Evaluation of school-based smoking-cessation interventions for self-described adolescent smokers.

Department of Population, Family, and Reproductive Health, School of Public Health, Johns Hopkins University, Student Health and Wellness Center, Baltimore, Maryland 21218, USA.
PEDIATRICS (Impact Factor: 4.47). 09/2009; 124(2):e187-94. DOI: 10.1542/peds.2008-2509
Source: PubMed

ABSTRACT The goal was to compare the efficacy of school-based, multisession, group smoking-cessation interventions versus a single group session in increasing quit rates among adolescent smokers.
Eight schools were assigned randomly to use 1 of 2 group smoking-cessation programs previously shown to increase quit rates among adolescents (Not on Tobacco [NOT] or Kickin' Butts). We reformatted the programs to twice-weekly 25- to 30-minute sessions delivered during lunch periods. Smoking status was assessed at end of program (EOP) and 1, 3, 6, and 12 months later. Self-reported quit status was confirmed with salivary cotinine levels.
A total of 407 students (56% black and 52% female; mean age: 16 years) participated. Kickin' Butts participants were no more likely to quit than control subjects. In the conservative analysis (students with missing follow-up data classified as smokers), NOT participants were 1.92 times (95% confidence interval [CI]: 1.09-3.40 times) more likely to self-report quitting at 1 month. In the Bayesian analysis (missing follow-up data imputed by using all available data), NOT participants were significantly more likely than control subjects to self-report quitting at EOP (relative risk [RR]: 1.26 [95% CI: 1.10-1.43]), 1 month (RR: 2.07 [95% CI: 1.68-2.56]), and 12 months (RR: 1.58 [95% CI: 1.22-2.04]). Cotinine-confirmed quit rates were significantly greater among NOT participants, compared with control subjects, at EOP and 1 month.
The reformatted NOT program had a modest effect on adolescents interested in quitting. Kickin' Butts, as reformatted for this project, did not have any effect on quit rates.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite most teenage smokers wanting to quit, their likelihood of success resembles that of flipping a coin. Evidence-based cessation programs, like the American Lung Association's Not-On-Tobacco (N-O-T) program, are effective. Evaluation of program dissemination is critical. This study uses the RE-AIM framework to evaluate the N-O-T program in West Virginia from 2000 to 2005. RE-AIM components consisted of four measures. Regional dissemination was measured using comparative differences between Regional Educational Service Agency regions (RESAs). Significant associations were found between RESAs for numerous characteristics. Among the RE-AIM components, two measures of Implementation were significantly different between RESAs. Variability between RESAs provided valuable descriptive evidence of N-O-T program dissemination in West Virginia. Therefore, geographical tailoring grounded in community-based participatory research could increase the N-O-T program's overall dissemination.
    Health Promotion Practice 03/2011; 13(4):506-14. · 0.55 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose. This study evaluated similarities and differences of enrollment rates using two different recruitment strategies for a tobacco control trial in rural and urban African-American (AA) elementary school families. Design. A comparative study, nested within a larger randomized controlled trial, was used to test the effectiveness of two recruitment approaches on enrollment rates in rural and urban AA families. Setting. The study was conducted in 14 Title 1 elementary schools in the southeastern United States: 7 rural and 7 urban. Subjects. There were 736 eligible AA families, and 332 (45%) completed informed consent and were enrolled into the study. Intervention. The Facilitate, Open and transparent communication, Shared benefits, Team and tailored, Educate bilaterally, and Relationships, realistic and rewards (FOSTER) approach guided the two recruitment strategies: (1) written informational packets provided to fourth graders to take home to parents; and (2) proactive, face-to-face family information sessions held at schools. Measures. Enrollment rates were based on responsiveness to the two recruitment strategies and completion of the informed consent process. Analysis. Chi-square, Cochran-Mantel-Haenszel, and Breslow-Day tests were performed. Results. Higher enrollment rates occurred during the family session for both rural and urban families (100% rural, 93.6% urban; p = .0475) than informational packets alone (28.7% rural, 22% urban; p < .0001). Rural family enrollment rates were overall higher than urban rates regardless of recruitment strategy (52.0% rural vs. 39.6% urban; p = .0008). Conclusion. The findings suggest the FOSTER approach, although effective in both rural and urban settings, was more successful in recruiting rural families.
    American journal of health promotion: AJHP 03/2013; 27(4):e91-e100. · 2.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim:Emerging racial/ethnic disparities in tobacco use behaviors and resulting long-term health outcomes highlight the importance of developing culturally tailored/targeted tobacco prevention and cessation interventions. This manuscript describes the efficacy and the components of prevention and cessation interventions developed for minority adolescents. METHODS: Thirteen studies focused on culturally tailoring and targeting tobacco prevention/cessation interventions were selected and information on intervention design (type, number of sessions), setting (school or community), theoretical constructs, culture-specific components (surface/deep structures), and treatment outcomes were extracted. RESULTS: Of the 13 studies, 5 focused on prevention, 4 on cessation, and 4 combined prevention and cessation, and most of the studies were primarily school-based, while a few used community locations. Although diverse minority groups were targeted, a majority of the studies (n = 6) worked with Hispanic adolescents. The most common theoretical construct examined was the Social Influence Model (n = 5). The overall findings indicated that culturally tailoring cessation interventions did not appear to improve tobacco quit rates among minority adolescents, but culturally tailored prevention interventions appeared to produce lower tobacco initiation rates among minority adolescents than control conditions.Conclusions:The results of review suggest that there is a critical need to develop better interventions to reduce tobacco use among minority adolescents and that developing a better understanding of cultural issues related to both cessation and initiation of tobacco use among minority populations is a key component of this endeavor.
    Nicotine & Tobacco Research 05/2012; · 2.48 Impact Factor