Social-Ecological Framework to Improve Youth Smoking Outcomes

描述（由申请人提供）：拟议的研究以社会生态模型为指导，目标是迅速发现美国肺脏协会的无烟青少年戒烟计划的有效性，覆盖面和采用的最佳条件，该计划是美国最广泛使用的青少年戒烟计划。我们的建议利用来自多个来源的现有数据，形成一个独特的N-O-T社会生态关系数据库。关系数据库的核心是我们新形成的N- o - t主数据集，该数据集汇集了12年（1998-2010）的N- o - t疗效和有效性试验，其中包括来自CO， FL， NC， NJ， WI和WV的N=11,000名青少年的异质样本。最重要的研究问题是：在RE-AIM框架中确定的宏观经济、政治和人口条件与N-O-T有效性、覆盖面和采用结果之间的关系中，哪些因素有利于调节？作为一个理论驱动的、具有成本效益的项目，N-O-T已经获得了多个联邦模型的有效性和可扩展性指定。然而，项目的覆盖面是一个重大问题，成千上万的青少年吸烟者没有得到服务。为了说明，N-O-T达到不到1%的青少年吸烟者在威斯康星州，那里的青少年吸烟率是全国最高的。要解决这一差距，需要进行研究，确定政策和系统战略，以加强戒烟规划的覆盖面、采用和有效性。因此，我们建议进行一项为期3年的深入研究，旨在迅速提高N-O-T的广泛使用，从而降低美国青少年吸烟率。我们的模型建立在与烟草使用相关的基于经验的因素之上。运用层次线性模型（HLM）和结构方程模型（SEM），从具有最令人信服的科学证据的调节因子（如烟草税、CIA、准入、规范和戒烟准备）开始，我们建议表征调节因子（如烟草税、烟草价格、清洁室内空气和学校环境）对政治、经济和人口因素与N-O-T计划有效性之间关系的影响；确定N-O-T到达和采用的最佳条件；并将调查结果转化为一套可立即实施的实际行动战略，以大幅增加接受N-O-T并实现戒烟的美国青年人数。

DESCRIPTION (provided by applicant): The proposed study is guided by a Social-Ecological Model, with the goal to rapidly uncover optimal conditions for effectiveness, reach, and adoption of the American Lung Association's Not On Tobacco teen smoking cessation program, the most widely used teen cessation program in the US. Our proposal capitalizes on existing data from multiple sources, forming a unique N-O-T Social Ecological Relational Database. Central to the relational database is our newly-formed N-O-T Master Dataset that aggregates 12 years (1998-2010) of N-O-T efficacy and effectiveness trials with a heterogeneous sample of N=11,000 teens from CO, FL, NC, NJ, WI, and WV. The overriding research question is: What factors favorably moderate the relationship between macro-level economic, political, and demographic conditions and N-O-T effectiveness, reach, and adoption outcomes as identified in the RE-AIM framework? As a theory-driven, cost effective program N-O-T has received multiple federal model designations for effectiveness and scalability. Yet, program reach is a significant problem, with hundreds of thousands of teen smokers left unserved. To illustrate, N-O-T reaches <1% of teen smokers in WV, where teen smoking rates are among the nation's highest. Addressing this gap requires research to identify policy and systems strategies that will enhance the reach, adoption, and effectiveness of cessation programs. Accordingly, we propose an intensive 3-year study intended to rapidly enhance widespread N-O-T use and thereby reduce US youth smoking prevalence. Our model builds on empirically-based factors associated with tobacco use. Applying Hierarchical Linear Modeling (HLM) and Structural Equation Modeling (SEM) and beginning with moderators having the most compelling scientific evidence (e.g., tobacco tax, CIA, access, norms, and readiness to quit), we propose to characterize the effects of moderators (e.g., tobacco tax, tobacco price, clean indoor air, and school environment) on the relation between political, economic, and demographic factors and N-O-T program effectiveness; to determine optimal conditions for N-O-T reach and adoption; and to translate findings into a set of practical action strategies that can be implemented immediately to substantially increase the number of US youths who receive N-O-T and achieve cessation.