SPIT TOBACCO USE PREVENTION/CESSATION

使用吐（无烟）烟草（ST）在美国年轻男性中的流行率越来越高，尤其是居住在农村地区的人，并使他们面临口腔癌和牙周组织破坏的风险。该提案有以下具体目标：（1）确定加州农村地区28所高中男生中以学校为基础的护士指导、个人和牙医协助的ST干预计划的有效性;（2）确定农村高中男生成功ST停止的预测因素。干预是基于认知社会学习理论和创新理论的扩散，并适用于公共卫生的角度接近ST用户在他们的环境和创新理论，并适用于公共卫生的角度接近ST用户在他们的环境，并试图改变社会规范，影响行为的变化。加州的28所农村高中将根据男性ST使用的基线患病率和入学人数进行分层，并在分层内随机分配到干预组或对照组。干预措施将包括学校咨询委员会;同伴领导的教育课程;由学校护士进行口头检查并建议戒烟或保持无烟，护士通过自己的嘴或照片向用户指出任何ST相关病变，提供简短的戒烟咨询，并促进三次小组随访复发预防会议，对ST相关口腔病变的学生进行为期1周的随访检查，并安排牙医对患有持续性病变的学生进行评估;以及由同龄人进行两次随访电话，以防止复发。在干预结束时和1年后，将比较两组之间经生化验证的自我报告戒烟率和自我报告开始率。将分析ST使用的基线和随访问卷评估，以确定与停用ST相关的个体特征。研究结果将有助于与烟草预防和戒烟相关的知识体系，从而有助于口腔癌的一级和二级预防以及与烟草使用相关的其他负面口腔健康影响。

Use of spit (smokeless) tobacco (ST) is increasing in prevalence among young American males, is especially prevalent among those residing in rural areas, and puts them at risk of oral cancer, and periodontal tissue destruction. This proposal has the following specific aims: (1) to determine the efficacy of a school-based nurse-directed, per- and dentist-assisted ST intervention program among male students in 28 high schools in rural areas of California and (2) to determine predictors of successful ST cessation among male students in rural high schools. The intervention is based on Cognitive Social Learning Theory and Diffusion of Innovation Theory and applies a public health perspective by approaching ST users in their environment and Innovation Theory and applies a public health perspective by approaching ST users in their environment and attempting to change social norms to effect behavioral change. Twenty-eight rural high schools in California will be stratified on baseline prevalence of male ST use and size of enrollment and randomly assigned within strata to either the intervention or the control group. The intervention will consists of a school advisory board; peer-led educational sessions; an oral exam and advice to quit or to stay tobacco-free by a school nurse who points out any ST-associated lesions to users by their own mouths or in photographs, provides brief cessation counseling, and facilitates three group follow-up relapse prevention sessions, conducts 1-week follow-up examines of students with ST-related oral lesions, and schedules students with persistent lesions for evaluation by a dentist; and, two follow-up telephone cells by a peer to prevent relapse. Biochemically validated self-reported quit rates and self reported initiation rates at the end of the intervention and 1 year later will be compared between groups. Baseline and follow-up questionnaire assessments of ST use will be analyzed to identify individual characteristics that are associated with quitting ST use. Results will contribute to the body of knowledge related to tobacco prevention and cessation and thereby to the primary and secondary prevention of oral cancer and other negative oral health effects associated with tobacco use.