Targeting high risk teens in the emergency department: A user-informed, theory-based intervention using text messaging to reduce teen pregnancy

摘要 急诊科（艾德）每年为1500万青少年提供护理，其中大多数是穷人、少数民族和 1 -6尽管人们越来越有兴趣扩大艾德的作用， 艾德提供者将有限的资源和时间限制视为实施的障碍 7，8需要新的干预措施，有效地适应艾德的工作流程。 先前的工作最近强调了一个重大的公共卫生问题--一个特别高的意外风险， 我们的青少年艾德人群中的怀孕率。3我们证明，使用我们的 艾德预计将在第二年怀孕，风险是全国平均水平的五倍，主要是 由于不使用避孕药。这些青少年在转诊时很少跟进生殖保健， 接受基于ED的妊娠预防干预，特别是使用短信。10 -13迄今为止， 没有任何干预措施成功地提高了这一高风险、难以接触到的艾德人群的避孕药具使用率。 劳伦S。Chernick，医学博士，理学硕士，是儿科急诊科的儿科助理教授 医学在哥伦比亚大学医学中心，并致力于改善生殖健康的结果 在艾德接受医疗服务的青少年。在建议的3年指导病人期间- 定向职业发展奖（K23），博士Chernick的知识和技能将通过 一个跨学科的导师和顾问团队致力于她的学术独立性的指导。博士 Chernick的多学科职业发展计划将侧重于以下四个关键模块：1）使用 移动的技术用于干预措施的实施和评估;（2）先进的临床试验设计和方法; (3)青少年研究的伦理和规范;（4）研究传播技巧和专业 发展Chernick博士的培训活动将得到一个原创项目的补充，该项目将加速 这些技能的应用。在目标1中，她将进行一项试点随机对照试验， 基于理论的，个性化的，互动的，预防怀孕短信干预（题为博士埃里卡）， 确定其可行性、可接受性和潜在功效。我们假设高危青少年女性艾德 接受埃里卡医生治疗的患者比接受标准治疗的女性更经常开始避孕 门诊转诊在目标2中，她将进行定性分析，以确定实现目标的障碍和推动因素。 在美国四个不同的ED实施生殖健康干预措施。这些数据将通知A 多中心临床试验，具有足够的把握度来测量避孕开始的临床显著变化。 博士Chernick的K23研究和培训将在准备R 01申请时达到高潮，以资助这一项目。 最终审判最终，有效和自动化的文本消息传递干预可以被其他人利用。 ED作为一种可重复和可扩展的手段，以促进生殖预防保健，减少意外青少年 怀孕，并改善整个美国的青少年健康结果。

ABSTRACT Emergency Departments (ED) care for 15 million adolescents each year, the majority being poor, minority, and participating in risky sexual behaviors.1–6 Despite a growing interest in expanding the role of the ED to provide preventive care, ED providers identify limited resources and time constraints as barriers to the implementation of public health interventions.7,8 Novel interventions are needed that fit efficiently within the ED workflow.9 Our prior work recently highlighted a significant public health problem—a particularly high risk of unintended pregnancy among our adolescent ED population.3 We demonstrated that 1 in 5 adolescent females who use our ED are expected to become pregnant in the following year, a risk five times the national average and primarily due to contraceptive non-use. These adolescents infrequently follow up for reproductive care when referred, yet are receptive to ED-based pregnancy prevention interventions, particularly using text messaging.10–13 To date, no intervention has successfully increased contraception use among this high risk, hard-to-reach ED population. Lauren S. Chernick, MD, MSc, is an Assistant Professor of Pediatrics in the Division of Pediatric Emergency Medicine at Columbia University Medical Center and is committed to improving the reproductive health outcomes of underserved adolescents using the ED for medical care. During the proposed 3-year Mentored Patient- Oriented Career Development Award (K23), Dr. Chernick’s knowledge and skills will be augmented through the guidance of an interdisciplinary team of mentors and advisors committed to her academic independence. Dr. Chernick’s multi-disciplinary career development plan will focus on the following four key modules: 1) the use of mobile technology for intervention delivery and evaluation; (2) advanced clinical trial design and methodology; (3) the ethics and regulations of researching adolescents; and (4) research dissemination skills and professional development. Dr. Chernick’s training activities will be complemented by an original project that will accelerate the application of these skills. In Aim #1, she will conduct a pilot randomized control trial of a user-informed, theory-based, personalized, interactive, pregnancy prevention text messaging intervention (entitled Dr. Erica) to determine its feasibility, acceptability and potential efficacy. We hypothesize that high risk adolescent female ED patients who receive Dr. Erica will more often initiate contraceptives than those females who receive standard outpatient referral alone. In Aim #2, she will conduct a qualitative analysis to identify barriers and enablers to the implementation of reproductive health interventions across four diverse EDs in the US. This data will inform a multi-center clinical trial with sufficient power to measure clinically significant changes in contraceptive initiation. Dr. Chernick’s K23 research and training will culminate in the preparation of a R01 application to fund this definitive trial. Ultimately, a text messaging intervention that is effective and automated can be utilized by other EDs as a reproducible and scalable means to promote reproductive preventive care, decrease unintended teen pregnancy, and improve adolescent health outcomes throughout the US.