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PEDIATRICS Vol. 107 No. 4 April 2001, p. e50

ELECTRONIC ARTICLE:
Effectiveness of a High School Smoking Cessation Program

Received Jun 7, 2000; accepted Nov 1, 2000.

William P. Adelman*, Anne K. Duggan*, Patricia Hauptman MSDagger , and Alain Joffe*

From the * Division of General Pediatrics and Adolescent Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland; and the Dagger  Baltimore City Health Department, Baltimore, Maryland.

Objective.  To evaluate the impact of a school-based smoking cessation program targeting adolescents interested in quitting.

Design.  Randomized clinical trial over one school year.

Setting.  Large public high school.

Participants.  Students interested in quitting smoking.

Intervention.  Seventy-four students were randomized to receive either: 1) a 6-week, 8-session, classroom-based, smoking cessation curriculum designed for adolescents (n = 35) or 2) an informational pamphlet on how to quit smoking with promise of the classroom curriculum in 3 months (n = 39).

Outcome Measures.  Change in smoking behavior measured by: 1) self-reported smoking cessation and exhaled carbon monoxide <6 parts per million (smoke-free); 2) self-reported quit attempts; and 3) change in cigarettes per day (cpd) at the end of the 6-week curriculum and then 4, 10, and 20 weeks later. Saliva cotinine was also measured at these points to validate these outcome measures.

Analysis.  Intention-to-treat.

Results.  Participants in the classroom group attended an average of 4.4 sessions. At the end of the curriculum, the classroom group was significantly more likely to be smoke-free (59% vs 17%), to have tried to quit smoking (82% vs 54%), and to reduce mean cpd (7.0 vs 1.0). Four weeks later, these differences persisted: smoke-free (52% vs 20%), quit attempt (85% vs 60%), and reduction in mean cpd (6.6 vs 1.6). Changes in saliva cotinine were consistent with reported outcome measures; those who were smoke-free had a significant reduction in saliva cotinine at the end of the intervention, and at 4 weeks. At 10 and 20 weeks after the curriculum, 41% and 31%, respectively, of the classroom group remained smoke-free. Once participants in the pamphlet group underwent the classroom intervention (average attendance of 2.2 sessions) their cessation rates were similar to the initial group: 31% at the end of the curriculum and 27% 10 weeks later.

Conclusion.  A school-based curriculum for adolescent smoking cessation is more effective than an informational pamphlet alone and reduces cigarette use by adolescents. More research is needed to test the reproducibility, sustainability, and generalizability of this curriculum to offer more smoking cessation options to teenagers.  Key words:  adolescent, smoking, cessation, high school, randomized clinical trial.




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