Challenges in Juvenile Smoking Suspension Research.


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Do Teens Need Help to Quit? 53% of HS understudies reported no less than one quit endeavor ... also, medicinal services experts who manage delicate wellbeing issues ...
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Challenges in Adolescent Smoking Cessation Research Deborah Moss, MD, MPH February 24, 2009

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OBJECTIVES Overview of juvenile smoking Challenges of directing immature suspension research Lessons from the "field" Implications

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Overview of teenager smoking Why research on pre-adult smoking is so basic

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90% of grown-up smokers began smoking as high schoolers Reducing youthful smoking is a general wellbeing need.

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Risks of Teen Smoking Health outcomes: Individual: C-V sickness, asthma and other lung infection, malignancies, fire harm, meningitis… Community: peer, guardian, pregnant exposer Associated with other danger practices: 3 x more inclined to utilize liquor 8 x more inclined to smoke maryjane 22 x more prone to utilize cocaine

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Youth Risk Behavior Survey – 2007 Results *before 13 taking into account an entire cigarette ever, secondary school use is one in most recent 30 days The most critical time for counteractive action is the move between center school to secondary school and first year of secondary school.

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Effective aversion methodologies Parent objection Household rules (without smoke home) Parental quitting* Public wellbeing approaches: Raise cigarette charges Monitor cigarette deals to minors Reduce introduction to smoking conduct (control smoking in films, advocate for smoke free open spots laws and strategies)

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Viewing smoking related messages improves the probability of smoking Movies (Dalton/Sargent, 2000-2006) Advertising and advancements (Pierce, 1996-1998)

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Tried Smoking (percent) James Sargent (2005), www.smokefreemovies.ucsf.edu

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Teen suspension

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Do Teens Want to Quit? Yes! 62% of secondary school understudies report a yearning to quit smoking (Marshall 2006)

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Do Teens Need Help to Quit? Yes! 53% of HS understudies reported no less than one quit endeavor (Marshall 2006) Yet, 16% of teenager smokers report stopping for 30 day time span (Zhu 1999) Teens think little of addictive nature of nicotine (TAPS) www.helpteensquit.org

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Lack of compelling treatment suggestions Insufficient confirmation (Grimshaw 2006, Sussman 2006) Research needs-C ochrane survey Well-planned, sufficiently controlled RCT\'s for immature smokers Minimum follow-up of 6 months Rigorous meaning of discontinuance (maintained, biochemical check) Recognize methodologic issues (enrollment, maintenance, development)

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Challenges in Youth Tobacco Use Research

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Challenges in youth tobacco control research 1. Human subject security 2. Enrollment 3. Maintenance 4. Psychosocial complexities**

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1. Human subject assurance Child as exploration subject Parental assent Confidentiality and obligatory reporting Vulnerable populaces Variability of elucidation Research suggestions: subject enlistment, representativeness of test, ampleness of test size, expense of study

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2. Enrollment Accessing high schoolers Lack of saw advantage (individual or prompt) Perceived obstructions – loss of protection, time responsibility, transportation Appealing to juvenile interests

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3. Maintenance Transience Maintaining contact Commitment Changing inspiration Peer impact

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4. Psychosocial multifaceted nature Psychiatric co-horribleness Low salary populaces Social determinants of danger practices The extent of the these difficulties in group tests has not yet been depicted.

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PASS Pennsylvania Adolescent Smoking Study (PASS)

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Primary Care Network for Adolescent Smoking Cessation Research The Network comprises of: Children\'s Hospital of Philadelphia Children\'s Hospital of Pittsburgh Lehigh Valley Hospital St. Christopher\'s Hospital for Children University of Pennsylvania

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PASS-diagram Primary Aim: Compare the viability of Motivational Interviewing (MI) to Structured Brief Advice (SBA) on decreasing smoking in young people Design: Multicenter RCT study Methods: Sample – 330 teenager smokers (14-18 years) Study bunches: 5 sessions of MI mediation or SBA Outcomes: 8, 12, 24 week follow-up utilizing self report and course of events take after back information + Saliva cotinine levels

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PASS: Study Flow Chart # screened - 2759 # enlisted – 357 (13% of screened) # randomized to MI - 177 # randomized to SBA - 178 # 8 weeks - 277 # 12 weeks - 272 # 24 weeks - 215

