A Tailored mHealth Vaping Prevention Intervention for Adolescents with Congenital Heart Defects

项目摘要/摘要：全球有240多万人患有先天性心脏病 每年产生61亿美元的医疗成本。戒烟对缓解冠心病至关重要 幸存者患获得性心血管并发症的风险，但青年电子烟(蒸发)危机暴露了 患有先天性心脏病的青少年(“青少年”)人口不断增长，易受与蒸发相关的潜在危害和 大大增加了传统香烟使用的风险。预防青少年吸食电子烟的干预措施 CHD是迫切需要的，但现有的计划对这一高危群体来说是不够的。福克斯博士的TL1 联谊会研究表明，31%的患有冠心病的青少年易受蒸发的影响，并被识别为 压力和缺乏疾病知识是潜在的风险因素，但现有的计划没有解决这些问题 考虑因素。拟议的研究将产生和评估第一个汽化预防干预措施 专为患有冠心病的青少年量身定做。目标1：从以证据为基础的课堂教学中调整课程 预防干预，将关键压力管理和疾病知识模块包括在移动 青少年(12-18岁)冠心病健康(MHealth)格式。干预适应/改进将通过以下方式进行：1) 与关键利益相关者(冠心病青少年、父母、心脏病专家)组成焦点小组，以了解干预措施 偏好，以及2)改编的mHealth干预的单臂试点试验(N=16)，重点是随访 小组收集信息以求精炼。目标2：评估移动健康的可行性/可接受性 通过先导性随机临床试验(RCT；N=72)进行干预。探索性目标3：初步探索 预防汽化指标的mHealth干预效果(与汽化相关的效果，感知 蒸发结果、电子烟知识)。这些目标与福克斯博士的职业目标直接一致，即成为 独立临床医生-科学家，具有行为RCT和可扩展疾病自我管理方面的专业知识 对过渡年龄青少年冠心病的干预。为了实现这一目标，福克斯博士需要接受高级培训 以下领域：1)行为干预科学，以设计和优化可以 在公共卫生层面上实施，如移动保健模式，2)随机对照研究方法和分析，以 严格评估行为干预的有效性和有效性，以及3)冠心病疾病自我评估 为过渡年龄青少年提供管理和保健，将冠心病患者的独特生活因素纳入 量身定制的干预措施。职业发展计划包括说明性和应用性培训，并利用专家 来自阿比盖尔的多学科(公共卫生、临床/定量心理学、心脏病学)指导 国家儿童医院的韦克斯纳研究所，世界上增长最快的儿科医院之一 研究中心，其学术附属机构俄亥俄州立大学和弗雷德·哈钦森癌症研究中心 中心。这份K23建议书将提供高质量的初步数据，并向用户灌输R01所需的专业知识 功效试验，朝着提高冠心病患者终身幸福感的最终目标迈进。

PROJECT SUMMARY/ABSTRACT: Congenital heart defects (CHD) affect over 2.4 million individuals in the U.S and generate $6.1 billion in annual healthcare costs. Avoidance of tobacco is vital to mitigate CHD survivors’ risk for acquired cardiovascular complications, but the youth e-cigarette (“vaping”) crisis exposes the growing and vulnerable population of adolescents (“teens”) with CHD to potential vaping-related harms and significantly increases risk for conventional cigarette use. Interventions to prevent vaping among teens with CHD are critically needed, but no existing programs are sufficient for this at-risk group. Dr. Fox’s TL1 fellowship research showed that 31% of teens with CHD are susceptible to vaping and identified perceived stress and poor disease knowledge as potential risk factors, but existing programs do not address these considerations. The proposed research will generate and evaluate the first vaping prevention intervention tailored for teens with CHD. Aim 1: Adapt curriculum from an evidence-based, classroom-delivered vaping prevention intervention to include critical stress management and disease knowledge modules in a mobile Health (mHealth) format for teens (12-18 years) with CHD. Intervention adaptation/refinement will occur via: 1) focus groups with key stakeholders (teens with CHD, parents, cardiologists) to understand intervention preferences, and 2) a single-arm pilot trial of the adapted mHealth intervention (N=16) with follow-up focus groups to gather information for refinement. Aim 2: Evaluate the feasibility/acceptability of the mHealth intervention via a pilot randomized clinical trial (RCT; N=72). Exploratory Aim 3: Explore the preliminary efficacy of the mHealth intervention for indicators of vaping prevention (vaping-related efficacy, perceived vaping outcomes, e-cigarette knowledge). These aims directly align with Dr. Fox’s career goal of becoming an independent clinician-scientist with expertise in behavioral RCTs and scalable disease self-management interventions for transition-aged teens with CHD. To achieve this goal, Dr. Fox requires advanced training in the following areas: 1) behavioral intervention science to design and optimize interventions that can be implemented on a public health level, such as mHealth modalities, 2) RCT methodology and analysis to rigorously evaluate behavioral interventions for efficacy and effectiveness, and 3) CHD disease self- management and healthcare for transition-aged teens to incorporate unique factors of living with CHD into tailored interventions. The career development plan involves didactic and applied training and leverages expert multidisciplinary (public health, clinical/quantitative psychology, cardiology) mentorship from The Abigail Wexner Research Institute at Nationwide Children’s Hospital, one of the worlds’ fastest growing pediatric research centers, its academic affiliate The Ohio State University, and the Fred Hutchinson Cancer Research Center. This K23 proposal will provide high-quality preliminary data and instill expertise needed for an R01 efficacy trial, advancing toward the ultimate goal of enhancing wellbeing across the lifespan of CHD.