SMOKING EXPERT SYSTEM FOR TEENS IN PRIMARY MEDICAL CARE

这项随机对照试验将测试Brief的长期疗效 临床医生的建议和专家系统互动式转换的途径 降低3200名青少年吸烟率的计算机程序 他们正在接受常规医疗护理。吸烟者和不吸烟者， 基线年龄在14岁至17岁之间的人将有资格享受这一基于人口的 高度针对个人需求量身定做的干预。这个 主要终点将是30天的吸烟率，按两年衡量 在随机化之后。次要措施将包括易感性 吸烟、吸烟习得或改变吸烟的阶段，以及其他烟草 使用措施。我们还将在后续工作中确定吸烟的预测因素 影响干预效果的因素。这项干预将 利用初级保健医生提供的可教导的时刻 计算机和多媒体的约会和吸引力 面向青少年的互动程序。这一战略的其他关键特征包括； 1)重点关注整个青少年群体(无论在什么时候吸烟 进入与否)；2)高度定制的基于理论驱动的阶段 干预；3)干预的简便性和实用性 临床医生；以及4)提供相对较低的可变成本 在常规医疗护理期间对青少年人口进行干预。 虽然这项研究将在HMO环境下进行，但干预措施 在任何初级cre医疗保健环境中都是实用的， 关爱青少年。

This randomized controlled trial will test the long-term efficacy of brief clinician advice and the Pathways to Change expert system interactive computer program for reducing the prevalence of smoking among 3,200 teens who are being seen for routine medical care. Both smokers and nonsmokers, ages 14 to 17 at baseline, will be eligible for this population-based intervention that is highly tailored to the needs of the individual. The primary endpoint will be 30-day smoking prevalence, as measured two years after randomization. Secondary measures will include susceptibility to smoking, stage of smoking acquisition or smoking change, and other tobacco use measures. We will also identify predictors of smoking at follow- and factors that moderate intervention effects. The intervention will capitalize on the teachable moment offered by a primary care physician appointment and the attractiveness of computers and this multimedia interaction program to teens. Others key attributes of this strategy are; 1) a focus on the whole population of adolescents (whether smoking at entry or not); 2) a highly tailored stage based theory-driven intervention; 3) the ease and practicality of the intervention for clinicians; and 4) the relatively low variable cost of delivering the intervention to the teen population seen during routine medical care. Although this study will be conducted in an HMO setting, the intervention would be practical in any primary cre medical care setting that provides care to adolescents.