 |
From left: Brenda Heim and Lisa Hays, both sophomores at Millard North High School, talk with UNMC staff, Tara Harper, Michaella Loewens and Mandy Khan, about a teenage smoking cessation study. Hays is participating in the study as a peer counselor. |
With a $2.2 million grant from the U.S. Department of Health and Human Services Public Health Services, researchers at UNMC are going into high schools in order to evaluate if a model they developed will help smoking teens quit or reduce smoking. The model calls on non-smoking friends to help them.
If the peer counseling model is proven effective, high schools could become new ground to help teenagers quit smoking.
“Teenagers who want to quit smoking have unique challenges that aren’t adequately addressed by smoking cessation programs,” said Kristine McVea, M.D., associate professor, UNMC Department of Family Medicine, and principal investigator of the four-year study that began in 2003. “Though smoking among adults has been declining, little progress has been made with teenagers as the prevalence of smokers has increased by one-third since 1991.”
Some of the reasons teenage smokers have less success in stopping smoking than adults is partly to do with maturity level, she said.
“They’re not prepared to quit and they don’t have much of a support system when they go to quit,” she said. “They make frequent, spontaneous quit attempts that involve little or no planning and attempts to quit often fail after a short time because they were not prepared to deal with temptations to smoke or with withdrawal symptoms.”
Each day in the United States, about 4,000 youths aged 12-17 try their first cigarette, according to a report by the United States Substance Abuse and Mental Health Services Administration. If current patterns of smoking behaviors continue, an estimated 6.4 million of today’s children can ultimately be expected to die prematurely from a smoking-related disease, according to the Centers for Disease Control and Prevention (CDC).
Statistics reported in the CDC’s 2004 Morbidity and Mortality Weekly indicate that although the percentage of high school students who smoke has declined in recent years, rates remain high – 22 percent of high school students report current cigarette use. The CDC reported in 2003 that 59 percent of Nebraska high school smokers had tried to quit.
“There’s not a lot of help for teenagers in high school to quit smoking,” Dr. McVea said. “Studies say it’s extremely difficult for teens to quit smoking. The conventional thinking is it’s not hard for them to stop because they haven’t been smoking as long or as much so it should be easier to quit than adult smokers. But it’s not. I think we were pretty naïve in thinking when we told teens to quit, that they would, but it’s just not that easy. In addition, cessation programs have difficulty attracting and retaining young smokers.”
One large study found 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 recruit 900 smokers in 24 Omaha, Lincoln and Council Bluffs area high schools to be part of an intervention group or control group. To date, 262 peer counselors and 250 smokers have been recruited.
Researchers expect to learn important findings through the study, which culminates in 2007.
“This program addresses scientific gaps regarding methods of reaching teen smokers and providing relevant, tailored cessation messages. It also shows potential for an effective intervention to be disseminated in a school setting to reach large numbers of young smokers,” Dr. McVea said.
In the study intervention group, 265 non-smoking high school students between the age of 15 and 18 will serve as peer counselors. They will receive training and then recruit about 450 smokers enrolled in the same high school, between the age of 15 and 18, who had smoked at least one cigarette every day in the past 30 days.
In the control group, 265 peer counselors will be recruited from control schools but will receive no training in smoking cessation skills. Teens in the control group will be asked to recruit up to four smoking friends. After data from the study is collected, peer counselors will receive smoking cessation training to offer to the smoking subjects they’ve recruited.
The research team sent in to recruit and work in the schools looks as young as their study participants. They also possess a key trait for getting teens to follow through with the study: relentlessness.
Not only will the study give researchers insight about their smoking cessation model, it has taught them a lot about teenage behavior. They’ve learned traditional approaches to working with teenagers don’t always work. They revised their strategies to more successfully reach teens.
“They have very busy lives and don’t have the longest attention span. It’s difficult to get them to commit and get follow-up data six months later,” said Jenenne Geske, Ph.D., the study’s research coordinator.
“Sometimes I have to go to students’ homes to have them complete their surveys,” said Mandy Khan, a UNMC clinical research associate. “They’re inaccessible during the day, they work and are busy on the weekends.”
Khan recalls phoning a hard-to-reach student on a Saturday morning from outside her home. “I asked her if she had five minutes to spare, she invited me in and I waited while she ate her cereal and filled out a survey.”
Recruiting for the study begins in high schools in the fall. In March and April, the research team contacts school district administrators to get approval to send letters to teachers offering five-minute presentations about their recruiting efforts, distributing flyers in the schools, and staffing a display booth for two weeks in a high-traffic area in the school.
Researchers say teens tell them the biggest reason they want to quit smoking is the cost. Some estimate smoking two packs a day costs about $2,400 a year.
“The kids that are really hooked on it don’t like the fact that they’re hooked on it,” Khan said. “Some of their parents and friends also smoke. They know it’s bad for them and it’s dirty. It’s not easy to quit, but if they quit now, they can avoid the long-term consequences of smoking.”
Teen smokers may start out by smoking at a party, said Michaella Loewens, clinical research associate. “Then it just snowballs,” she said. “The more they smoke, the less offensive it becomes to their system.”
Tara Harper is a smoking cessation specialist who provides peer counselor training. She said if the model is successful, the goal would be to implement it in schools. “Schools that like to participate will be offered a training plan they could work into a health class or whatever class they’d like,” Harper said.
Some schools have peer-counseling programs for such topics as drugs, alcohol and teen pregnancy.
During four-hour training sessions with intervention group peer counselors, which includes pizza and pop, they teach how to counsel smokers through quitting, including how to gauge smokers’ readiness to quit, set up quit plans and dates, educate smokers on withdrawal symptoms, learn how to talk to the smoker at various stages of quitting and what to offer as substitutes for smoking.
For participating in the study, all teens receive a $10 gift card for filling out an initial survey. A peer counselor in the intervention group can make up to $50 for completing the study, Harper said.
To prevent bias, formal results of the study are kept confidential from the researchers, but they’ve heard positive comments from teens. “We’ve heard of kids quitting,” said Harper, a smoking cessation specialist. “They’ll tell you. They want you to know it’s successful.”
 |
Jonathan Ingram is a peer counselor in the study. |
In learning how to help his friends quit, he also may be able to help his family.
“Everybody in my family smokes,” Ingram said. Though Ingram said he gets “yelled at” sometimes when talking to family members about their smoking, he keeps on them.
Besides Benson and Millard North high schools, other participating schools are: Abraham Lincoln High School (Council Bluffs), Blair High School, Bryan High School, Burke High School, Central High School, Elkhorn High School, Fremont High School, Lincoln Southeast, Lincoln Northeast and Lincoln North Star, Millard South High School, North High School, South High School, and Papillion-La Vista’s Senior and South high schools, Northwest High School, Plattsmouth High School and Westside High School.