Curbing Tobacco Use in Suburban and Rural Schools

说明(申请人提供)：青少年中的烟草使用仍然是一个主要的公共卫生问题。在过去的2-30年里，在制定面向青少年的烟草控制方案方面取得了相当大的进展。现在有几个节目是通过互联网提供的。然而，其中许多程序未能充分利用现有现代技术，如交互、动画、视频片段、视频游戏组件和其他对当代精通计算机的年轻人具有巨大吸引力的功能。我们的长期目标是开发面向青少年的控烟项目，这些项目非常成功地说服年轻人避免使用烟草产品，或者如果他们已经在使用这种产品，那么就戒烟。我们最近完成的由NCI资助的研究“通过光盘预防和戒烟青少年吸烟”(Project ASPIRE)纳入了适合青少年的现代技术，并显示出显著的有益影响，特别是在预防吸烟方面。拟议的项目是ASPIRE项目的延续，将在ASPIRE项目的优势基础上再接再厉，并在重要方面加以扩展。与以前的CD-ROM不同，新的干预措施将以互联网为基础。虽然最初的计划是为市中心主要是少数族裔青少年(6%的白人)设计并测试的，但新计划将针对一群具有明显不同的种族构成(约50%的白人)和社会经济地位特征的郊区和农村高中生。在仔细考虑新的目标人群和干预环境后，将对原有的ASPIRE干预计划进行大幅重新设计。由于非城市青少年吸烟者中吐痰烟草的高流行率(根据我们的初步研究，35%)，吐痰烟草也将在新的计划中得到解决。最后，在新计划中，课堂课程将通过强大的二维社会支持成分得到加强：(1)通过互联网公告栏和聊天室在家中提供虚拟支持；(2)通过训练有素的学校人员(教师、教练、辅导员和护士)提供人力支持。我们的具体目标是确定新的干预措施是否导致(1)吸烟开始的减少，(2)戒烟的增加，(3)对吐痰烟草使用的积极影响，(4)跨理论模型中吸烟和吐痰烟草使用变化阶段的积极进展，以及(5)与标准护理条件相比，调节烟草使用的关键变量的积极变化。这项研究将是一项分组随机对照试验，共有2000名年龄在14-16岁之间的参与者参加，他们来自德克萨斯州东南部郊区和农村的16所高中。随访评估将在6周、6、12和18个月进行。

DESCRIPTION (provided by applicant): Tobacco use among adolescents remains a major public health problem. Over the past 2-3 decades, considerable progress has been made in developing adolescent-oriented tobacco control programs. Several programs are now being offered via the Internet. However, many of these program fail to take full advantage of available modern technology such as interactivity, animations, video segments, video-game components, and other features that hold tremendous appeal for contemporary, computer-savvy youth. Our long-term goal is to develop adolescent-oriented tobacco control programs that are extremely successful in convincing young people to avoid using tobacco products or, if they are already using such products, to quit. Our recently completed NCI-funded study, "Teen Smoking Prevention and Cessation via CD-ROM" (Project ASPIRE), incorporated adolescent-friendly modern technology and demonstrated a significant beneficial impact, particularly in smoking prevention. The proposed project is a continuation of Project ASPIRE and will build on the strengths of Project ASPIRE and expand it in important ways. The new intervention, unlike its CD-ROM-based predecessor, will be Internet-based. While the original program was designed for and tested among inner-city, predominantly minority adolescents (6% whites), the new program will be targeted at a group of suburban and rural high school students with a substantially different ethnic make-up (approximately 50% whites) and socio-economic status characteristics. The original Project ASPIRE intervention will be substantially redesigned with careful consideration of the new target population and intervention setting. Because of the high prevalence of spit tobacco consumption among non-urban teenage tobacco users (35% according to our preliminary study), spit tobacco will also be addressed in the new program. Finally, in the new program, the classroom curriculum will be fortified with a strong, two-dimensional social support component: (1) virtual support at home via Internet bulletin boards and chat rooms and (2) human support via trained school personnel (teachers, coaches, counselors, and nurses). Our specific aims are to determine whether the new intervention results in (1) a reduction in smoking initiation, (2) an increase in smoking cessation, (3) a positive impact on spit tobacco use, (4) positive progression through the Transtheoretical model's stages of change in both smoking and spit tobacco use, and (5) positive change in key variables known to mediate tobacco use compared to a standard care condition. The study will be a group-randomized, controlled trial with 2000 participants aged 14-16 years from 16 high schools in suburban and rural southeast Texas. Follow-up assessments will be conducted at 6 weeks and at 6, 12, and 18 months.