Tobacco Cessation Treatment for Alaska Native Youth

描述（由申请人提供）：青少年吸烟是美国一个主要的公共卫生问题。青少年中烟草使用的流行率目前在美国印第安人和阿拉斯加原住民中最高。居住在阿拉斯加西部育空-库斯科维姆三角洲地区的阿拉斯加原住民中，大约29%的11-14岁青少年和63%的15-18岁青少年吸烟。以前没有工作评估过阿拉斯加土著青少年的戒烟干预措施。这项提案建立在我们与Y-K三角洲阿拉斯加原住民社区的成功伙伴关系和7年合作记录的基础上。本提案的目的是为12至17岁的Y-K三角洲阿拉斯加土著青少年戒烟开发和试点一种新颖的、文化上合适的行为治疗方法。行为干预将包括一个为期2天、以小组为基础的初始项目，以及为期6周的随访支持。社会认知（学习）理论是提出干预的概念基础。我们期望，作为第一阶段项目的结果，我们将开发出一种可复制的、可行的、可接受的干预措施，其有效性可以在未来的大规模随机临床试验中进行测试。该项目将分两个阶段进行。在第一阶段，我们将根据青少年咨询小组的反馈制定干预措施，并制定顾问手册。后续战略也将被制定、试验和完善。20名青少年将完成该议定书，该议定书将根据参与者和咨询师的反馈以迭代的方式加以完善。第二阶段包括一项试点临床试验，将采用组随机设计，在第0周（基线）、第6周和第26周进行评估。8个村庄随机分为行为干预组和对照组（书面自助材料+戒断线转诊）。每个村庄将招收10名青少年，共计80名参与者。我们将评估干预的可行性和可接受性，根据治疗可接受性的定性评分，以及招募和保留率来确定。在第6周和第26周，我们将估计干预对生化证实的戒烟率的影响程度，并估计组内相关性（ICC）。在第6周，我们将评估干预对感知社会支持、戒烟自我效能和其他与我们的理论框架一致的变化机制的基线变化的影响。与健康相关的总体目标是为阿拉斯加土著青年制定有效的治疗方案，最终降低他们患烟草相关疾病的风险。公共卫生相关性：居住在阿拉斯加西部育空-库斯科维姆（Y-K）三角洲地区的阿拉斯加土著青少年中约有一半使用烟草。本研究提出了一种行为干预戒烟是文化上适合该地区的青少年。为阿拉斯加土著青年制定有效的戒烟干预措施可能最终降低他们患癌症和其他烟草相关疾病的风险。

DESCRIPTION (provided by applicant): Tobacco use among adolescents is a major public health problem in the United States. The prevalence of tobacco use among adolescents is currently highest among American Indians and Alaska Natives. Among Alaska Natives residing in the Yukon-Kuskokwim (Y-K) Delta region of western Alaska, approximately 29% of 11-14 year olds, and 63% of 15-18 year olds, use tobacco. No prior work has evaluated tobacco cessation interventions for Alaska Native adolescents. This proposal builds on our successful partnership and 7 year track record of collaboration with the Y-K Delta Alaska Native community. The objective of this proposal is to develop and pilot test a novel, culturally- appropriate, behavioral treatment approach for tobacco cessation among Y-K Delta Alaska Native adolescents ages 12 to 17. The behavioral intervention will include an initial, 2 day, group-based program with follow-up support for 6 weeks. Social cognitive (learning) theory is the conceptual basis for the proposed intervention. We expect that as a result of this stage I project, we will have developed a replicable, feasible, and acceptable intervention, the efficacy of which can be tested in future large-scale randomized clinical trials. This project will take place in two phases. In phase 1, we will develop the intervention with feedback from a teen advisory group, and develop a counselor manual. Follow-up strategies will also be developed, pilot- tested, and refined. Twenty adolescents will complete the protocol, which will be refined in an iterative manner based on feedback from participants and counselors. Phase 2, consisting of a pilot clinical trial, will apply a group-randomized design with assessments at weeks 0 (baseline), 6, and 26. Eight villages will be randomized to receive either the behavioral intervention or control condition (written self-help materials + quit line referral). Ten adolescents will be enrolled from each village, for a total of 80 participants. We will assess the feasibility and acceptability of the intervention, as determined by qualitative ratings of treatment acceptability, and recruitment and retention rates. We will estimate the magnitude of the effect of the intervention compared to the control condition on the biochemically confirmed tobacco abstinence rate at weeks 6 and 26, and estimate the intraclass correlation (ICC). At week 6, we will evaluate the effect of the intervention on changes from baseline on perceived social support, self-efficacy for stopping tobacco use, and other mechanisms of change consistent with our theoretical framework. The overall health related objective is to develop effective treatment programs for Alaska Native youth that will ultimately reduce their risk of tobacco- related disease. PUBLIC HEALTH RELEVANCE: About half of Alaska Native adolescents residing in the Yukon-Kuskokwim (Y-K) Delta region of western Alaska use tobacco. This study proposes to develop a behavioral intervention for tobacco cessation that is culturally appropriate for youth of this region. Developing effective tobacco cessation interventions for Alaska Native youth may ultimately reduce their risk of cancer and other tobacco-related disease.