Mar 14, 2007


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.


Target population: High school students
who use tobacco products

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.


Sussman, S., Dent, C.W., Lichtman, K.L.
Project EX: Outcomes of a teen smoking cessation program.
Journal of Addictive Behaviors, 26,425-438.

Evaluated population: Continuation high
school students in southern California.

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

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:<a


Sussman, S., Dent, C.W., Lichtman, K.L. (2001).
Project EX: Outcomes of a teen smoking cessation program. Journal of
Addictive Behaviors, 26,

KEYWORDS: High School, Adolescence (12-17), Young
Adulthood, Youth, Young Adults, Clinic-based, Provider-based, School-based,
Social/Emotional Health, Behavioral Problems, Substance Use, Tobacco Use,
Community Service, Vocational Learning, Education, Asian.

Program information last updated