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Patnode CD, O'Connor E, Whitlock EP, et al. Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Dec. (Evidence Syntheses, No. 97.)

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Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet].

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Appendix GBehavioral Intervention Details

FocusStudyBehavioral Intervention DescriptionBehavioral Intervention Duration
Combined Prevention and CessationBauman, 200286Successive mailings of four booklets and health educator telephone discussions with parents 2 weeks after each mailing. Booklets focused on family motivation to participate and engage, family characteristics known to influence adolescents not specific to alcohol and tobacco use, tobacco- and alcohol-specific predictors that originate in the family, and predictors that originate outside the family. Booklets all had specific activities to reinforce content that the families completed on their own. Health educators encouraged participation of all family members, answered parents' questions, and recorded information. Adolescent was reached through family members and was not contacted directly by health educator.Four booklets and related activities completed by family members over 15 weeks (total time ∼4 hours and 25 minutes), ∼8 phone calls with health educator over 15 weeks discussing program and completing standard protocol (total time ∼57.5 minutes per family); for families that completed all four units, it required an average of nearly 6 months (173.2 days [SD, 71.3]) between booklet one and completion of the fourth unit.
Hollis, 200591Teen Reach (Research Approaches to Cancer in a Health Maintenance Organization). Staff provided primary care clinicians with a 30- to 60-second suggested advice message to encourage teens to stop smoking or to not start. Clinicians were asked to encourage the patient to talk briefly with a health counselor immediately after the visit. Teens had a 10- to 12-minute session on the computer with the PTC expert system, which assessed their stage of readiness to begin smoking or their stage of change to quit smoking and then delivered tailored advice and encouragement. The program included testimonial movies and graphics. Teens had 3 to 5 minutes of post-PTC motivational counseling. Handouts included a synopsis of stage-relevant advice and small quit kits. There were two booster sessions with the PTC and health counselor over the remaining 11 months.One 30- to 60-second advice message from PCP; one to three 3- to 5-minute sessions with health counselor over 12 months; one 10- to 12-minute computer session.
Kentala, 199993Nonsmokers were given positive feedback regarding smoking abstinence. After the dental exam, all patients were shown photos showing effects of smoking on teeth. Smokers were given a mirror to assess signs of smoking on their own teeth. Smokers and nonsmokers received the usual dental exam.Brief part of annual dental visit (only a couple minutes).
Lando, 200795Brief advice on smoking cessation and prevention during dental exam. Videos from the CDC and Massachusetts Department of Public Health. Motivational interviewing to either encourage cessation or encourage prevention. Brief supportive telephone calls.60 seconds of advice from dental hygienist or dentist; one 15- to 20-minute session of motivational interviewing; 3–6 phone calls over 6 months (estimated 10 minutes per call).
Pbert, 200879Providers asked about smoking, advised cessation or continued abstinence, and referred the patient to a peer counselor. Peer counseling combined the 5A model with motivational interviewing and behavior change counseling.Advice from the pediatrician given during normal clinic visit (assumed brief). 15- to 30-minute session with peer counselor at the clinic. Four 10-minute phone calls over 21 weeks.
Prado, 200797Familias Unidas aimed to increase parental involvement, positive parenting, parent-adolescent communication, and family support. Parent-centered intervention, majority of components were delivered to parents (adolescent participation limited to family visits and discussion circles). Parents were placed in positions of leadership and expertise and built on panHispanic values, such a primacy of family, sanctity of parental authority, and roles of parents as the family's leaders and educators. Hispanic-specific cultural issues were integrated in all aspects of the intervention, from the underlying theoretical model, to the specific content of the intervention, to the format of the activities. Also included Parent Preadolescent Training for HIV (PATH), which focused on increasing parent-adolescent communication about sex and HIV risks. Intervention was delivered in Spanish.15 group sessions, eight family visits, and two parent-adolescent circles. Approximately 49 hours over 1 year.
Stevens, 200298Dartmouth Prevention Cohort Study. Primary care clinician focused on alcohol and tobacco use. Discussed risks with the child and parent. Signed a contract that the family would talk about risks at home and develop a family policy about alcohol and tobacco. Family received signed letter by their clinician reinforcing the agreement and a refrigerator magnet to post the contract. Reminded of the importance of family communication regarding alcohol and tobacco at subsequent office visits for 36 months. Clinician's role was to provide risk behavior information, encourage family communication, and offer help. Brochure on effective communication. 12 newsletters for each of the parents and children mailed to reinforce messages. Biannual telephone calls.1 baseline session with PCP; 24 newsletters over 36 months; six phone calls over 36 months; additional PCP encouragement if additional office visits.
Curry, 200311Five intervention components addressed important individual, interpersonal, and environmental factors known to influence the smoking onset process: the child's attitudes, beliefs, and knowledge; dispositional factors such as high risk taking; the beliefs, attitudes, and behaviors of parents and peers; and tobacco marketing and availability. Families received a packet with materials for parents and children and a video with viewing guide. Parents received two counseling telephone calls and a mailed newsletter. Parent handbook provided information to encourage, motivate, and reinforce parent-child communication about tobacco. Children's packet included a pen and stickers with antitobacco messages and a comic book that described the dangers of tobacco, advertising deceptiveness, and how to resist peer pressure to smoke. Could receive motivational message during any routine primary care appointments. (22% of IG and 15% of CG said their provider discussed tobacco with their child; 17% of IG and 3% of CG said the provider mentioned the Steering Clear project.)One counseling call 3–6 weeks after receipt of written materials, additional call 14 months after enrollment. 28-minute video.
