Evaluation of Developmentally Appropriate Programs for Adolescent Tobacco Cessation

By Coleman-Wallace, Debbie; Lee, Jerry W. et al. | Journal of School Health, October 1999 | Go to article overview

Evaluation of Developmentally Appropriate Programs for Adolescent Tobacco Cessation


Coleman-Wallace, Debbie, Lee, Jerry W., Montgomery, Susanne, Blix, Glen, Wang, Dongqing Terry, Journal of School Health


Tobacco use constitutes the most preventable cause of morbidity and mortality in the United States, accounting for more deaths than alcohol, car accidents, heroin, cocaine, crack, homicide, firearms, and AIDS combined.[1] Much of the damage due to smoking, however, can be reversed within one year of quitting.[2,3] Decreasing the number of smokers should be a national priority according to Healthy People 2000.[4] Over the past decade smoking declined among the adult population, but not among adolescents.[5] Despite numerous smoking prevention programs, roughly nine of 10 adult smokers started smoking during adolescence.[6]

National surveys reveal that most adolescent smokers made one or more unsuccessful attempts to quit smoking.[7,8] Adolescents also tend to overestimate the success of their peers at quitting.[9] According to the 1989 Teenage Attitudes and Practices Survey only about 1.5% of teens who ever smoked were successful at smoking cessation.[10] Therefore, adolescents want to quit, but they lack the ability or the resources necessary to quit smoking.

The literature contains information about adult smoking cessation programs but lacks information about adolescent smoking cessation programs, because few adolescent programs exist, and of these, few have been evaluated or published.[6] Prevention programs in schools concentrated on primary

prevention, or programs that prevent initiation of smoking. Adolescents often experiment with smoking or smokeless (chew/dip) tobacco products. Nicotine, being highly addictive and present in all tobacco products, often results in experimenters becoming addicted. These addicted adolescent tobacco users, in turn, increase the amount of peer pressure on their peers to use tobacco products, so the cycle continues unchecked because smoking cessation programs are not offered to adolescents who cannot quit on their own.[11,12]

With the increase in smoking among adolescents, schools need effective smoking cessation programs. However, the Centers for Disease Control and Prevention (CDC) reports that evaluation of adolescent smoking cessation programs typically were anecdotal or descriptive.[6,13] With lack of published literature concerning effective, developmentally appropriate programs for adolescent tobacco cessation, school administrators may be reluctant to commit time and limited resources to provide smoking cessation programs. This study addressed this need by conducting a quantitative and a qualitative evaluation of two adolescent programs.

THE PROGRAMS

The programs were implemented throughout the United States prior to formal evaluation which was conducted in six public high schools in Southern California. The programs were developed specifically for the adolescent population and address both smoking and smokeless tobacco use. The programs consisted of eight, one-hour sessions designed for small groups of eight to 12 adolescents with an adult facilitator. The group provided social pressure or positive peer pressure to quit tobacco use.

Description of Programs

The Tobacco Education Group (TEG), a general education program, sought to motivate tobacco users to have the desire to quit using tobacco. The TEG curriculum included:

* personal reasons for smoking or chewing tobacco;

* pressures to use tobacco;

* demonstrations of short-term consequences of tobacco use; and

* discussions of long-term consequences of tobacco use.

The Tobacco Awareness Program (TAP), a tobacco cessation program, was designed for adolescents who desire to quit using tobacco. The TAP curriculum included:

* short-term and long-term consequences of smoking;

* triggers to tobacco use and coping strategies;

* pitfalls to be expected during and after quitting;

* use of culturally sensitive materials; and

* individual choice of methods to quit. …

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