Published online July 27, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e187-e194 (doi:10.1542/peds.2008-2509)
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ARTICLE

Evaluation of School-Based Smoking-Cessation Interventions for Self-Described Adolescent Smokers

Alain Joffe, MD, MPHa,b, Clea McNeely, DrPHb, Elizabeth Colantuoni, PhDc,d, Ming-Wen An, PhDc, Weiwei Wang, PhDc and Daniel Scharfstein, ScDc

a Student Health and Wellness Center, Departments of
b Population, Family, and Reproductive Health
c Biostatistics, Bloomberg School of Public Health
d Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland

OBJECTIVE: The goal was to compare the efficacy of school-based, multisession, group smoking-cessation interventions versus a single group session in increasing quit rates among adolescent smokers.

METHODS: Eight schools were assigned randomly to use 1 of 2 group smoking-cessation programs previously shown to increase quit rates among adolescents (Not on Tobacco [NOT] or Kickin' Butts). We reformatted the programs to twice-weekly 25- to 30-minute sessions delivered during lunch periods. Smoking status was assessed at end of program (EOP) and 1, 3, 6, and 12 months later. Self-reported quit status was confirmed with salivary cotinine levels.

RESULTS: A total of 407 students (56% black and 52% female; mean age: 16 years) participated. Kickin' Butts participants were no more likely to quit than control subjects. In the conservative analysis (students with missing follow-up data classified as smokers), NOT participants were 1.92 times (95% confidence interval [CI]: 1.09–3.40 times) more likely to self-report quitting at 1 month. In the Bayesian analysis (missing follow-up data imputed by using all available data), NOT participants were significantly more likely than control subjects to self-report quitting at EOP (relative risk [RR]: 1.26 [95% CI: 1.10–1.43]), 1 month (RR: 2.07 [95% CI: 1.68–2.56]), and 12 months (RR: 1.58 [95% CI: 1.22–2.04]). Cotinine-confirmed quit rates were significantly greater among NOT participants, compared with control subjects, at EOP and 1 month.

CONCLUSIONS: The reformatted NOT program had a modest effect on adolescents interested in quitting. Kickin' Butts, as reformatted for this project, did not have any effect on quit rates.

Key Words: adolescents • smoking cessation

Abbreviations: EOP—end of program • ITT—intention to treat • NOT—Not on Tobacco • CI—confidence interval • RR—relative risk

Accepted Mar 17, 2009.


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