Development of a contextually tailored and optimized smoking cessation intervention for homeless youth

摘要 科学假设。100万无家可归的年轻人吸烟-占人口的70%。不仅无家可归 青年吸烟率是其他青年人口的2.5倍，他们从事风险更大的吸烟行为。 许多无家可归的年轻人想戒烟，但大多数试图戒烟的人没有得到支持。 干预没有已知的研究集中在戒烟的有效性与无家可归的青年-a 公共卫生监督明显。正如NCI烟草控制研究优先事项工作组所指出的那样， 在过去20年里，烟草治疗方面的科学进展很少。此外， 由于获得烟草的比率不同，特权人群和弱势人群之间的烟草使用有所增加 以及对现有戒烟干预的治疗反应。 培训计划。通过这项K 07职业发展赠款，Nemeth博士将接受以下方面的直接培训： 成瘾和新的行为干预科学，以及这些知识在指导研究中的应用 该方案的目标是在实施过程中优化针对无家可归青年的戒烟干预措施。辅导 该团队包括NIH资助的研究人员，他们在社区干预开发方面具有专业知识， 无家可归的青少年和开发新的戒烟策略的方法学途径 得到了NCI的认可。整体培训计划将使Nemeth博士具备实施戒烟的技能 使用多阶段优化STrategy对弱势青年人群进行干预开发研究 （MOST）方法论。 指导研究。具体目标1将为无家可归者戒烟建立一个理论框架 青少年结合特定阶段的能力和机会，影响参与戒烟的动机 (MOST步骤1）。具体目标1将使用定性和定量方法确定：（1）内部 需要为无家可归的青年提供能力以及社会和物质环境机会 鼓励吸烟者戒烟并进行支持治疗（目标1a）;（2）吸烟者的内部条件是什么？ 无家可归的青少年吸烟者，在他们的社会和物理环境，与1）动机， 2）过去的尝试？(Aim 1 b）。在无家可归者戒烟理论框架的指导下， 具体目标2将确定一套戒烟干预组成部分，并评估其实施情况 可行性（MOST步骤2）。这一目标将适用于无家可归者戒烟的理论框架 （1）确定一套戒烟干预措施，以测试对青少年戒烟的影响， 未来研究（目标2a）;以及（2）评估实施戒烟组成部分的可接受性和可行性 在无家可归的青年吸烟者及其服务提供者中开展了一项调查（目标2b）。这项工作有很大的潜力， 减少无家可归青年吸烟造成的发病率和死亡率。 向研究独立过渡。这种应用方法响应了一个关键的科学目标 NCI烟草控制研究优先工作组建议， 以及高危人群行为健康戒烟治疗的有效性。培训 和指导研究计划将建立内梅特博士作为烟草控制干预科学家 定位于实施NIH资助的多组分行为优化研究 对受到严重创伤和脆弱的青年群体采取干预措施。

ABSTRACT Scientific Premise. One million homeless youth smoke --70% of the population. Not only do homeless youth smoke at a rate 2.5 times higher than other youth populations, they engage in riskier smoking practices. Many homeless youth want to stop smoking, but most who attempt to quit do so without supported intervention. No known study has focused on smoking cessation effectiveness with homeless youth—a notable public health oversight. As the NCI Tobacco Control Research Priorities working group has noted, there have been few scientific advances in tobacco treatment in the past 20 years. Moreover, disparities in tobacco use between privileged and vulnerable populations have increased due to differential rates in access and treatment response to existent tobacco cessation intervention. Training Plan. Through this K07 career development grant, Dr. Nemeth will receive direct training in addiction and novel behavioral intervention science, and application of this knowledge to mentored research implementation, to optimize a contextually tailored cessation intervention for homeless youth. The mentoring team includes NIH-funded researchers with expertise in community-based intervention development for homeless youth and methodological approaches to the development of novel tobacco cessation strategies endorsed by the NCI. The overall training plan will equip Dr. Nemeth with skills to implement cessation intervention development studies with vulnerable youth populations using Multiphase Optimization STrategy (MOST) methodology. Mentored Research. Specific Aim 1 will establish a theoretical framework for cessation among homeless youth incorporating phase-specific capabilities and opportunities impacting motivation to engage in cessation (MOST Step 1). Using qualitative and quantitative approaches, Specific Aim 1 will determine: (1) What internal capabilities and social and physical environmental opportunities need to be in place for homeless youth smokers to be motivated to quit and engage supported treatment (Aim 1a); (2) What conditions internal to homeless youth smokers, and in their social and physical environment, are associated with 1) motivation to quit and 2) past quit attempts? (Aim 1b). Guided by the theoretical framework for cessation among homeless youth, Specific Aim 2 will identify a set of cessation intervention components and assess their implementation feasibility (MOST Step 2). This aim will apply a theoretical framework for smoking cessation among homeless youth in order to: (1) identify a set of cessation intervention components to test for effect on abstinence in future study (Aim 2a); and (2) assess acceptability and feasibility of cessation component implementation among homeless youth smokers and among their service providers (Aim 2b). This work has strong potential to reduce subsequent morbidity and mortality caused by smoking among homeless youth. Transition to Research Independence. This applied approach responds to a key scientific goal recommended by the NCI Tobacco Control Research Priorities working group that aims to increase access to, and the effectiveness of, behavioral health tobacco cessation treatment for high-risk populations. The training and mentored research plan will establish Dr. Nemeth as a tobacco control intervention scientist positioned to implement NIH-funded research in the optimization of multi-component behavioral interventions with highly traumatized and vulnerable youth populations.