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首页> 外文期刊>American journal of public health >The Linking Lives Health Education Program: A Randomized Clinical Trial of a Parent-Based Tobacco Use Prevention Program for African American and Latino Youths
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The Linking Lives Health Education Program: A Randomized Clinical Trial of a Parent-Based Tobacco Use Prevention Program for African American and Latino Youths

机译：连结生命健康教育计划：针对非裔美国人和拉丁裔青少年的基于父母的预防烟草使用计划的随机临床试验

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Objectives. We evaluated the effectiveness of a parent-based add-on component to a school-based intervention to prevent cigarette smoking among African American and Latino middle school youths. Methods. Mother–adolescent dyads (n = 1386) were randomly assigned to 2 groups: (1) a school-based smoking-prevention intervention or (2) the same intervention with a parent-based add-on component called Raising Smoke-Free Kids. Mothers in the experimental condition received the parent add-on component. Mothers in the control condition received information on selecting a high school. All adolescents received a version of Project Towards No Tobacco Use (TNT). The primary outcome was a reduction in adolescent cigarette smoking. Follow-up data were obtained from 1096 mother–adolescent dyads at 15 months postintervention. Results. At follow-up, the odds of smoking cigarettes were reduced by 42% for adolescents in the parent add-on condition versus the TNT-only condition. Mothers in the parent add-on condition were more likely than were mothers in the TNT-only condition to set rules about risk-sensitive social activities and to be perceived as trustworthy by their child. Group differences also were found in the frequency and quality of mother–adolescent communication. Conclusions. Including parent add-on components in school-based smoking prevention programs can reduce smoking behavior on the part of inner-city middle school youths. Each day in the United States, more than 4000 adolescents aged 12 to 17 years try their first cigarette. 1 If current smoking patterns continue, an estimated 6.4 million of today's children can be expected to eventually die from a smoking-related disease. 2 Ethnic and racial disparities in smoking-related morbidity and mortality are well-documented. Data suggest that African Americans and Latinos are particularly vulnerable to the negative consequences of tobacco use. 3 , 4 Research suggests that parents can play an important role in preventing cigarette smoking among African American and Latino youths. 5 – 8 Parenting processes associated with protective effects include parent-adolescent communication about tobacco use, 9 parental disapproval of smoking, 8 and the institution of parental rules that discourage smoking. 10 , 11 In addition, studies have documented inverse relationships between high levels of parent–adolescent connectedness and involvement with adolescent smoking. 12 – 14 In recent years, a number of interventions have involved parents to prevent adolescent tobacco use. 15 – 19 A recent systematic review identified 22 randomized clinical trials of family-based interventions to prevent smoking; of these, the reviewers deemed 17 to be methodologically sound. 