Curry Susan J, Hollis Jack, Bush Terry, Polen Michael, Ludman Evette J, Grothaus Louis, McAfee Tim
Center for Health Studies, Group Health Cooperative, Seattle, WA, USA.
Prev Med. 2003 Dec;37(6 Pt 1):617-26. doi: 10.1016/j.ypmed.2003.09.015.
Each day more than 2000 youth under age 18 become daily smokers and the age of tobacco initiation has been going down. Health care settings can partner with families to encourage parent-child interactions that prevent youth tobacco use. This study evaluates a smoking prevention intervention package for parents and children (aged 10-12) provided through their managed care organization.
A two-arm (usual care vs intervention) randomized trial was employed. The intervention included a mailed parental smoking prevention kit, outreach follow-up telephone calls to the parent by a health educator, child materials, medical record cues for physicians to deliver prevention messages, and parent newsletter. Outcome measures were susceptibility to smoking, experimentation with smoking, and smoking in the past 30 days as assessed by 20-month follow-up surveys of children.
A total of 4,026 families enrolled in the study. The response rate to the 20-month follow-up was 88%. There were no significant effects of the intervention on any of the primary outcomes. The intervention was associated with modest but statistically significant increases in parent-child discussions of smoking related topics.
A minimal-intensity family-based prevention program did not significantly reduce rates of susceptibility or tobacco use among youth aged 10-12 at baseline and 11 to 14 at follow-up. Development and evaluation of innovative approaches to tobacco use prevention must continue, despite our disappointing results. Parents and health care systems are too important to abandon as channels for prevention messages.
每天有超过2000名18岁以下青少年开始每日吸烟，且开始吸烟的年龄一直在下降。医疗机构可以与家庭合作，鼓励亲子互动，以预防青少年吸烟。本研究评估了通过管理式医疗组织为父母和10至12岁儿童提供的吸烟预防干预方案。
采用双臂随机试验（常规护理组与干预组）。干预措施包括邮寄给父母的吸烟预防套件、健康教育工作者给父母的外展随访电话、儿童资料、医生传递预防信息的病历提示以及家长通讯。通过对儿童进行20个月的随访调查来评估吸烟易感性、尝试吸烟情况以及过去30天内的吸烟情况等结果指标。
共有4026个家庭参与了该研究。20个月随访的回复率为88%。干预措施对任何主要结果均无显著影响。该干预措施与亲子间关于吸烟相关话题讨论的适度增加有关，但在统计学上有显著意义。
一个低强度的家庭预防项目在基线时未显著降低10至12岁青少年以及随访时11至14岁青少年的吸烟易感性或吸烟率。尽管结果令人失望，但仍必须继续开展和评估预防烟草使用的创新方法。父母和医疗保健系统作为预防信息的传播渠道非常重要，不能放弃。
