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Smoking among children and adolescents has tremendous public health importance. Onset and development of smoking occurs primarily in adolescence, and because tobacco is highly addictive, regular use in adolescence develops into nicotine dependency. Smoking among adolescents is likely to continue into the adult years, increasing the risk of numerous long-term negative health consequences. However, after three decades of efforts to prevent smoking among children, large numbers of young people continue to smoke, particularly high-risk teens. Unfortunately, adolescent smokers are difficult to recruit and retain in smoking cessation studies and traditional classroom interventions may not reach those particularly in need of support. Even more discouraging, programs that have been effective with adults, when tried with adolescents in school clinics and classrooms, have not shown much promise. Many believe that advances in health promotion among young people, including motivating interest in smoking cessation, will focus on appropriate use of new technologies such as computers.
The primary goal of this proposal is to develop and pilot test an innovative approach to smoking cessation that might be particularly attractive to hard-to-reach teens. The proposed intervention will take place in the context of an emerging Internet technology—a 3-dimensional chat room medium, while also using a state-of-the-art counseling approach—motivational interviewing conducted by a smoking cessation facilitator. This innovative combination of 3-D chat room technology with motivational counseling for behavior change has never, to our knowledge, been tested. Yet, the approach is likely to have a great deal of appeal to teens that typically enjoy using the Internet and may especially like the animated interaction available in a 3-D chat-room format. In addition, teens may find the motivational interviewing approach much less offensive than more traditional behavior change counseling for "rebellious" behaviors, such as smoking.
Participants will be 50 high-risk teen smokers recruited from four continuation schools in nearby rural communities. Participants will use school computer resources to access the chat room. Following an introduction to the chat room, participants will interact in six 1-hour chat sessions over a 2-month period that address topics shown to be effective and unique to the cessation experience of adolescents. The chat room will be pilot tested and evaluated using responses to on-line surveys and content of chat sessions. Feasibility (use and acceptability), as well as immediate effectiveness in changing attitudes and behavior will be tested. If found to be well-received and effective, the chat room approach will be further developed and tested in a larger sample with a comparison group. |
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Smoking among children and adolescents has tremendous public health importance. Onset and development of smoking occurs primarily in adolescence, and because tobacco is highly addictive, regular use in adolescence develops into nicotine dependency. Smoking among adolescents is likely to continue into the adult years, increasing the risk of numerous long-term negative health consequences. Yet, even after three decades of efforts to prevent smoking among children, large numbers of young people continue to smoke, particularly high-risk teens.
Unfortunately, adolescent smokers are difficult to recruit and retain in smoking cessation interventions, and traditional classroom interventions may not reach those particularly in need of support. Even more discouraging, cognitive-behaviorally oriented cessation interventions that have been effective with adults, when tried with adolescents in school clinics and classrooms, have not shown much promise. Many believe that advances in health promotion among young people, including motivating interest in smoking cessation, will focus on innovative and appropriate use of emerging technologies such as computerized communication.
This 13-month study pilot-tested an innovative, relatively untested yet promising approach to adolescent smoking cessation using a one-group, repeated measures design. An Internet-based 3-dimensional "world" whereby young smokers interact (i.e., chat) in real-time with a trained cessation facilitator and each other was developed to capitalize on the demonstrated benefits of facilitator-led structured motivational interviewing strategies, as well as peer-to-peer interaction. Using school computers, participants interacted in seven 1-hour intervention chat sessions addressing topics shown to be effective and unique to the cessation experience of adolescents. The chat room was tested and evaluated using responses to on-line self-report surveys and content analyses of results from chat session monitoring. Feasibility (e.g., use and acceptability), as well as immediate effectiveness (e.g., changes in self-efficacy, intentions, and self-reported quit rates) was tested with high-risk teen smokers recruited from six alternative education high schools in nearby rural communities.
Analyses indicated that high-risk teen smokers volunteered for the study, participated at high levels, and rated the approach very positively. Complete data for 18 participants showed statistically significant changes in reports of quitting, amount smoked, and intentions to quit. Positive trends also were seen in past-week abstinence rates, number of quit attempts, and attitudes toward quitting.
The chat room approach showed high feasibility and acceptability, and may offer effective intervention for a population that is resistant to quitting smoking. The approach circumvents the expense and logistical problems involved in delivering school-based classroom programs. Because of design limitations, additional testing of this innovative approach is needed. |
