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可预防因素，大多数吸烟者在青春期早期就开始吸烟。每年约有70%的青少年接受医疗护理，儿科诊所的环境为干预青少年开始吸烟和继续吸烟的过程提供了独特的机会。我们建议在常规护理中使用儿科医生提供的干预措施和同伴咨询。这是向青少年提供预防吸烟和戒烟干预措施的一种相对未经检验的工具。这项为期四年的随机临床试验的具体目的是：(1)完善一种由提供者提供的办公室干预措施，用于儿科办公室，以预防和戒烟青少年为目标；(2)制定可在儿科诊所内建立的同伴咨询协议；(3)进行随机临床试验，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。8个儿科临床研究点的13 - 17岁青少年将被纳入研究，无论其吸烟状况如何。每个站点共有300名青少年（8个站点共2400名）将完成基线和随访评估。参与的儿科站点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提供简短的提供者提供的干预，以及关注吸烟的社会方面的同伴咨询；(2)常规护理（UC）控制条件。在SI站点内，所有儿科提供者将接受提供者提供的简短预防和戒烟干预的培训，将建立办公室管理系统以支持提供者对青少年的干预，并在诊所内提供同伴咨询师的干预。主要结果测量将是吸烟的流行程度，定义为在过去30天内吸烟，在6个月和12个月的评估中，SI青少年与UC状况进行比较。其他结果将包括青少年的态度、信念和吸烟相关行为，以及提供者的知识、态度和实践行为。制定有效的由提供者提供的青少年预防和戒烟同伴咨询方案对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极好的机会，以达到大量的青少年。在这种情况下使用同伴咨询师，具有解决与青少年吸烟有关的困难社会问题的潜力，是预防和青年戒烟的一种新颖和潜在的有力方法。

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.