Targeting high risk teens in the emergency department: A user-informed, theory-based intervention using text messaging to reduce teen pregnancy

针对急诊科的高危青少年：基于用户知情、基于理论的干预措施，使用短信来减少青少年怀孕

• 批准号: 10007637
• 负责人: Lauren Stephanie Chernick
• 金额: $ 16.64万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-13 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10007637
• 关键词: Academic Medical Centers; Accident and Emergency department; Adolescent; Advisory Committees; Affect; Age; Award; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Clinical Trials; Clinical Trials Design; Complement; Contraceptive Agents; Contraceptive Usage; Contraceptive methods; Counseling; Data; Development; Development Plans; Effectiveness; Elements; Emergency Care; Emergency Department patient; Emergency Department-based Intervention; Emergency Medicine; Emergency department visit; Ethics; Evaluation; Exhibits; Feedback; Female; Female Adolescents; Focus Groups; Funding; Geography; Goals; Grant; Health; Health Promotion; Healthy People 2020; High-Risk Pregnancy; Instruction; Intervention; Interview; K-Series Research Career Programs; Knowledge; Learning; Learning Module; Measures; Medical; Mentors; Meta-Analysis; Methodology; Methods; Minority; Multi-Institutional Clinical Trial; Multicenter Trials; Outcome; Outpatients; Participant; Pediatrics; Persons; Physicians; Population; Pregnancy; Pregnancy in Adolescence; Preparation; Preventive; Preventive Intervention; Preventive care; Preventive service; Provider; Public Health; Randomized; Randomized Controlled Trials; Regulation; Reproducibility; Reproductive Health; Research; Research Personnel; Research Training; Resources; Risk; Risk Behaviors; Role; Self Efficacy; Sexual Health; Site; Source; Technology; Teenagers; Testing; Text Messaging; Time; Training Activity; United States; Universities; Woman; Work; adolescent health; adolescent health outcomes; base; behavior change; behavioral health; binge drinking; career development; clinically significant; control trial; design; digital; evidence base; follow-up; high risk; high risk sexual behavior; high-risk adolescents; improved; innovation; interest; mHealth; mobile computing; motivated behavior; multidisciplinary; novel; patient oriented; pediatric emergency; peer; pregnancy prevention; pregnant; primary outcome; professor; programs; public health intervention; reproductive; reproductive health intervention; reproductive health of adolescents; research data dissemination; role model; skills; theories; underserved minority; unintended pregnancy

ABSTRACT Emergency Departments (ED) care for 15 million adolescents each year, the majority being poor, minority, and participating in risky sexual behaviors.1–6 Despite a growing interest in expanding the role of the ED to provide preventive care, ED providers identify limited resources and time constraints as barriers to the implementation of public health interventions.7,8 Novel interventions are needed that fit efficiently within the ED workflow.9 Our prior work recently highlighted a significant public health problem—a particularly high risk of unintended pregnancy among our adolescent ED population.3 We demonstrated that 1 in 5 adolescent females who use our ED are expected to become pregnant in the following year, a risk five times the national average and primarily due to contraceptive non-use. These adolescents infrequently follow up for reproductive care when referred, yet are receptive to ED-based pregnancy prevention interventions, particularly using text messaging.10–13 To date, no intervention has successfully increased contraception use among this high risk, hard-to-reach ED population. Lauren S. Chernick, MD, MSc, is an Assistant Professor of Pediatrics in the Division of Pediatric Emergency Medicine at Columbia University Medical Center and is committed to improving the reproductive health outcomes of underserved adolescents using the ED for medical care. During the proposed 3-year Mentored Patient- Oriented Career Development Award (K23), Dr. Chernick’s knowledge and skills will be augmented through the guidance of an interdisciplinary team of mentors and advisors committed to her academic independence. Dr. Chernick’s multi-disciplinary career development plan will focus on the following four key modules: 1) the use of mobile technology for intervention delivery and evaluation; (2) advanced clinical trial design and methodology; (3) the ethics and regulations of researching adolescents; and (4) research dissemination skills and professional development. Dr. Chernick’s training activities will be complemented by an original project that will accelerate the application of these skills. In Aim #1, she will conduct a pilot randomized control trial of a user-informed, theory-based, personalized, interactive, pregnancy prevention text messaging intervention (entitled Dr. Erica) to determine its feasibility, acceptability and potential efficacy. We hypothesize that high risk adolescent female ED patients who receive Dr. Erica will more often initiate contraceptives than those females who receive standard outpatient referral alone. In Aim #2, she will conduct a qualitative analysis to identify barriers and enablers to the implementation of reproductive health interventions across four diverse EDs in the US. This data will inform a multi-center clinical trial with sufficient power to measure clinically significant changes in contraceptive initiation. Dr. Chernick’s K23 research and training will culminate in the preparation of a R01 application to fund this definitive trial. Ultimately, a text messaging intervention that is effective and automated can be utilized by other EDs as a reproducible and scalable means to promote reproductive preventive care, decrease unintended teen pregnancy, and improve adolescent health outcomes throughout the US.

