Mobilizing the Community to Reduce Teen Prescription Drug Abuse

描述（由申请人提供）：青少年滥用处方药是一个严重且日益严重的问题。最新的全国数据显示，在过去的一年里，美国超过15%的12年级学生至少使用过一种非医疗用途的处方药。研究表明，青少年很容易从家里的家人或朋友那里获得可能被滥用的处方药。这项R21申请建立在先前研究的基础上，并提出了一项为期两年的可行性研究，以适应和实施一个综合社区预防模式（包括社区动员、家庭环境战略和医疗环境战略），以减少青少年在家中滥用处方药的可能性。研究地点将设在田纳西州南部阿巴拉契亚地区的一个县，据报道，那里的处方药滥用问题严重。我们提出的环境战略将借鉴最近在阿拉斯加州实施的由nida资助的综合社区预防模式，以减少有害合法产品（吸入剂、非处方药、家用产品和处方药）的可得性。具体目的是：(1)适应和实施针对青少年处方药滥用的综合社区处方药滥用预防模型；(2)评估被认为对青少年处方药滥用干预效果起中介作用的近端结果（社区参与、医生办公室和药房工作人员的倡导以及家庭中处方药的可获得性）的变化。我们还将评估实施质量的哪些方面（例如，覆盖范围、剂量、保真度）可以解释变化。评估青少年对滥用处方药的可获得性的近端结果变化的研究设计是干预前后仅限组的设计，该设计将利用来自5年级、7年级、9年级和11年级学生的小组数据，这些学生将在连续学年的两个时间点接受调查。其他近端结果的分析将利用参与环境策略的家长、医生办公室工作人员和药房工作人员的数据。家庭环境战略和医疗环境战略的活动都将以减少青少年在家中滥用处方药为目标。根据以往的研究成果，关键的影响因素被认为是规范，包括对青少年处方药滥用问题的关注，以及规则、法规和政策。我们提出的一套补充方法，包括旨在支持家庭环境战略的医疗环境战略，代表了一种新的和创新的预防青少年处方滥用问题的方法。这项研究的意义在于它有可能适应一个综合社区预防模式，以帮助防止青少年滥用处方药。公共卫生相关性：青少年滥用处方药是一个日益严重的问题。本研究旨在调整和实施一种综合社区预防模式，包括社区动员和环境战略（旨在支持家庭环境战略的医疗环境战略），重点是减少家庭中这些药物的可得性。如果这种方法成功，它将有助于解决这一严重的公共卫生问题。

DESCRIPTION (provided by applicant): Teen prescription drug abuse is a significant and growing problem. The latest national figures show that over 15% of 12th graders in the U.S. used at least one type of prescription drug for non-medical use in the past year. Research has shown that prescription drugs that can be abused are often readily available to teens either from family members in the home or from friends. This R21 application builds on previous research and proposes a two-year feasibility study to adapt and implement an integrated community prevention model (to include community mobilization, a home environmental strategy, and a medical environmental strategy) to reduce the availability of prescription drugs in the home for abuse by teens. The research setting will be one county in Southern Appalachian Tennessee in which prescription drug abuse is reported to be a problem. Our proposed environmental strategies will incorporate learnings from a recent NIDA-funded integrated community prevention model that was implemented in Alaska to reduce availability of harmful legal products (inhalants, over-the-counter drugs, household products, and prescription drugs). The specific aims are to (1) adapt and implement an integrated community prescription drug abuse prevention model that targets prescription drug abuse among teens, and (2) assess change in proximal outcomes (community engagement, advocacy by physicians' office and pharmacy staff, and the availability of prescription drugs in the home) believed to mediate intervention effects on teen prescription drug abuse. We will also assess what aspects of implementation quality (e.g., reach, dosage, fidelity) may explain the change. The research design for assessing change in the proximal outcome of teens' perceived availability of prescription drugs for abuse is a pre-post intervention-group-only design that will utilize data from a panel of students in grades 5, 7, 9, and 11 at baseline who will be surveyed at two time points in consecutive school years. Analyses of the other proximal outcomes will utilize data from participating parents, physicians' office staff, and pharmacy staff who participate in environmental strategies. Activities in both the home environmental strategy and the medical environmental strategy will be directed toward reducing availability of prescription drugs for abuse by teens in the home. Based on learnings from previous research, key contributing factors are posited to be norms, including concern over the problem of teen prescription drug abuse, and rules, regulations and policies. Our proposed set of complementary approaches, including a medical environmental strategy designed to support the home environmental strategy, represents a new and innovative prevention approach to the problem of teen prescription abuse. The significance of this study is its potential to adapt an integrated community prevention model to help prevent teens' abuse of prescription drugs. PUBLIC HEALTH RELEVANCE: Prescription drug abuse among teens is a significant and growing problem. This study seeks to adapt and implement an integrated community prevention model including community mobilization and environmental strategies (a medical environmental strategy designed to support a home environmental strategy) focused on reducing availability of these drugs in the home. If the approach is successful, it could help address this serious public health problem.