School Nurse-delivered Smoking Cessation Intervention

在美国，吸烟是导致疾病和过早死亡的最大可预防原因。青少年吸烟是成人吸烟的最大预测因素，并与青春期的不良健康影响有关。22%的高中生报告说最近吸烟(过去30天)。作为学校环境中的主要卫生专业人员，学校护士有巨大的机会在治疗青少年吸烟者方面发挥关键作用。一项由调查人员在马萨诸塞州71所高中进行的随机对照试验(RCT)证明了学校护士为想要戒烟的青少年提供四次个别咨询干预的可行性，以及其在提高自我报告的短期(6周和3个月)戒烟率方面的潜在效果。尽管前景看好，但这项初步研究缺乏对维持干预效果的生化验证和长期跟踪，而且是在以白人为主的学生群体中进行的。这项申请寻求使用更严格的方法来评估干预的有效性，包括对自我报告的吸烟行为和较长期跟踪(干预后6个月和12个月)的生化验证，一项将干预与仅限信息的注意力控制条件进行比较的研究设计，以及从不同种族的学校招募人员以增加我们研究结果的概括性。这项拟议研究的总体目标是进行一项随机对照的学校试验(RCT)，以评估学校护士提供的戒烟干预在提高吸烟高中生30天戒烟率方面的有效性。将招募40所服务于不同学生群体的高中，并随机分配到两种条件之一：(1)特别干预(SI)--根据学校护士提供的公共卫生服务(PHS)临床实践指南，进行四次30分钟的以患者为中心的戒烟咨询干预课程；或(2)仅提供信息(IO)注意控制比较条件-与学校护士进行四次单独课程，以检查吸烟状况，并提供标准化的一系列吸烟和戒烟信息小册子。参与者评估将在研究开始时(基线)以及6周、3个月、6个月和12个月的随访时进行。将从每所学校(n=1200)招募30名在过去30天内报告吸烟并愿意参加戒烟干预研究的9至12年级学生，在12个月的跟踪调查(n=1000)中为每所学校提供25项完整的评估。如果发现有效，研究产品(即干预方案、学生材料、培训手册和干预实施的估计成本)将促进向全国学校护士传播干预措施。

Smoking is the largest preventable cause of disease and premature death in the United States. Adolescent smoking is the greatest predictor of adult smoking and is associated with adverse health effects during adolescence. Twenty-two percent of high school students report current smoking (past 30 days). As the primary health professional in the school setting, school nurses have a tremendous opportunity to play a key role in treating adolescent smokers. A randomized controlled trial (RCT) conducted by the investigators in 71 high schools in Massachusetts demonstrated the feasibility of school nurses delivering a four-session individual counseling intervention to adolescents who want to stop smoking and its potential efficacy in increasing self-reported short term (6-week and 3-month) quit rates. Although promising, the preliminary study lacked biochemical validation and long-term follow-up on the maintenance of the intervention effects, and was conducted with a primarily white student population. This application seeks to evaluate the effectiveness of the intervention using a more rigorous methodology, including biochemical validation of self-reported smoking behavior and longer-term follow-up (6 and 12 months post-intervention), a study design that compares the intervention to an information only attention-control condition, and recruitment from ethnically diverse schools to increase the generalizability of our findings. The overall aim of the proposed study is to conduct a randomized controlled school-based trial (RCT) to evaluate the effectiveness of a school nurse-delivered smoking cessation intervention in increasing 30 day abstinence rates among high school students who smoke. Forty high schools serving a diverse student population will be recruited and randomly assigned to one of two conditions: (1) Special Intervention (SI) - four 30-minute individual patient-centered smoking cessation counseling intervention sessions based on the Public Health Service (PHS) clinical practice guideline delivered by school nurses; or (2) Information Only (IO) attention-control comparison condition - four individual sessions with the school nurse to check smoking status and deliver a standardized series of informational pamphlets on smoking and cessation. Participant assessments will occur at study entry (baseline) and at 6-week, 3-, 6-, and 12-month follow-up. Thirty students enrolled in grades 9 through 12 who report smoking within the past 30 days and willingness to participate in a smoking cessation intervention study will be recruited from each school (n=1200) to provide 25 completed assessments per school at 12-month follow-up (n=1000). If found effective, the study products (i.e., intervention protocol, student materials, training manual, and estimated costs of intervention implementation) will facilitate dissemination of the intervention to school nurses nationally.