Adolescent Smoking Cessation in Pediatric Primary Care

儿科初级保健中的青少年戒烟

• 批准号: 7268151
• 负责人: JONATHAN D KLEIN
• 金额: $ 15.07万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7268151
• 关键词: Abstinence; Academy; Adolescence; Adolescent; Adult; Affect; American; Attitude; Baseline Surveys; Caring; Childhood; Chronic Disease; Classification; Clinical; Clinical Trials; Communities; Counseling; Data; Distance Learning; Effectiveness of Interventions; Enrollment; Evaluation; Evaluation Research; Family; Funding; Future; Goals; Grant; Guidelines; Internet; Intervention; Lead; Learning; Literature; Maintenance; Measures; Modeling; Motivation; Network-based; Outcome; Patient Self-Report; Patients; Pattern; Pediatric Research; Pediatrics; Physicians; Pilot Projects; Practice based research; Prevention; Preventive; Primary Health Care; Procedures; Protocols documentation; Provider; Randomized; Randomized Clinical Trials; Relapse; Research Personnel; Resources; Screening procedure; Services; Site; Smoke; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Staging; Surveys; System; Teenagers; Telephone; Testing; Thinking; Time; Tobacco Use Cessation; Training; United States Agency for Healthcare Research and Quality; United States Public Health Service; Visit; Week; Youth; adolescent smoking; base; behavior change; effectiveness clinical trial; follow-up; improved; research study; smoking cessation; tool

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.

描述（由申请人提供）：大多数青少年吸烟者想要戒烟，但尝试失败。虽然成人戒烟咨询有效，但针对青少年戒烟咨询的证据有限。我们提出一项试点研究，这对于未来开展儿童初级保健机构中青少年戒烟干预措施有效性的随机临床试验至关重要。在之前的 AHRQ 资助的研究中，我们试点了临床医生培训和实践系统变革干预措施。在这个拟议的 R-21 项目中，我们以这些成功的策略为基础，向青少年提供试点干预措施、评估青少年接受咨询的情况以及戒烟结果。我们将与美国儿科学会办公室环境儿科研究 (PROS) 基于实践的研究网络 (PBRN) 合作测试这些策略。我们的具体目标是： 1）建立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，进一步证明对基于指南的系统变更和临床医生戒烟咨询干预措施的实施和维护的忠诚度，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 模型进行行为改变咨询，以及 c) 临床医生将青少年患者转介至互联网和基于社区的辅助工具和资源，以及 3) 评估这些试点干预措施对戒烟干预措施实施以及中间结果（包括自我报告的戒烟尝试和戒烟结果）的影响。我们将评估 10 个 PROS 实践地点的提供者的实践招募和戒烟培训和提供情况，并评估这些地点青少年对研究程序的可接受性。我们的系统干预借鉴了有关使用瓦格纳慢性病护理模型的实践系统变化的文献，以及我们对跨理论（变化阶段）模型和公共卫生服务 5A 模型的临床干预，以提供有效的行为改变咨询。多达 1000 名青少年将在走访前完成一项简短的基线调查。吸烟者将在 2-3 周、3 个月和 6 个月时通过电话进行调查，为未来的研究提供戒烟结果的初步估计。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。研究临床医生在初级保健社区儿科实践中的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。