Researchers at UNMC have been awarded a grant for nearly $2.2 million to study a smoking cessation model that addresses the unique challenges of teenage smokers. The four-year grant was awarded by the U.S. Department of Health and Human Services Public Health Services.
Teen smoking is a significant problem that is inadequately addressed, researchers say. Smoking cessation among teens is different than among adults. Researchers say teens make frequent, spontaneous quit attempts that involve little or no planning and attempts to quit often fail after a short time because the smokers were not prepared to deal with temptations to smoke or with withdrawal symptoms.
The effectiveness of peer counseling
The main objective of the UNMC study is to determine the effectiveness of peer counseling to assist high school students to quit or reduce smoking, become more ready to quit and have more favorable attitudes about quitting. Part of the study also will assess the effectiveness of the peer counselor training program and examine the role of peer counselors.
A total of 900 smokers in 16 high schools within a 50-mile radius of UNMC will be recruited for the study and be assigned randomly to an intervention group or control group. It’s estimated about 22 percent of high school students in the 16 schools are regular smokers.
“We have developed an innovative program using peer counselors to deliver smoking cessation messages. Our pilot studies have been promising and shown the potential to help large numbers of teens in an efficient way,” said Kristine McVea, M.D., associate professor, UNMC department of family medicine and principal investigator of the grant.
Smoking concerns
Statistics say smoking, the leading preventable cause of cancer mortality in the United States, contributes to 87 percent of lung cancers, and is associated with cancer of the mouth, pharynx, larynx, esophagus, pancreas, cervix, kidney and bladder. Most smokers begin using tobacco in early adolescence, and almost all users start before the age of high school graduation. The U.S. Centers for Disease Control and Prevention has estimated that 5 million children in the United States ultimately will die a premature death due to smoking related illnesses unless this trend is dramatically reversed.
Dr. McVea said although smoking rates among adults have been declining, little progress has been made with adolescents as the prevalence of smokers has increased by one-third since 1991. Recent surveys indicate that by their high school graduation, more than 39 percent of students are using cigarettes and 19 percent are regular smokers.
Teen quit smoking attempts often fail
Adolescents who want to quit smoking receive little social support, don’t properly prepare for quit attempts, and often fail, Dr. McVea said. In addition, cessation programs have difficulty attracting and retaining young smokers, and lack strong evidence demonstrating the effectiveness of existing youth programs.
In addition, she said physicians have fewer opportunities to interact with adolescents than any other age group and tend to offer them less smoking cession counseling than adults. Without help, 80 percent of self-initiated quit attempts by teens end in failure within one month. Little support is currently available for self-initiated quit attempts by adolescents.
“Many students who smoke frequently talk to their friends about quitting,” Dr. McVea said. “One large study found that 57 percent of high school students had tried to influence their peers not to smoke, including 29 percent of smokers. Among adolescent smokers trying to stop smoking, 14 percent said their friends were the reason they had made a quit attempt, and 39 percent reported that their friends helped them in their attempts.”
Collecting research data
Researchers will collect data from two groups — an intervention group and a control group.
In the intervention group, 265 non-smoking high school students between the ages of 15 and 18 will be recruited to be peer counselors who know at least two smoking friends in high school. The peer counselors will receive training, then recruit about 450 smokers between the ages of 15 and 18, who had smoked at least one cigarette every day for the past 30 days, and are enrolled in the same high school as the peer counselor.
The intervention peer counselor and smoker will interact daily to address smoking cessation, assess their friend’s readiness to change, explore the pros and cons of smoking and provide advice, support and encouragement in stopping smoking. The sessions also will include negotiating a quit date and a cessation plan.
In the control group, 265 untrained peer “counselors” will be recruited from control schools but will receive no training in smoking cessation skills. This control group of “counselors” will be asked to recruit up to four smoking friends into the control group for a total of 450 smokers. After data from the study is collected, “counselors” will receive smoking cessation training to offer their group of smokers help in quitting smoking.
Assessing smokers
Each smoker with be assessed at one month, three months and six months to measure successful smoking cessation. Successful smoking cessation is defined as abstinence from smoking for six months. Nicotine replacement products or those prescribed by private physicians will be presented as an option to help the teens quit.
“We expect to learn important findings regarding the effectiveness of a new smoking cessation intervention targeting adolescents,” Dr. McVea said. “This innovative program addresses scientific gaps regarding methods of reaching teen smokers and providing relevant, tailored cessation messages. This program shows the potential to be an effective intervention that could be disseminated in a school setting to reach large numbers of young smokers.”