Program

Nov 07, 2007

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 cessationcounseling 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

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.

Five Major Steps to Intervention (The “5A’s”). U.S.Public Health Service. Retrieved from: http://www.surgeongeneral.gov/tobacco/5steps.htm

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.