PRIMARY CARE AND SELF HELP INTERVENTION FOR TEEN SMOKERS

摘要(由申请人提供)在美国，每天大约有2145名青少年开始吸烟；针对这一人群进行有效戒烟干预的证据基础刚刚开始出现。对吸烟的简短初级保健干预，并转介到适当的附属机构，已被证明对成年人有效；目前的临床指南建议将这种干预扩大到青少年患者。尽管最近有人呼吁采取行动，但青少年初级保健提供者的戒烟干预措施仍然很少。目前的试验是一项随机对照试验，旨在检验初级保健提供者通过转介辅助手段戒烟对青少年戒烟的有效性。初步数据表明，与通常的护理对照相比，干预条件下的提供者更多地采用了特定的吸烟筛查和咨询行为，尽管这些系统和临床干预措施的采用并不普遍。就这一保健提供系统可以作为向青少年提供循证戒烟干预措施的结构而言，需要确定基于证据的保健提供者办公室系统干预措施，并需要传播干预的基础设施。目前的项目有100名儿科和家庭医生，其中一半现在有使用简短干预系统的经验。利用当前试验产生的证据基础、实地经验教训和从实践中获得的具体协作反馈，拟议的项目将确定一套建议的最佳做法，供初级保健办公室使用学术细节实施青少年戒烟干预。(请注意，还有其他实施以实践为基础的干预措施的模式，每一种模式都需要类似的程序；目前的项目将确定和打包学术详细模式的实地最佳做法，这是我们小组有相当经验的模式)。开发这种“最佳做法”工具包将为传播循证戒烟干预措施提供关键的基础设施，因为这些干预措施是从目前的试验和正在进行的其他青少年试验中产生的。

ABSTRACT(provided by applicant) Approximately 2,145 adolescents begin smoking each day in the US; an evidence base for effective cessation interventions for this population is just beginning to emerge. Brief primary care interventions for smoking with referral to appropriate adjuncts have been shown to be effective with adults; current clinical guidelines recommend extending this intervention to adolescent patients. Although there have been recent calls to action, tobacco cessation interventions by adolescent primary care providers remain low. The current trial is a randomized controlled trial to examine the effectiveness of a brief primary care provider intervention with referral to adjuncts for adolescent smoking cessation. Preliminary data indicate greater adoption of specific smoking screening and counseling behaviors by providers in intervention conditions relative to usual care control, although adoption of the systems and clinical interventions was not universal. To the extent that this health care delivery system can serve as a structure for providing evidence-based tobacco cessation interventions to adolescents, evidence based health care provider office systems interventions need to be identified and the infrastructure for intervention needs to be disseminated. The current project has 100 pediatric and family practices engaged, half of whom are now experienced in working with the brief intervention system. Using the evidence base generated from the current trial, lessons learned in the field, and specific collaborative feedback from practices, the proposed project would identify a set of recommended best practices for primary care office implementation of adolescent smoking cessation intervention using academic detailing. (Note that other models for implementing practice-based interventions exist and similar processes are needed for each; the current project will identify and package for the field best practices for the academic detailing model which is the one with which our team has had considerable experience). The development of such a "best practices" tool kit will provide critical infrastructure for dissemination of evidence-based cessation interventions as they emerge from the current trial and other adolescent trials underway.