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Guide
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Project EX
OVERVIEW
Project EX is a school-based smoking cessation program that targets high school smokers. Project EX relies on a series of eight clinic sessions that teach students about the harmful consequences and characteristics of tobacco use and provide them with motivational activities to help them quit. The ultimate goal of Project EX is smoking cessation. The program has been evaluated, with 18 schools being randomly assigned to a control group or one of two experimental groups: clinic-only or clinic plus a school-as-community component. Both treatments were found to increase the likelihood of quitting among teens.
Project EX is a state-funded smoking cessation program. It is derived from two curricula used in the Project Toward No Tobacco Use which emphasize the chemical and psychosocial dependencies associated with tobacco. Project EX collapsed components of these curricula into five clinic sessions. To enhance the appeal of the clinic sessions, program designers also conducted a variety of focus groups to determine activities that would make the sessions more fun and motivational for students. Ultimately, the Project EX curriculum was expanded into eight full sessions to incorporate a variety of activities that take the form of games, “talk-shows” and alternative-medicine activities, such as yoga.
Project EX is implemented over the course of six weeks. The first four sessions take place during a two-week period and largely emphasize the skills, knowledge, and preparedness to quit. The remaining four sessions are held once a week and focus on actually quitting and maintaining the attempt to quit. Clinic sessions are held at school during school hours and those who participate receive class credit.
The first session of Project EX focuses on ground rules of the program, reasons for using and quitting tobacco products, in addition to family concerns regarding smoking. Session two explores the effects tobacco has on stress and provides alternative coping techniques. In session three, topics include the harmful substances and effects of tobacco use. Session four discusses the option of addressing addiction, the quitting process, and withdrawal symptoms associated with the process. Session five marks the point where students first attempt to quit. During this session, students are presented with information on nicotine addiction in addition to strategies to manage withdrawal symptoms and psychological coping techniques. Sessions six through eight continue to focus on maintenance strategies, managing withdrawal symptoms, and avoiding relapse.
Continuation high schools are alternative public high schools for students with academic and behavioral problems, a population considered at high risk for smoking. Eighteen continuation high schools representing five southern California counties were selected to participate in the study. A total of 335 student smokers participated in the study.
Approach: Schools were randomly assigned to one of three conditions which included a Project EX clinic-only group, a control group, and a Project EX clinic plus a School-as-Community (SAC) component. Each condition had an equal number of schools.
The SAC component was intended to produce a social climate in schools that would encourage smoking cessation among all students. Under supervision from teachers, students organized community service, recreational and job opportunities in addition to a newsletter, all of which were designed to promote a school-wide anti-tobacco stance.
All students were administered a school-wide tobacco use prevalence survey to determine individual tobacco use. Six project facilitators, trained to deliver the clinics, attended each classroom in the intervention schools to present students with information on the availability of a tobacco cessation clinic. Students who reported tobacco use in the past thirty days and voluntarily agreed to participate were eligible for the study. Students must have joined the clinic on or before the fourth session.
One hundred and thirty-nine students participated in the clinic-only condition. The clinic + SAC had n=120 and the control condition had n=76 students. Students in the control condition were assessed at baseline and at the three-month follow-up. All students in the two interventions were assessed at baseline, post-clinic, and at three months. All assessments were administered at school during school hours by trained Institute Data Collection staff members. Assessments were based on self-report questionnaires.
Measures in the evaluation included tobacco use behavior (lifetime and 30-day rates), tobacco use intentions, nicotine dependence, stages of tobacco use and cessation, and demographic characteristics. Tobacco use included cigarettes, cigars and smokeless tobacco products. Nonsmoking reports were verified by breath samples.
Results: Of the 259 smokers who enrolled in the Project EX clinics, 54 percent completed the program. Retention did not differ significantly between conditions, nor did the groups differ on demographic measures.
At the three-month follow-up, 51 percent of the original sample was available for assessment. Attrition did not affect the conditions differently. Because no difference was found between the two intervention conditions at post-test, the two groups were collapsed for analyses at three months. Intention-to-treat (ITT) results find that 30 percent of those in the experimental groups had not smoked for 30 days, compared with 14 percent of the control group.
After examining the validity of self-report data using the breath samples, researchers found that approximately 15 percent of the sample over-reported quitting. This tendency occurred equally in both conditions. After adjusting for over-reporting, 30-day abstinence rates decreased overall but differences between control and intervention conditions remained statistically significant.
One limitation of the evaluation is that school events or health education classes that also target smoking among teens coincided with the implementation and evaluation of Project EX.
Link to program curriculum: http://tnd.usc.edu/ex/index.php
Sussman, S., Dent, C.W., Lichtman, K.L. (2001). Project EX: Outcomes of a teen smoking cessation program. Journal of Addictive Behaviors, 26, 425-438.
Program categorized in this guide according to the following:
Evaluated participant ages: 9th-12th grades
Program age ranges in the Guide: 12-14, 15-21
Program components: clinic-based, provider-based, or miscellaneous; school-based
Measured outcomes: social and emotional health and development; behavioral problems
Program information last updated 3/14/07
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© Child Trends 2004 |