Adolescent Smoking Cessation in Pediatric Primary Care

描述（由申请人提供）：大多数青少年吸烟者想戒烟，并试图戒烟失败。虽然成人戒烟咨询是有效的，但青少年戒烟咨询的证据有限。我们提出了一个试点研究至关重要的发展未来的随机临床试验的有效性，青少年戒烟干预在儿科初级保健设置。在以前的AHRQ资助的研究中，我们试行了临床医生培训和实践系统改变干预措施。在这个建议的R-21项目中，我们建立在这些成功的策略和试点交付的干预措施，青少年接受咨询，和戒烟的结果进行评估。我们将与美国儿科学会办公室儿科研究（PROS）实践研究网络（PBRN）合作测试这些策略。我们的具体目标是：1）建立实践招募青少年和家庭进行研究评估的可行性; 2）随着时间的推移，进一步证明对基于系统变化和临床医生戒烟咨询干预的指南的实施和维护的忠实性，包括：a）使用图表工具进行系统筛查; B）使用公共卫生服务5A模式的行为改变咨询，以及c）临床医生将青少年患者转介到互联网和基于社区的咨询师和资源，以及3）评估这些试点干预措施对戒烟干预措施实施的影响，以及对中间结果的影响，包括自我报告的戒烟尝试和戒烟结果。我们将在10个PROS实践中心评价实践招募和戒烟培训以及提供者的提供，并评估这些中心青少年对研究程序的可接受性。我们的系统干预借鉴文献实践系统的变化，使用瓦格纳的慢性病护理模式，我们的临床干预的跨理论（阶段的变化）模型和公共卫生服务5A模型有效的行为改变咨询。多达1000名青少年将在油井访视前完成一项简短的基线调查。吸烟者将在2-3周以及3个月和6个月时接受电话调查，以提供戒烟结果的初步估计，供未来研究使用。我们将测试措施，描述青少年吸烟模式，并探讨干预措施对100名吸烟者的动机，戒烟，戒烟/复吸态度和其他吸烟行为的影响。该项目将产生关于实施的试点数据，这些数据对于未来在儿科护理中进行基于PBRN的大型青少年戒烟试验至关重要。研究在初级保健社区为基础的儿科实践中的临床医生干预措施，有可能改善戒烟的临床预防服务，并迅速传播有效的干预措施。

DESCRIPTION (provided by applicant): Most adolescent smokers want to quit and have tried to unsuccessfully. While adult cessation counseling is effective, the evidence for cessation counseling for adolescents is limited. We propose a pilot study essential to developing future randomized clinical trials of the effectiveness of adolescent cessation interventions in pediatric primary care settings. In a previous AHRQ funded study, we piloted clinician training and practice systems change interventions. In this proposed R-21 project, we build on these successful strategies and pilot delivery of interventions to adolescents, evaluation of adolescent receipt of counseling, and cessation outcomes. We will test these strategies in partnership with the American Academy of Pediatrics Pediatric Research in Office Settings (PROS) practice based research network (PBRN). Our specific aims are to: 1) Establish the feasibility of practices' recruitment of adolescents and families for research evaluation; 2) Further demonstrate fidelity to implementation and maintenance of guidelines based system changes and clinician cessation counseling interventions over time, including: a) systematic screening using charting tools; b) behavior change counseling using the public health service 5 A's model, and c) clinician referral of adolescent patient to Internet and community-based adjuncts and resources, and 3) Assess the impact of these pilot interventions on delivery of cessation interventions, and on intermediate outcomes, including self-reported quit attempts and cessation outcomes. We will evaluate practice recruitment and smoking cessation training and delivery by providers in 10 PROS practice sites, and assess acceptability of study procedures to adolescents in these sites. Our systems intervention draws from literature on practice systems changes using Wagner's chronic disease Care Model, and our clinical interventions on the transtheoretical (stages of change) model and the Public Health Service 5A model for effective behavior change counseling. Up to 1000 adolescents will complete a short baseline survey prior to well-visits. Smokers will be surveyed by phone at 2-3 weeks and at 3 and 6 months, to provide preliminary estimates of cessation outcomes for future studies. We will test measures, describe patterns of smoking among youth, and explore the effect of interventions on motivation, quitting, abstinence/ relapse attitudes, and other smoking behaviors for 100 smokers. This project will result in pilot data on implementation essential to conducting future large PBRN-based trials of adolescent cessation in pediatric care. Studying clinician interventions in primary care community-based pediatric practice has the potential to lead to improved clinical preventive services for tobacco cessation and also to rapid dissemination of effective interventions.