a significant demand for effective cessation programs. Unfortunately, however, there is limited evidence regarding successful youth smoking cessation programs. Because so few programs have been successful, relatively little is known about the socio-demographic, psychological, and contextual characteristics of those teens who undertake structured cessation programs and how these characteristics combine to influence to cessation success or failure. Lack of such knowledge is important because in order to match interventions with those who are most likely to benefit from such programs, as well as to modify existing treatments for those who fail in established interventions, we must first understand the characteristics of those individuals and programs that succeed and those that fail. The present study seeks to address these issues by conducting extensive higher-order analyses, including structural equation modeling and hierarchical linear modeling, of the largest database of teen smokers undergoing cessation treatment in a single, empirically supported intervention - the American Lung Association's Not On Tobacco (NOT) program. By recognizing and attending to the nested nature teen smoking and teen smoking cessation, it is our hope to connect distinct ecological and individual-level variables that influence smoking cessation; thereby illuminating the complex interplay between individual smokers and both his/her proximal and distal social ecology. The contribution of the present study will be significant because it will be the first to evaluate a large database of adolescents seeking to quit smoking through a single empirically supported structured intervention. The results of the proposed study will help determine the role of individual factors (e.g., smoking history, nicotine dependence) as well as several nested factors, including peer smoking environment, cessation group dynamics, and school, community and state level factors. Such knowledge will be critical in the identification of youth at-risk for treatment failure, as well as the identification of critical contextual and policy factors at the individual, local and state level that may relate to smoking cessation success or failure. Project Narrative The proposed study is an extensive analysis of a multiple levels of influence on teen smoking cessation. The state-of-the-art statistical analyses, including structural equation modeling and hierarchical linear modeling, will help illuminate how individual factors, parental and peer influences and school, county and state factors combine to impact the outcomes of teens seeking to quit smoking through an empirically supported cessation program. The proposed research has relevance to public health and cancer control because of the potential that this research has to guide smoking cessation recruitment, program modification, and school, county and state-wide polices regarding smoking.