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PASS Recruitment: site examination

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PASS: Recruitment techniques Community destinations - Hill House - Hosanna House - Sarah Heinz House - Adagio Health - Tobacco Free Allegheny - Job Corps - Focus on Renewal - Planned Parenthood of Western PA - Woman, Infants and Children (WIC) - Saint Athanasius Church (West View) - Race for the Cure - American Cancer Society - American Lung Association - American Respiratory Alliance – Heinz field - County pools - A+ Schools - Schools Clinical destinations Adolescent Medicine at Children\'s Hospital (CHP) Adolescent In-patient Unit at CHP Primary Care Center at CHP Family Medicine (Shadyside, Matilda Theis) Children\'s/UPMC at Turtle Creek Children\'s Community Pediatrics (CCP) Pittsburgh, Oakland, & Bloomfield workplaces Emergency Department at CHP Dental Department at CHP Pulmonary, Allergy, and Immunology facilities at CHP East Liberty Family Health Center Media PAT Bus Cards (East Liberty Garage) (6/08) CHP Quarterly Newsletter: Promises CHP telephone holding up message UPMC Extra Pittsburgh Parent Magazine City Paper KennyTales Craig\'s List Flyers posted in nearby neighborhoods Facebook

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PASS Demographics : CHP

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Challenges: Lessons from the field 1. Human subject security 2. Enrollment 3. Maintenance 4. Psychosocial complexities**

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PASS: Describe the extent of psychosocial complexities Examined all "events"= IRB-reportable and non-reportable archived events Event sorts: Serious unfavorable occasions Adverse occasions Unanticipated issues Protocol deviation Notes to record Withdrawals

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Event Frequency *Events: IRB-reportable and recorded non-reportable events † 4 withdrawals were incorporated however not considered critical or important occasions ‡ 2 withdrawals were incorporated yet not considered noteworthy or pertinent occasions

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Events: Themes Legal Psychiatric co-dreariness Psychosocial multifaceted nature Illicit medication use Lack of social backings

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Legal Issues Arrest Detention/Incarceration Custody issues Change in authority Unclear lawful guardianship Legal issues expanded requests on study assets and contrarily influenced maintenance.

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Psychiatric Co-dreariness Psychiatric hospitalizations Crisis intercession/Psychiatric ER administrations Psychiatric hindrance Reporting issues Extent of psychiatric co-bleakness brought about unexpected staff and study asset requests; these perceptions proposed the requirement for specific preparing for examination staff and the need to widen our exploration past the center of tobacco use.

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Psychosocial many-sided quality Deaths of relatives or companions Miscarriages CYF association Partner misuse Victims of attack Homelessness and appetite Responding to these psychosocial complexities devoured work force assets and frequently required a level of expert skill not foreseen in study readiness. The anxiety in these adolescent\'s lives mirrors a weight of wellbeing dangers that go past smoking and require a gander at the social environment that impacts these practices.

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Illicit medication use Rehab hospitalization Safety concerns Reporting issues Interferes with mediation Tobacco use screening needs to incorporate particular inquiries regarding cigarette smoking instead of just questioning about smoking.

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Lack of backings Misrepresenting age or character Homeless - alluded to protect Used examination "home" as asset –help with backslide after study, unnatural birth cycle. Tyke care amid visit *(not reported) These cases brought up that 1) the exploration site turns into an examination home; 2) adolescents in this populace gathering need assets past simply tending to their smoking and this must be considered when planning and planning for future studies.

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Implications Study outline Broaden research question Research staff preparing Budget reevaluation/Resource portion Interdisciplinary coordinated efforts IRB Adolescent Service conveyance experts/Clinicians Mental wellbeing/Addiction analysts

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Questions for Discussion What are a few suggestions for reacting to the difficulties raised today? How illustrative it is safe to say that this is test of teenager smokers? What exactly degree does the prerequisite for parental assent skew the specimen? Does this degree legitimize a waiver of parental assent? What would we be able to gain from analysts and human services experts who manage delicate wellbeing issues to better enroll and hold high hazard youth? In what manner can future studies be intended to address the bigger societal issues of at-danger youth?

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