抽象的 急诊科（ED）每年为1500万青少年照顾 参加冒险的性行为。1-6尽管有兴趣扩大ED的作用以提供 预防保健，ED提供商确定有限的资源和时间限制是实施的障碍 公共卫生干预措施。7,8需要有效地融合ED工作流程的新型干预措施。9我们 最近的工作最近强调了一个重大的公共卫生问题 - 特别是意外的高风险 我们的青春期人口中的怀孕。3我们证明了使用我们的五分之一的青春期女性 ED预计将在次年怀孕，这是全国平均水平和初选的五倍 由于避孕不使用。这些青少年很少在被转诊时跟进复制护理 接受基于ED的预防妊娠干预措施，特别是使用文本消息传递。10-13迄今为止 在这种高风险，难以到达的人群中，任何干预措施都没有成功增加避孕的使用。 劳伦·切尔尼克（Lauren S. 哥伦比亚大学医学中心的医学，并致力于改善复制品健康成果 服务不足的青少年使用ED进行医疗服务。在拟议的三年指导的患者期间 - 定向职业发展奖（K23），切尔尼克博士的知识和技能将通过 致力于她的学术独立性的导师和顾问团队的指导。博士 切尔尼克的多学科职业发展计划将重点关注以下四个关键模块：1） 用于干预和评估的移动技术； （2）高级临床试验设计和方法论； （3）研究青少年的伦理和法规； （4）研究传播技巧和专业 发展。切尔尼克博士的培训活动将由一个将加速的原始项目完成。 这些技能的应用。在AIM＃1中，她将对用户信息的飞行员随机控制试验， 基于理论的，个性化的，互动的，预防文本消息干预（标题为Erica博士） 确定其可行性，可接受性和潜在有效性。我们假设高风险的青春期女性 接受埃里卡博士的患者比那些接受标准的女性更常见发起避孕药 仅门诊转诊。在AIM＃2中，她将进行定性分析，以确定障碍和推动者 在美国四个潜水员ED的生殖健康干预措施实施。这些数据将告知 多中心临床试验具有足够的能力来衡量避孕启动的临床显着变化。 切尔尼克博士的K23研究和培训将在准备R01的申请中为此提供最高水平 权威性试验。最终，有效和自动化的文本消息干预可以由其他 EDS作为可复制和可扩展的手段，用于促进可复制的预防性护理，减少意外的青少年 怀孕，并改善美国的青少年健康状况。

项目成果

Prediction of Suicide Attempts and Suicide-Related Events Among Adolescents Seen in Emergency Departments.

• DOI: 10.1001/jamanetworkopen.2022.55986
• 发表时间: 2023-02-01
• 期刊: JAMA NETWORK OPEN
• 影响因子: 13.8
• 作者: Brent, David A.;Horowitz, Lisa M.;Grupp-Phelan, Jacqueline;Bridge, Jeffrey A.;Gibbons, Robert;Chernick, Lauren S.;Rea, Margaret;Cwik, Mary F.;Shenoi, Rohit P.;Fein, Joel A.;Mahabee-Gittens, E. Melinda;Patel, Shilpa J.;Mistry, Rakesh D.;Duffy, Susan;Melzer-Lange, Marlene D.;Rogers, Alexander;Cohen, Daniel M.;Keller, Allison;Hickey, Robert W.;Page, Kent;Casper, T. Charles;King, Cheryl A.
• 通讯作者: King, Cheryl A.

Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles?

急诊科的避孕措施：我们准备好克服障碍了吗？

• DOI: 10.1089/jwh.2020.8294
• 发表时间: 2020
• 期刊: Journal of women's health (2002)
• 作者: Fischer,Kayleigh;Chernick,LaurenS
• 通讯作者: Chernick,LaurenS

Preferences for Expedited Partner Therapy Among Adolescents in an Urban Pediatric Emergency Department: A Mixed-Methods Study.

城市儿科急诊科青少年对快速伴侣治疗的偏好：一项混合方法研究。

• DOI: 10.1097/pec.0000000000001746
• 发表时间: 2021
• 期刊: Pediatric emergency care
• 影响因子: 1.4
• 作者: Shamash,Zohar;Catallozzi,Marina;Dayan,PeterS;Chernick,LaurenS
• 通讯作者: Chernick,LaurenS

A User-Informed, Theory-Based Pregnancy Prevention Intervention for Adolescents in the Emergency Department: A Prospective Cohort Study.

• DOI: 10.1016/j.jadohealth.2020.07.020
• 发表时间: 2021-04
• 期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine
• 作者: Chernick LS;Stockwell MS;Gonzalez A;Mitchell J;Ehrhardt A;Bakken S;Westhoff CL;Santelli J;Dayan PS
• 通讯作者: Dayan PS

Designing illustrative social media stories to promote adolescent peer support and healthy sexual behaviors.

• DOI: 10.1177/20552076221104660
• 发表时间: 2022-01
• 期刊: DIGITAL HEALTH
• 影响因子: 3.9
• 作者: Chernick, Lauren S.;Konja, Alexis;Gonzalez, Ariana;Stockwell, Melissa S.;Ehrhardt, Anke;Bakken, Susanne;Westhoff, Carolyn L.;Dayan, Peter S.;Santelli, John
• 通讯作者: Santelli, John