Researchers at the University of Nebraska Medical Center 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.
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.
Teen smoking is a significant problem that is inadequately addressed,
say researchers. 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.
A total of 900 smokers in 24 Omaha, Lincoln and Council Bluffs high
schools will be recruited for the study and be assigned randomly to an
intervention group or control group. Its estimated about 22 percent of
high school students in the 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.
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
the time of high school graduation, more than 39 percent of students are
using cigarettes and 19 percent are regular smokers.
She said the challenge for adolescents is though they want to quit smoking,
they receive little social support, dont properly prepare for quit attempts,
and often fail. In addition, cessation programs have difficulty attracting
and retaining young smokers, and strong evidence demonstrating the effectiveness
of existing youth programs is currently lacking.
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.
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 age of 15 and 18 will be recruited to be peer counselors who know at
least two smoking friends of high school age. The peer counselors will
receive training then recruit about 450 smokers between the age 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 friends 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.
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.