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

针对急诊科的高危青少年：基于用户知情、基于理论的干预措施，使用短信来减少青少年怀孕

• 批准号: 10007637
• 负责人: Lauren Stephanie Chernick
• 金额: $ 16.64万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-13 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10007637
• 关键词: Academic Medical Centers; Accident and Emergency department; Adolescent; Advisory Committees; Affect; Age; Award; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinical Trials; Clinical Trials Design; Complement; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Development; Development Plans; Effectiveness; Elements; Emergency Care; Emergency Department patient; Emergency Department-based Intervention; Emergency Medicine; Emergency department visit; Ethics; Evaluation; Exhibits; Feedback; Female; Female Adolescents; Focus Groups; Funding; Geography; Goals; Grant; Health; Health Promotion; Healthy People 2020; High-Risk Pregnancy; Instruction; Intervention; Interview; K-Series Research Career Programs; Knowledge; Learning; Learning Module; Measures; Medical; Mentors; Meta-Analysis; Methodology; Methods; Minority; Multi-Institutional Clinical Trial; Multicenter Trials; Outcome; Outpatients; Participant; Pediatrics; Persons; Physicians; Population; Pregnancy; Pregnancy in Adolescence; Preparation; Preventive; Preventive Intervention; Preventive care; Preventive service; Provider; Public Health; Randomized; Randomized Controlled Trials; Regulation; Reproducibility; Reproductive Health; Research; Research Personnel; Research Training; Resources; Risk; Risk Behaviors; Role; Self Efficacy; Sexual Health; Site; Source; Technology; Teenagers; Testing; Text Messaging; Time; Training Activity; United States; Universities; Woman; Work; adolescent health; adolescent health outcomes; base; behavior change; behavioral health; binge drinking; career development; clinically significant; control trial; design; digital; evidence base; follow-up; high risk; high risk sexual behavior; high-risk adolescents; improved; innovation; interest; mHealth; mobile computing; motivated behavior; multidisciplinary; novel; patient oriented; pediatric emergency; peer; pregnancy prevention; pregnant; primary outcome; professor; programs; public health intervention; reproductive; reproductive health intervention; reproductive health of adolescents; research data dissemination; role model; skills; theories; underserved minority; unintended pregnancy

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.

摘要 急诊科(ED)每年照顾1500万青少年，其中大多数是穷人、少数族裔和 参与危险的性行为1-6尽管人们越来越有兴趣扩大教育署的作用，以提供 预防保健，急诊科提供者认为有限的资源和时间限制是实施的障碍 公共卫生干预措施。7、8项新的干预措施需要有效地适应ED的工作流程。 先前的研究最近强调了一个重大的公共卫生问题--意外感染的风险特别高 在我们的青少年ED人群中怀孕。3我们证明，使用我们的 预计ED将在下一年怀孕，这一风险是全国平均水平的五倍，主要是 由于没有使用避孕药具。这些青少年在被转介时很少跟进生殖保健，但 接受以ED为基础的避孕干预措施，特别是使用短信。10-13迄今， 没有任何干预措施成功地增加了这一高风险、难以接触到的ED人群中的避孕用具使用量。 劳伦·S·切尼克，医学博士，理学硕士，儿科急诊科儿科学助理教授 在哥伦比亚大学医学中心工作，致力于改善生殖健康结果 未得到充分服务的青少年使用急诊室进行医疗护理的情况。在拟议的3年指导患者期间- 定向职业发展奖(K23)，切尼克博士的知识和技能将通过 在致力于她的学术独立的跨学科导师和顾问团队的指导下。Dr。 切尼克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 (2)先进的临床试验设计和方法学； (3)研究青少年的道德和规则；(4)研究传播技巧和专业知识 发展。切尼克博士的培训活动将得到一个原始项目的补充，该项目将加快 这些技能的应用。在目标1中，她将对一名用户知情的患者进行试点随机对照试验， 基于理论的、个性化的、交互式的怀孕预防短信干预(名为Dr.Erica) 确定其可行性、可接受性和潜在疗效。我们假设高危青春期女性ED 接受埃里卡医生治疗的患者会比接受标准避孕措施的女性患者更常采取避孕措施。 仅门诊转诊一项。在目标2中，她将进行定性分析，以确定 在美国四个不同的急诊室实施生殖健康干预措施。此数据将通知 多中心临床试验，具有足够的能力来衡量避孕措施开始时的临床显著变化。 Chernick博士的K23研究和培训将最终以准备R01申请为其提供资金 最终的审判。最终，有效和自动化的短信干预可以被其他人利用 EDS作为一种可重复和可扩展的手段来促进生殖预防保健，减少意外青少年 怀孕，并改善全美青少年的健康状况。

项目成果

Adolescent Male Receptivity of and Preferences for Sexual Health Interventions in the Emergency Department.

• DOI: 10.1097/pec.0000000000002563
• 发表时间: 2022-05-01
• 期刊: PEDIATRIC EMERGENCY CARE
• 影响因子: 1.4
• 作者: Chernick, Lauren S.;Wallace, Brendan K.;Potkin, Maxmoore T.;Bell, David L.;Dayan, Peter S.
• 通讯作者: Dayan, Peter S.

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments.

• DOI: 10.1001/jamanetworkopen.2022.55986
• 发表时间: 2023-02-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Brent, David A.;Horowitz, Lisa M.;Grupp-Phelan, Jacqueline;Bridge, Jeffrey A.;Gibbons, Robert;Chernick, Lauren S.;Rea, Margaret;Cwik, Mary F.;Shenoi, Rohit P.;Fein, Joel A.;Mahabee-Gittens, E. Melinda;Patel, Shilpa J.;Mistry, Rakesh D.;Duffy, Susan;Melzer-Lange, Marlene D.;Rogers, Alexander;Cohen, Daniel M.;Keller, Allison;Hickey, Robert W.;Page, Kent;Casper, T. Charles;King, Cheryl A.
• 通讯作者: King, Cheryl A.

Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles?

急诊科的避孕措施：我们准备好克服障碍了吗？

• DOI: 10.1089/jwh.2020.8294
• 发表时间: 2020
• 期刊: Journal of women's health (2002)
• 作者: Fischer,Kayleigh;Chernick,LaurenS
• 通讯作者: Chernick,LaurenS

Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department: A Mixed-Methods Study.

城市儿科急诊科青少年对快速伴侣治疗的偏好：一项混合方法研究。

• DOI: 10.1097/pec.0000000000001746
• 发表时间: 2021
• 期刊: Pediatric emergency care
• 影响因子: 1.4
• 作者: Shamash,Zohar;Catallozzi,Marina;Dayan,PeterS;Chernick,LaurenS
• 通讯作者: Chernick,LaurenS

A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study.

• DOI: 10.1016/j.jadohealth.2020.07.020
• 发表时间: 2021-04
• 期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine
• 作者: Chernick LS;Stockwell MS;Gonzalez A;Mitchell J;Ehrhardt A;Bakken S;Westhoff CL;Santelli J;Dayan PS
• 通讯作者: Dayan PS