20 Of these 17 studies, 9 tested a family intervention against a no-treatment control group, and 4 of those 9 yielded statistically significant positive effects; 1 study that compared a family-based intervention with a school-based intervention found the family-based intervention to be more effective, and of the 7 studies that evaluated whether a family-plus-school program had incremental effects as compared with a school program alone, none yielded significant effects. 20 Most of the intervention studies that used parent-based add-on components were not realistic from a practical standpoint, lacked a theoretical basis, or suffered from methodological limitations. When tests evaluate whether parent-based add-on components have incremental effects over and above a nonparent intervention, a demanding standard is being set. This is because the parent add-on component is judged to be effective only to the extent that it affects youths whom the original program was unable to affect, and such youths are likely to be more resistant to change than were those affected by the original program. Although none of the tobacco-focused programs in the systematic review showed incremental effects, 20 we located 2 HIV-prevention programs that found a parent add-on component to have incremental effects on cigarette smoking. Wu et al. 19 tested whether a parental monitoring add-on incrementally affected multiple risk behaviors, including cigarette smoking, as compared with an HIV-prevention program alone. The researchers reported an incremental effect on whether the adolescent had ever smoked a cigarette at the 6-month follow-up but not at the 12-month follow-up. 19 Prado et al. 18 evaluated an incremental effect of a parent add-on for an HIV-prevention program aimed at sexual risk behavior and for a program aimed at cardiovascular health that directly addressed smoking (HeartPower! for Hispanics; the HEART program). They found no evidence for incremental parent add-on effects on smoking for the HEART program, but they reported that the HIV program plus the parent add-
机译：目标。我们评估了基于父母的附加组件在学校干预中预防非裔美国人和拉丁裔初中青年吸烟的有效性。方法。母亲-青少年双联（n = 1386）被随机分为2组：（1）以学校为基础的吸烟预防干预措施，或（2）以父母为基础的附加组件，即“培养无烟儿童”进行的干预。在实验条件下的母亲会收到父母的附加组件。处于控制状态的母亲会收到有关选择高中的信息。所有青少年都收到了“禁止吸烟计划”（TNT）版本。主要结果是减少了青少年吸烟。干预后15个月，从1096例母亲－青少年二元组获得了随访数据。结果。在随访中，与仅使用TNT的情况相比，在父母附加条件下青少年的吸烟几率降低了42％。父母附加条件下的母亲比仅TNT情况下的母亲更有可能制定关于风险敏感的社交活动的规则，并被孩子视为值得信赖。母婴沟通的频率和质量也存在群体差异。结论。在学校的吸烟预防计划中包括家长附加组件，可以减少内城中学生的吸烟行为。在美国，每天有4000多名12到17岁的青少年尝试使用第一支香烟。 1 如果当前的吸烟方式继续下去，估计今天有640万儿童最终会死于吸烟相关疾病。 2 吸烟相关的发病率和死亡率方面的种族和种族差异已得到充分证明。数据表明，非洲裔美国人和拉丁美洲人特别容易受到烟草使用的负面影响。 3，4 研究表明，父母可以在预防非洲裔美国人和拉丁美洲人青少年吸烟中发挥重要作用。 > 5 – 8 与保护作用有关的育儿过程包括父母与青少年之间关于烟草使用的沟通， 9 父母不赞成吸烟， 8 和制定父母规则 10，11 另外，研究表明，父母与青少年之间的高度联系与青少年吸烟之间存在反比关系。 12 – 14 近年来， 15-19 最近的一项系统评价确定了22项基于家庭的干预措施以防止吸烟的随机临床试验。 20 在这17项研究中，有9项针对未治疗的对照组进行了家庭干预测试，而这9项中有4项在统计学上具有积极意义。一项将家庭干预与学校干预进行比较的研究发现，家庭干预更为有效;在评估家庭加学校计划与学校计划相比是否具有增量效果的7项研究中 20 大多数使用基于父母的附加组件的干预研究从实践的角度来看都是不切实际的，缺乏理论基础或受到方法论的限制。当测试评估基于父项的附加组件是否具有超出非父项干预的增量影响时，将设定一个苛刻的标准。这是因为，父母附加组件仅在影响原始程序无法影响的年轻人的范围内才被认为是有效的，并且与受原始程序影响的年轻人相比，这些年轻人更容易抵御改变。尽管系统评价中没有一个以烟草为重点的计划显示出增加的效果，但 20 我们找到了2个HIV预防计划，这些计划发现父母的附加成分对吸烟具有递增的影响。 Wu et al。 19 测试了与单独的艾滋病毒预防计划相比，父母监护附加程序是否会逐步影响包括吸烟在内的多种风险行为。研究人员报告说，对青少年是否在6个月的随访中是否抽过烟而不是在12个月的随访中有渐进的影响。 19 Prado等人。 18 评估了父母附加组件对针对性风险行为的HIV预防计划以及对吸烟直接针对的心血管健康计划（HeartPower！for西班牙裔; HEART计划）的增量作用。他们没有发现证据表明父母对HEART计划的增加会增加吸烟对吸烟的影响，但他们报告说，艾滋病毒计划加上父母对吸烟的影响，

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