A Review of the Literature on Adolescent Smoking and Cessation Programs

Over 4.5 million adolescents smoke cigarettes (Johnston, 2001; American Lung Association, 2003) half of all adolescents who become addicted to cigarettes will smoke for at least 20 years before they quit (Choi, Ahluwalia, Nazir, 2002), 80% of adult smokers began when they were adolescents (Abrantes et al., 2008), and an estimated 6.4 million children aged <18 years living today will die prematurely as adults because they began using tobacco during adolescence (American Lung Association, 2003; Centers for Disease Control and Prevention [CDC], 2006c). A majority of adolescents wants to quit tobacco with up to two-thirds reporting an attempt at quitting in 2007 (Abrantes et al., 2008). Smoking cessation programs for adolescents are not well studied and have not received the same amount of research that smoking cessation programs for adults have received (Sussman, Sun, Dent, 2006; Abrantes et al., 2008). This review of the literature on adolescent smoking and cessation programs provides a summary of what has been studied to date and what needs to be done in order to provide the best evidence-based smoking cessation programs for adolescents.Master of Public Healt

Supporting early adolescent tobacco refusal self-efficacy: an intervention study

The decline in adolescent tobacco and nicotine product use has now ceased, therefore more attention is required on prevention, in which supporting tobacco refusal selfefficacy holds great potential. This study aimed to develop an intervention to support early adolescent tobacco refusal self-efficacy and to evaluate the effectiveness of the intervention among early adolescents in comprehensive school grades 4 to 6. The study was conducted in two phases. The development phase included three sub-studies strengthening the theoretical basis for the intervention and further developing a previously developed digital health game intervention. 1) A qualitative descriptive study described self-efficacy in peer interactions among adolescents (n = 155). 2) A systematic review summarised evidence on digital interventions to support refusal self-efficacy in child and adolescent health promotion. 3) A cross-sectional study explored factors associated with tobacco refusal self-efficacy among early adolescents (n = 295). The evaluation phase consisted of a two-arm cluster randomised controlled trial to examine the effectiveness of the intervention in schools at three measurement points on tobacco refusal self-efficacy among early adolescents (n = 781). This study found that adolescents’ have an active role in the formation of their self-efficacy, and it is also influenced by their social atmosphere. Tobacco refusal self-efficacy in early adolescence is especially influenced by the social atmosphere, namely the smoking behaviour of peers and relatives. The evidence supported the use of digital interventions with a sound theoretical basis to promote refusal selfefficacy. The results demonstrated the effectiveness of the intervention on tobacco refusal self-efficacy among 12-year-olds and early adolescents with a smoking friend or parent, and on the sources of tobacco refusal self-efficacy. Based on the results, early adolescent tobacco refusal self-efficacy can be strengthened through the intervention. The results support the implementation of the intervention into school contexts. In general, a systematic evaluation of existing digital health interventions is needed to support their implementation.Varhaisnuorten tupakoimattomuuden edistäminen minäpystyvyyttä tukevalla interventiolla Nuorten tupakka- ja nikotiinituotteiden käytön väheneminen on pysähtynyt, mikä korostaa tarvetta ennaltaehkäisylle ja kieltäytymiseen liittyvän minäpystyvyyden tukemiselle. Tämän tutkimuksen tavoitteena oli kehittää minäpystyvyyttä tukeva interventio edistämään nuorten tupakoimattomuutta ja arvioida sen vaikuttavuutta varhaisnuorilla peruskoulun 4.–6. luokilla. Tutkimus toteutettiin kahdessa vaiheessa. Kehittämisvaiheeseen sisältyi kolme osatutkimusta, joissa intervention teoreettista perustaa vahvistettiin ja aiemmin laadittua digitaalista peli-interventiota jatkokehitettiin. 1) Laadullisessa kuvailevassa tutkimuksessa kuvattiin nuorten (n = 155) näkemyksiä minäpystyvyydestään kaverisuhteissa. 2) Järjestelmällisessä kirjallisuuskatsauksessa koottiin näyttöä digitaalisista interventioista kieltäytymiseen liittyvän minäpystyvyyden tukemisessa lasten ja nuorten terveyden edistämisessä. 3) Poikkileikkaustutkimuksessa tarkasteltiin varhaisnuorten (n = 295) tupakasta kieltäytymiseen liittyvään minäpystyvyyteen yhteydessä olevia tekijöitä. Arviointivaiheessa arvioitiin intervention vaikuttavuutta varhaisnuorten (n = 781) kieltäytymiseen liittyvän minäpystyvyyden tukemisessa kouluissa ryvästetyllä satunnaistetulla kontrolloidulla tutkimuksella kolmena mittausajankohtana. Tuloksissa korostui nuorten oma aktiivinen rooli minäpystyvyytensä muotoutumisessa, ja sosiaalisen ilmapiirin rooli. Varhaisnuorilla tupakasta kieltäytymiseen liittyvän minäpystyvyyden yhteys sosiaaliseen ilmapiiriin tunnistettiin erityisesti kavereiden ja sukulaisten tupakoinnin osalta. Tutkimusnäyttö tuki vankan teoreettisen perustan omaavien digitaalisten interventioiden käyttöä kieltäytymiseen liittyvän minäpystyvyyden edistämisessä. Tulokset osoittivat intervention vaikuttavuuden tupakasta kieltäytymiseen liittyvän minäpystyvyyden tukemisessa 12-vuotiailla ja nuorilla, joilla oli tupakoiva kaveri tai vanhempi, ja tupakasta kieltäytymiseen liittyvän minäpystyvyyden lähteiden tukemissa. Tulosten perusteella varhaisnuorten tupakasta kieltäytymiseen liittyvää minäpystyvyyttä voidaan tukea kehitetyllä interventiolla. Tulokset tukevat intervention käyttöönottoa kouluissa. Olemassa olevien interventioiden järjestelmällistä arviointia tarvitaan niiden käyttöönoton tukemiseksi

