Adolescent Smoking Cessation in Pediatric Primary Care

描述(申请人提供)：大多数青少年吸烟者想戒烟，并曾尝试戒烟，但未获成功。虽然成人戒烟咨询是有效的，但针对青少年的戒烟咨询证据有限。我们建议开展一项先导性研究，以开发未来在儿科初级保健环境中青少年戒烟干预的有效性的随机临床试验。在之前AHRQ资助的一项研究中，我们试行了临床医生培训和实践系统改变干预措施。在这个拟议的R-21项目中，我们建立在这些成功的战略和向青少年提供干预的试点交付、青少年接受咨询的评估和戒烟结果的基础上。我们将与美国儿科学会办公室儿科研究(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)确定招募青少年和家庭进行研究评估的可行性；2)进一步展示实施和维护基于指南的系统变化和临床医生戒烟咨询干预措施的忠诚度，这些指南包括：a)使用图表工具进行系统筛选；b)使用公共医疗服务5A模式进行行为改变咨询；c)临床医生将青少年患者转诊至互联网和基于社区的辅助设备和资源，3)评估这些试点干预措施对戒烟干预措施的提供和对中间结果的影响，包括自我报告的戒烟尝试和戒烟结果。我们将评估10个专业实践站点的实践招募、戒烟培训和提供者提供的实践，并评估这些站点的青少年对研究程序的可接受性。我们的系统干预来自使用瓦格纳的慢性病护理模型的实践系统变化的文献，以及我们针对有效行为变化咨询的跨理论(阶段变化)模型和公共卫生服务5A模型的临床干预。多达1000名青少年将在探井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个月时接受电话调查，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，并探索干预措施对100名吸烟者的动机、戒烟、戒烟/复吸态度等吸烟行为的影响。该项目将产生关于实施情况的试点数据，这对开展未来以PBRN为基础的关于青少年停止在儿科护理中的大型试验至关重要。研究初级保健、社区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.