DESCRIPTION (Applicant's Description) The national prevalence of past month
smoking among 9th - 12th graders has increased steadily, from 27.5 percent
in 1991 to 34.5 percent in 1995. Although extensive research has been
conducted to change adolescent smoking behavior, the scope of these studies
has been limited in that they have largely focused on the primary prevention
of smoking onset, have targeted young adolescents, and have mostly taken
place in school settings. The reduction of overall smoking among high
school-aged adolescents requires effective interventions that incorporate
both smoking prevention and cessation, yet such research is lacking.
We propose to conduct a randomized controlled trial to assess the
effectiveness of a non-school based, multi-component intervention strategy
to reduce prevalence of past month smoking by 1) changing normative
expectations around the issue of smoking among adolescents, ages 14-17, and
2) providing cessation assistance for those adolescents who smoke. A total
of 3000 adolescents who are dependents of members belonging to a large
health maintenance organization and who respond to a mailed survey to
collect baseline data will be randomized to receive either the
multi-component intervention or usual care. The intervention will take
place over 2 years and consist of 1) a youth advisory group, 2) youth action
teams, 3) behavioral prescriptions, sent to all adolescents at regular
intervals during the intervention, 4) a contest to increase motivation, and
5) cessation assistance to smoking adolescents using motivational
interviewing techniques. A follow-up survey will be conducted at the end of
the intervention period.
The proposed intervention proposes to achieve a 5-6 percent reduction from
baseline in the overall smoking prevalence among adolescents in the
intervention compared to those in the control. The overall expected
difference of 5-6 percent in smoking prevalence as a result of this study
would have dramatic public health impact at the population level, and would
be especially important, given the clear need for new, effective approaches
to reverse the smoking trends in this population.
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