Poster Session: 2017 Community Engagement and Research Symposium

List of posters presented at the 6th annual Community Engagement and Research Symposium, held Friday, March 3, 2017, at the University of Massachusetts Medical School, Worcester, MA. Some presenters agreed to make the full text of their posters available; these posters can be viewed in the symposium\u27s Poster Archive

The American Academy of Health Behavior 2024 Annual Scientific Meeting: Health Communication, (Mis-)Information, and Behavior: Leveraging Technology for Behavioral Interventions and Health Behavior Research

The American Academy of Health Behavior (AAHB) hosted its 24th Annual Scientific Meeting at The DeSoto Hotel in Savannah, Georgia on April 14-17, 2024. The meeting\u27s theme was “Health Communication, (Mis-)Information, and Behavior: Leveraging Technology for Behavioral Interventions and Health Behavior Research . This publication describes the meeting theme and includes the refereed abstracts presented at the 2024 Annual Scientific Meeting

Saliva continine levels of babies and mothers living with smoking fathers under different housing types in Hong Kong: a cross-sectional study

Paper Session 15 - The Challenge of Second-Hand Smoke: PA15-3BACKGROUND: After the Smoking Ordinance enacted in HK since 1/2007, shifting of smoking from outdoor to home was found, home becomes a major source of secondhand smoke (SHS) exposure of nonsmokers. OBJECTIVES: It aimed to assess the SHS exposure of babies and mothers living with smoking fathers of two housing types by using a biomarker. METHODS: Trios of smoking father, non-smoking mother and a baby under 18-months were recruited from Maternal and Child Health Centres (MCHCs) from 6/2008 to 10/2009. Consented couples completed the baseline survey including demographic data, fathers’ household smoking behaviors and mothers’ actions in protecting babies from household SHS exposure. Saliva samples from baby and mother were collected and then sent to the National University of Singapore for cotinine analyses. Log-transformations were used for the saliva cotinine due to skewed data. There were 2 housing types (public/private) and father was asked if they smoked at home (yes/no). MANOVA was used to compare the babies’ and mothers’ cotinine levels when fathers smoked at home under the 2 housing types. RESULTS: 1,158 trios were consented. 1,142 mothers’ and 1,058 babies’ samples were assayed. The mean age of the fathers and mothers was 35.5(±7.0) and 31.2(±4.9). The mean mothers’ cotinine level was 12.15ng/ml (±61.20) while babies’ was 2.38ng/ml (±6.01). 606 and 501 trios were living in public and private housing. Fathers’ smoked at home led to higher mothers’ and babies’ saliva cotininary (mean log of mothers’ cotininary: 0.14±0.62 vs. 0.05±0.55, p=0.06; babies: 0.16±0.38 vs. 0.07±0.34, p=0.003). Housing types influenced babies’ cotinine level (public: 0.17±0.37; private: 0.10±0.36, p=0.01). MANOVA showed that fathers smoked at home (Λ=0.99, p=0.01) and housing types (Λ=0.99, p=0.01) were positively related to the saliva cotinine levels. CONCLUSIONS: Father smoked at home and the housing types have greater impact on babies’ saliva cotininary, showing that they were highly exposed at home and in public housing environment. HK government should promote smoke-free homes and to provide more smoking cessation services to minimize the household SHS exposure to babiespublished_or_final_versio

