Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois;
Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois.
Pediatrics. 2020 Oct;146(4). doi: 10.1542/peds.2020-0644.
We tested a Public Health Service 5As-based clinician-delivered smoking cessation counseling intervention with adolescent smokers in pediatric primary care practice.
We enrolled clinicians from 120 practices and recruited youth (age ≥14) from the American Academy of Pediatrics Pediatric Research in Office Settings practice-based research network. Practices were randomly assigned to training in smoking cessation (intervention) or social media counseling (attentional control). Youth recruited during clinical visits completed confidential screening forms. All self-reported smokers and a random sample of nonsmokers were offered enrollment and interviewed by phone at 4 to 6 weeks, 6 months, and 12 months after visits. Measures included adolescents' report of clinicians' delivery of screening and counseling, current tobacco use, and cessation behaviors and intentions. Analysis assessed receipt of screening and counseling, predictors of receiving 5As counseling, and effects of interventions on smoking behaviors and cessation at 6 and 12 months.
Clinicians trained in the 5As intervention delivered more screening (β = 1.0605, < .0001) and counseling (β = 0.4354, < .0001). In both arms, clinicians more often screened smokers than nonsmokers. At 6 months, study arm was not significantly associated with successful cessation; however, smokers in the 5As group were more likely to have quit at 12 months. Addicted smokers more often were counseled, regardless of study arm, but were less likely to successfully quit smoking.
Adolescent smokers whose clinicians were trained in 5As were more likely to receive smoking screening and counseling than controls, but the ability of this intervention to help adolescents quit smoking was limited.
我们测试了一项基于公共卫生服务 5As 的临床医生提供的戒烟咨询干预措施，针对的是儿科初级保健实践中的青少年吸烟者。
我们从 120 个实践中招募了临床医生，并从儿科学会儿科办公室实践研究网络中招募了青少年（年龄≥14 岁）。实践被随机分配接受戒烟培训（干预组）或社交媒体咨询（注意控制组）。在临床就诊期间招募的青少年完成了机密的筛查表格。所有自我报告的吸烟者和随机抽取的非吸烟者都有机会参加，并在就诊后 4 至 6 周、6 个月和 12 个月通过电话进行访谈。测量包括青少年报告的临床医生进行的筛查和咨询、当前的烟草使用情况以及在 6 个月和 12 个月时的戒烟行为和意图。分析评估了筛查和咨询的接受情况、接受 5As 咨询的预测因素，以及干预措施对吸烟行为和戒烟的影响。
接受 5As 干预培训的临床医生进行了更多的筛查（β=1.0605， <.0001）和咨询（β=0.4354， <.0001）。在两个臂中，临床医生更常筛查吸烟者而非非吸烟者。在 6 个月时，研究组与成功戒烟没有显著相关性；然而，5As 组的吸烟者在 12 个月时更有可能戒烟。无论研究组如何，成瘾吸烟者更常接受咨询，但成功戒烟的可能性较低。
接受 5As 培训的青少年吸烟者更有可能接受吸烟筛查和咨询，而不是对照组，但该干预措施帮助青少年戒烟的能力有限。
