) Prevention of tobacco use is a national priority and is the focus of this proposal. Traditional tobacco prevention interventions fail to adequately reach low-income, high risk youth from culturally diverse backgrounds. Children at risk for tobacco use are concentrated in medical care settings that serve low-income populations, the same populations that face the heaviest burdens from tobacco related illnesses. Tobacco use interventions delivered in primary care clinics can personalize messages in the context of a shared patient and provider agenda for optimal health. Counseling in the care clinic has potential to engage youth who are hard to reach in school and community settings, and it can be matched to the concerns of individual children. Therefore, we propose to test the incremental efficacy of a tailored, motivational counseling intervention over brief provider advice alone. The defined population comprises low-income, culturally diverse children ages 9-13 who present for care at a large, academic pediatric urban clinic. Patients (n=620) will be randomly assigned to one of two interventions: (a) brief provider advice, self-help print materials, and provider follow-up at routine medical visits; or (b) brief provider advice, self-help print material, provider follow-up, plus point of service counseling sessions with a health educator, a counseling summary for the medical record to guide health care providers in delivering tailored messages at follow-up, parent education about factors that promote child resistance to tobacco use, and individually tailored letters to both child and parent to boost counseling messages. A comprehensive office system will be used to promote the delivery of the brief provider intervention. The enhanced intervention is based on principles of motivational interviewing with tailoring based on assessment variables. We hypothesize that at the 24 month assessment 93% of children in the enhanced intervention group versus 85% in the brief advice group will remain in the three groups at lowest risk for future smoking, i.e., nonsusceptible nonsmokers, susceptible nonsmokers, and early experimenters, compared to high risk groups of advanced experimental and addicted smokers.