Prevention OnlyAusems, 200285Three tailored newsletters mailed at 3-week intervals addressed to the student. Included essential components of successful social influence programs. Contents of letters were individualized. The first letter contained information regarding students' beliefs about smoking and the short-term consequences of smoking. The second letter focused on the influence of the social environment and intentions to not smoke in the future. The third letter described refusal techniques and included an exercise about cigarette refusal.Three newsletters mailed at 3-week intervals (Intervention ran from November 1997 to early February 1998).
Fidler, 200188Age-related materials about the advantages of remaining a nonsmoker. Some materials addressed other smoking-related issues and only incidentally referred to the dangers and health effects of smoking. Sent certificates affirming their nonsmoking decision and status and were encouraged to contact the project team if they wished.Four mailings over 12 months.
Haggerty, 200790Universal substance abuse and problem behavior preventive intervention for families (at least one parent and their teen together) including parenting, youth, and family components. The workbook includes the following components: roles (relating to your teen), risks (identifying and reducing them), protection (bonding with your teen to strengthen resilience), tools (working with your family to solve problems), involvement (allowing everyone to contribute), policies (setting family policies on health and safety issues), and supervision (supervising without invading).IG1: Completed activities at home within 10 weeks. Contacted by phone once per week.IG2: Seven group and family sessions over 7 weeks, 2.5 hours for sessions 1, 4, and 7; 2 hours for sessions 2, 3, 5, and 6. Home practice encouraged.
Hovell, 199681Staff created a tobacco-free environment by formalizing a nonsmoking office policy, removing tobacco ads, discontinuing magazines with such ads, and displaying tobacco prevention information. Patients received antitobacco “prescriptions” with a specific antitobacco message preprinted on the form (topics: announcement of tobacco-free office, tobacco advertising, tobacco and sports, smokeless tobacco, nicotine and tobacco addiction, passive smoking, tobacco and teeth, and negative consequences of tobacco use), a space for their name to be filled in, and a place to sign the prescription. Assume there was also a brief counseling session with the orthodontist.Zero to more than seven prescriptions delivered individually over 2 years.
Jackson, 200692Participants received five core activity guides mailed to their homes at approximate 2-week intervals (one additional booster guide was received 1 year after baseline). Delivery of newsletters, tip sheets, and incentives was timed as appropriate to complement or reinforce each program guide.Five activity guides mailed at 2-week intervals; one booster guide received 1 year after baseline.
Cessation OnlyColby, 200587Motivational interviewing. Pros and cons of smoking and quitting, highlighted ambivalence and identified salient aspects of smoking. Personalized feedback sheet that summarized information from baseline assessment. Corrective normative feedback; personalized information about health effects, CO, and dependence level; and financial costs. Detailed action plan, anticipation of barriers, strategizing methods to overcome barriers. Enhanced self-efficacy. Same handouts as CG, feedback sheet, goal sheet, and information about strategies for quitting and coping with withdrawal. Telephone booster call to reinforce initial progress toward goals, emphasized personal choice for change, discussed coping skills and problem-solving, and promoted self-efficacy.One baseline session (35 minutes); one 15- to 20-minute telephone booster session at 1 week.
Colby, 2012104Same intervention as Colby 2005. One motivational interviewing session plus one booster phone call, as well as print materials. Additional component where parents of intervention participants were asked to participate in one session that focused on increasing parent support for the adolescent's goals for changing smoking, increasing clear communication, and establishing home smoking rules. Parents in both conditions were mailed informational materials on helping adolescents quit smoking.One baseline session (45 minutes), one 15- to 20-minute telephone booster session at 1 week, and one 15- to 20-minute discussion with parents.
Pbert, 201180Based on the 5A model and adapted to be developmentally appropriate for adolescents. Advised the student to stop smoking. Assessed motivation to quit. Assisted the adolescent to quit by addressing pros/cons of smoking, personal reasons for quitting, anticipated problems, previous quit attempts, nicotine addiction, quit methods, setting a quit date, triggers, and strategies. Assisted the adolescent to quit by addressing managing triggers, handling social situations, withdrawal symptoms and their management, managing cravings, managing stress, minimizing weight gain, gaining support, taking control of one's environment, and rewarding oneself. Assisted in maintaining abstinence if the adolescent quit. Nurse asked open-ended questions to actively engage adolescent.Weekly private one-on-one sessions for 4 weeks (two 30-minute sessions, two 15-minute sessions).
Cessation Only (Medication)Killen, 200494Both IG and CG received the behavioral intervention. Group-based skills training. Groups met weekly and were supervised by trained counselors. Counselors demonstrated the use of specific, concrete, self-regulatory skills for coping with risky situations without resorting to smoking and helped participants develop action plans to promote nonsmoking in self-identified, high-risk situations. (Medication: IG: 150 mg bupropion + NRT; CG: placebo + NRT)Weekly group sessions (∼8 participants/group) for 10 weeks (assumed), 45 minutes each.
Muramoto, 200796Both IG and CG received the behavioral intervention. Brief individual counseling sessions standardized to address a series of topics addressing teaching skills related to changing smoking behaviors (e.g., identifying social support, identifying motivations and barriers to quitting, recognition of triggers for smoking, management of nicotine craving and withdrawal symptoms, and stress management). Telephone number for state quit line provided for additional behavioral support. (Medication: IG1: 150 mg bupropion; IG2: 300 mg bupropion; CG: placebo)Seven individual sessions over 7 weeks, 10- to 20-minutes each.

Abbreviations: 5A = Ask, Advise, Assess, Assist, Arrange Followup; CDC = Centers for Disease Control and Prevention; CG = control group; CO = carbon monoxide; IG = intervention group; NRT = nicotine replacement therapy; PCP = primary care practitioner; PTC – Pathways to Change.

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