School Nurse-delivered Smoking Cessation Intervention

在美国，吸烟是导致疾病和过早死亡的最大可预防原因。青少年吸烟是成年吸烟的最大预测因素，并与青少年时期的不良健康影响有关。22%的高中生报告正在吸烟（过去30天）。作为学校环境中的初级卫生专业人员，学校护士有巨大的机会在治疗青少年吸烟者方面发挥关键作用。在马萨诸塞州71所高中进行的一项随机对照试验（RCT）证明了学校护士为想要戒烟的青少年提供四次个人咨询干预的可行性，以及它在提高自我报告的短期（6周和3个月）戒烟率方面的潜在功效。虽然有希望，但初步研究缺乏生化验证和对干预效果维持的长期随访，并且主要是在白人学生群体中进行的。本申请旨在使用更严格的方法评估干预的有效性，包括对自我报告的吸烟行为进行生化验证和长期随访（干预后6个月和12个月），将干预与仅信息的注意力控制条件进行比较的研究设计，以及从不同种族的学校招募以增加我们研究结果的可推广性。本研究的总体目的是进行一项随机对照学校试验（RCT），以评估学校护士提供的戒烟干预在提高吸烟高中生30天戒断率方面的有效性。将招募40所高中，为不同的学生群体提供服务，并随机分配到以下两种条件之一：(1)特殊干预(SI) -根据学校护士提供的公共卫生服务（PHS）临床实践指南，进行4次30分钟的以患者为中心的戒烟咨询干预会议；或(2)只提供信息（IO）的注意力控制比较条件-与学校护士进行四次单独的会话，以检查吸烟状况，并提供标准化的一系列关于吸烟和戒烟的信息小册子。参与者评估将在研究开始（基线）和6周、3个月、6个月和12个月的随访中进行。从每所学校招募30名在过去30天内报告吸烟并愿意参加戒烟干预研究的9至12年级学生（n=1200），在12个月的随访中为每所学校提供25份完整的评估（n=1000）。如果发现有效，研究产品（即干预方案、学生材料、培训手册和实施干预的估计成本）将有助于在全国范围内向学校护士传播干预措施。

Smoking is the largest preventable cause of disease and premature death in the United States. Adolescent smoking is the greatest predictor of adult smoking and is associated with adverse health effects during adolescence. Twenty-two percent of high school students report current smoking (past 30 days). As the primary health professional in the school setting, school nurses have a tremendous opportunity to play a key role in treating adolescent smokers. A randomized controlled trial (RCT) conducted by the investigators in 71 high schools in Massachusetts demonstrated the feasibility of school nurses delivering a four-session individual counseling intervention to adolescents who want to stop smoking and its potential efficacy in increasing self-reported short term (6-week and 3-month) quit rates. Although promising, the preliminary study lacked biochemical validation and long-term follow-up on the maintenance of the intervention effects, and was conducted with a primarily white student population. This application seeks to evaluate the effectiveness of the intervention using a more rigorous methodology, including biochemical validation of self-reported smoking behavior and longer-term follow-up (6 and 12 months post-intervention), a study design that compares the intervention to an information only attention-control condition, and recruitment from ethnically diverse schools to increase the generalizability of our findings. The overall aim of the proposed study is to conduct a randomized controlled school-based trial (RCT) to evaluate the effectiveness of a school nurse-delivered smoking cessation intervention in increasing 30 day abstinence rates among high school students who smoke. Forty high schools serving a diverse student population will be recruited and randomly assigned to one of two conditions: (1) Special Intervention (SI) - four 30-minute individual patient-centered smoking cessation counseling intervention sessions based on the Public Health Service (PHS) clinical practice guideline delivered by school nurses; or (2) Information Only (IO) attention-control comparison condition - four individual sessions with the school nurse to check smoking status and deliver a standardized series of informational pamphlets on smoking and cessation. Participant assessments will occur at study entry (baseline) and at 6-week, 3-, 6-, and 12-month follow-up. Thirty students enrolled in grades 9 through 12 who report smoking within the past 30 days and willingness to participate in a smoking cessation intervention study will be recruited from each school (n=1200) to provide 25 completed assessments per school at 12-month follow-up (n=1000). If found effective, the study products (i.e., intervention protocol, student materials, training manual, and estimated costs of intervention implementation) will facilitate dissemination of the intervention to school nurses nationally.