PROVIDER AND PEER DELIVERED YOUTH SMOKING INTERVENTION

在美国，吸烟是导致疾病和过早死亡的最大的可预防原因，大多数吸烟者在青春期早期就开始开始吸烟。 每年约有70%的青少年接受医疗护理，儿科诊所提供了一个独特的机会来干预青少年开始吸烟和继续吸烟的过程。 我们建议在常规护理期间使用儿科提供者提供的干预措施和同伴咨询。这是一个相对未经测试的工具，为青少年提供吸烟预防和戒烟干预。这项为期四年的随机临床试验的具体目标是：（1）完善提供者提供的办公室干预措施，用于儿科办公室，以预防和停止青少年吸烟;（2）制定可在儿科诊所内制定的同伴咨询方案;和（3）进行一项随机临床试验，以评估提供者提供的干预和同伴咨询与常规护理相比的有效性。将招募入组研究时在8个儿科临床研究中心就诊的13 - 17岁青少年，无论其吸烟状况如何。 每个研究中心共有300名青少年（8个研究中心2400名）将完成基线和随访评估。参与的儿科研究中心将被随机分配到以下两种情况之一：（1）特殊干预（SI），包括针对每个青少年开始吸烟的阶段量身定制的简短提供者提供的干预，以及专注于吸烟社会方面的同伴咨询;或（2）家庭护理（UC）控制条件。 在SI研究中心内，所有儿科提供者将接受由提供者提供的简短吸烟预防和戒烟干预培训，将建立一个办公室管理系统，以支持提供者对青少年的干预，同伴咨询师将在诊所内提供干预。主要结局指标将是与UC疾病相比，SI青少年在6个月和12个月评估时的吸烟率，定义为在过去30天内吸烟。其他结果将包括青少年的态度，信仰和吸烟相关的行为，以及提供者的知识，态度和实践行为。发展有效的提供者提供和同伴咨询计划，预防和戒烟的青少年吸烟这一重要的公共卫生问题具有广泛的适用性。 儿科诊所的访问提供了一个很好的机会，以达到大量的青少年。 在这种情况下，使用同伴辅导员，他们的潜力，以解决困难的社会问题，吸烟的青少年，是一种新的和潜在的强大的方法来预防和戒烟的青年。

Cigarette smoking is the single largest preventable cause of disease and premature death in the United States and most smokers begin smoking in early adolescence. With approximately 70 percent of adolescents being seen for medical care each year, the pediatric clinic setting offers a unique opportunity to intervene in the process of initiation and continued cigarette smoking by adolescents. We propose to use pediatric provider-delivered interventions and peer counseling delivered during routine care. This is a relatively untested vehicle for providing smoking prevention and cessation interventions to adolescents. The specific aims of this four year randomized clinical trial are to: (1) refine a provider-delivered office intervention for use in pediatric offices targeting prevention and cessation of smoking in adolescents; (2) develop a peer counseling protocol that can be instituted within a pediatric clinic; and (3) conduct a randomized clinical trial to evaluate the effectiveness of the provider-delivered intervention and peer counseling compared to usual care. Adolescents aged 13 to 17 at study enrollment who are seen in the eight pediatric clinic study sites will be recruited, regardless of smoking status. A total of 300 adolescents per site (2400 across 8 sites) will complete baseline and follow-up assessments. Participating pediatric sites will be randomly assigned to one of two conditions: (1) Special Intervention (SI), consisting of a brief provider-delivered intervention tailored to the stages of smoking initiation of each adolescent, and peer counseling focused on the social aspects of smoking; or (2) Usual Care (UC) control condition. Within the SI sites, all pediatric providers will receive training in the brief provider-delivered smoking prevention and cessation intervention, an office management system will be established to support the provider intervention with adolescents, and peer counselors will provide intervention within the clinics. The main outcome measure will be prevalence of smoking, defined as smoking a cigarette in the last 30 days, at 6- and 12-month assessment in adolescents in the SI compared to the UC condition. Additional outcomes will include adolescents' attitudes, beliefs, and smoking-related behavior, and providers' knowledge, attitudes, and practice behaviors. Development of effective provider-delivered and peer counseling programs for prevention and cessation of smoking among adolescents has broad applicability for this important public health problem. Pediatric clinic visits present an excellent opportunity to reach a large number of adolescents. The use of peer counselors within this setting, with their potential to address the difficult social issues related to smoking among adolescents, is a novel and potentially powerful approach to the prevention and cessation of smoking by youth.