Feasibility of School-Based Smoking Cessation Programs
Gillespie, Amaya, Stanton, Warren, Lowe, John B., Hunter, Beth, Journal of School Health
After decades of anti-smoking messages and intense lobbying, substantial gains have been achieved. Current smoking research indicates more adults are trying to quit smoking, and adult smoking has declined substantially in most developed countries during the latter half of this century.[1,2] However, up to 30% of Australians currently smoke - a rate similar to the United States - and youth still are being attracted to the habit.[3,4] A recent study of cigarette and alcohol use by Australian high school students indicated an increase in regular smoking. Russell stated that more than 90% of teen-agers who smoke three-four cigarettes face the possibility of 30-40 years of regular smoking, since only 35% of regular smokers succeed in quitting permanently before age 60. While adults are trying to quit, young people are taking up the habit, which may warrant a change in the traditional emphasis on smoking prevention in school-based programs.
Charlton suggested young people intend to give up smoking, and many do make attempts to quit. However, young smokers do not have great success in quitting, and cessation rates yielded from structured programs are low. Furthermore, confidence in quitting has been reported to decrease dramatically as smoking intensity increases, suggesting success is more probable for lighter than heavier smokers.[11,12]
Needs and experiences of young people who smoke regularly, especially those at school, differ in some important ways from adults. Although the biological effects may be broadly similar, the social implications are clearly different. Schools tend to treat smoking as a discipline issue rather than a health issue. Therefore, responses to student smoking tend to be punitive, even in the absence of objective evidence to support the effectiveness of this approach. Adult smokers can expect to receive assistance with their health risk behavior and the effects of giving up, but young people at school meet with very different circumstances. Underlying this type of response are assumptions that young people do not want to give up smoking, and that quitting should not present problems to the young person.[6,13]
The literature suggests that cessation programs tried with youth, based largely on adult programs, yielded varied levels of success.[6,9] Aimed almost exclusively at school age students, these programs, listed by Stanton et al, used a range of approaches but with an emphasis on techniques used in smoking prevention. Among adult samples, the stages of change model has shown that contemplation or intention to quit is an important precursor to quit attempts, but has only recently been applied to descriptions of adolescent smoking, according to unpublished data by Warren Stanton, John B. Lowe, and Amaya Gillespie.
Surprising as it may seem, given the breadth and strength of smoking research, relatively little attention has been given to consulting adolescents on the process of quitting, preferences for trying to quit, or actual experiences of attempting to quit.[6,16] Furthermore, little is known about designing effective programs specifically to encourage and assist young smokers to quit. At the planning level, the potential for cessation programs within individual school environments will be mediated by a range of variables such as current policies and practice related to staff, receptivity of parent groups, and student confidence in cessation programs.
This paper explores implications of previous attempts at quitting, or intentions to quit in the future in terms of programmatic issues such as a) program facilitator preferences, b) what should be included in programs, and c) recruitment and organization of programs. The study investigated responses to these and related issues, by consulting high school students who smoke about their attitudes to smoking and quitting, and the feasibility of operating school-based smoking cessation programs. …