School Nurse-Delivered Adolescent Smoking Cessation Counseling Intervention

OVERVIEW

The School Nurse-Delivered Adolescent Smoking Cessation Counseling Intervention is based on the 5A model recommended by the Public Health Service and Bandura’s Social Cognitive Theory constructs. It is designed to develop health knowledge and build adolescent’s skills and self-efficacy to stop smoking. Schools were randomly assigned to the 5A model on usual smoking cessation activities. An evaluation of the intervention found that it had significant impacts on plans to quit, self-confidence to quit, and cessation of smoking.

DESCRIPTION OF PROGRAM

Target population: adolescent tobacco users

The school nurse-delivered adolescent cessation counseling intervention encompasses two approaches: an intervention and a counseling approach. The intervention approach is based on the 5A model recommended by the Public Health Service, which includes Ask (about tobacco use), Advise (all tobacco users to quit), Assess (tobacco users willingness to quit), Assist (tobacco users in quitting) and Arrange (follow-up). For the adolescent smoking cessation counseling intervention, the 5A model was modified and includes: Ask (adolescent about his/her smoking status), Advise (the student top stop smoking) Assess (motivation to stop smoking), Assist (the adolescent to quit smoking), and Arrange (follow-up) and adolescent’s skills and self-efficacy to stop smoking. The intervention is based on the 5A model: (follow-up) recommended by the Public Health Service All school nurses from the intervention schools were trained on the 5A intervention. The counseling component is based on Bandura’s Social Cognitive Theory, and encompasses a patient-centered method in which the nurse asked open-ended questions to students to help the engage thoughts, ideas, behaviors, and preferences for action. The intervention is divided into 4 sessions, and delivered over the course of 30 days. The intervention allows for additional sessions if the student needs it or starts smoking again.

EVALUATION(S) OF PROGRAM

Pbert, L., Osganian, S. K., Gorak, D., Druker, S., Reed, G., O’Neill, K. M., & Sheetz, A. (2006). A school nurse-delivered adolescent smoking cessation intervention: A randomized controlled trial. Preventive Medicine, 43, 312-320.

Evaluated population: A total of 1,148 students participated in the study. The student populations were predominantly white (90 % intervention, 80% control) and female (71% intervention, 74% control), with an average age of 17 years.

Approach: Seventy-one public high schools in Massachusetts were recruited to participate in the study. Schools were pair-matched based on size of student enrollment, race/ethnic demographics of the students, and receipt of school health services funding, and were then randomized to the intervention and control conditions. Thirty-seven schools (n = 571 students) were randomly assigned to the school nurse-delivered smoking cessation counseling intervention group, and 34 schools (n = 577 students) were randomly assigned to the control group (e.g., usual smoking cessation care program). Tobacco use screenings were conducted by school nurses, and students were enrolled in the study if they were identified as a tobacco user. A self-report questionnaire was administered to measure frequency and amount of tobacco use in the past 30 days; self confidence to quit; family and friends’ tobacco use; nicotine dependence; and use of nicotine replacement therapies. The questionnaire was completed at three ponts: at baseline, prior to intervention; six weeks following intervention; and three months after baseline. As a result of the low number of students reporting smokeless tobacco use (3.1%), the investigation was limited to cigarette smoking.

Results: Reports of smoking cessation, defined as not smoking within the past 30 days were significantly greater in the intervention schools compared with control schools at both 6 weeks and 3 month follow-ups. 14 % of students in intervention schools reported smoking cessation at 6 weeks, as did 24% at the three months, compared with 2% of students in control schools at 6 weeks and 5% at three months. Compared with the control students, the number of days smoked in the past 30 days was significantly lower at both 6 weeks and 3 months (15 days vs. 24 days, and 14 days vs. 23 days, respectively) for the intervention students. In a secondary analysis of the data, the odds of smoking 10 or fewer cigarettes per day were 2.6 times greater in the intervention compared with control schools and 3.5 times greater at 3 months. In addition, students in the intervention schools also were 8 times more likely to quit at 6 weeks, and 6 times more likely at 3 months, than students in control schools. Similar results were found for student reports of self confidence to quit, plans to quit, friends smoking, and level of nicotine addiction.

Note: Analyses were designed to adjust for the effect of clustering within schools.

SOURCES FOR MORE INFORMATION

References

Five Major Steps to Intervention (The "5A's"). U.S. Public Health Service. http://www.surgeongeneral.gov/tobacco/5steps.htm.

Program categorized in this guide according to the following:

Evaluated participant ages: 9^th-12^th graders/ Program age ranges in the Guide: 15-21

Program components: school-based

Measured outcomes: physical health

KEYWORDS: Adolescence (12-17), Young Adulthood (17-24), Youth (16+), High School, White or Caucasian, Black or African American, Hispanic or Latino, School-based, Life Skills Training, Counseling/Therapy, Campaign, Substance Use, Tobacco Use

Program information last updated 11/7/2007.

		© Child Trends 2003