Where can teens find health information? A survey of web portals designed for teen health information seekers

The Web is an important source for health information for most teens with access to the Web (Gray et al, 2005a; Kaiser, 2001). While teens are likely to turn to the Web for health information, research has indicated that their skills in locating, evaluating and using health information are weak (Hansen et al, 2003; Skinner et al, 2003, Gray et al, 2005b). This behaviour suggests that the targeted approach to finding health information that is offered by web portals would be useful to teens. A web portal is the entry point for information on the Web. It is the front end, and often the filter, that users must pass through in order to link to actual content. Unlike general search engines such as Google, content that is linked to a portal has usually been pre-selected and even created by the organization that hosts the portal, assuring some level of quality control. The underlying architecture of the portal is structured and thus offers an organized approach to exploring a specific health topic. This paper reports on an environmental scan of the Web, the purpose of which was to identify and describe portals to general health information, in English and French, designed specifically for teens. It answers two key questions. First of all, what portals exist? And secondly, what are their characteristics? The portals were analyzed through the lens of four attributes: Usability, interactivity, reliability and findability. Usability is a term that incorporates concepts of navigation, layout and design, clarity of concept and purpose, underlying architecture, in-site assistance and, for web content with text, readability. Interactivity relates to the type of interactions and level of engagement required by the user to access health information on a portal. Interaction can come in the form of a game, a quiz, a creative experience, or a communication tool such as an instant messaging board, a forum or blog. Reliability reflects the traditional values of accuracy, currency, credibility and bias, and in the web-based world, durabililty. Findability is simply the ease with which a portal can be discovered by a searcher using the search engine that is most commonly associated with the Web by young people - Google - and using terms related to teen health. Findability is an important consideration since the majority of teens begin their search for health information using search engines (CIBER, 2008; Hansen et al, 2003). The content linked to by the portals was not evaluated, nor was the portals’ efficacy as a health intervention. Teens looking for health information on the Web in English have a wide range of choices available but French-language portals are much rarer and harder to find. A majority of the portals found and reviewed originated from hospitals, associations specializing in a particular disease, and governmental agencies, suggesting that portals for teens on health related topics are generally reliable. However, only a handful of the portals reviewed were easy to find, suggesting that valuable resources for teens remain buried in the Web

Effects of a text message-based motivational interviewing intervention on cigarette smoking in college students.

Purpose: The purpose of this dissertation was to examine the effects of a novel text message-based motivational interviewing intervention on cigarette smoking behavior in college students. Three manuscripts comprised this dissertation and included: a state of the science review of motivational interviewing and text message-based smoking behavior interventions in adolescents and young adults; a critical review and analysis of instruments used to measure nicotine dependence in young adults; and a quasi-experimental study testing the effects of a novel text message-based motivational interviewing intervention on cigarette smoking behavior in college students. Background: Cigarette smoking is the number one preventable cause of chronic disease and death in the United States. Despite available information and preventive efforts, approximately 10% of college students smoke cigarettes. Although many studies have confirmed this public health concern, few attempted modification of smoking behavior in college students. A critical review of the literature revealed that the vast majority of smoking behavior research in college students was epidemiological in nature, and few interventions were designed specifically for college students who smoke. Main findings from this review suggested that motivational interviewing and text messaging interventions were successfully used among adolescents and young adults and hold strong potential for college students. However, more investigations, especially studies examining joint interventions of motivational interviewing and text-messaging, are needed. The second manuscript reviewed commonly used self-report nicotine dependence measures used with young adult populations. Three instruments, including the Fagerstrӧm Test for Nicotine Dependence, the Cigarette Dependence Scale, and the Hooked on Nicotine Checklist, were identified as the most commonly used instruments and were subjected to further psychometric analysis. Methods: The third manuscript summarized a quasi-experimental study designed to test the effects of a novel text message-based motivational interviewing intervention (iMI) on cigarette smoking behavior in college students and to provide a better understanding of smoking behavior regulation. The aims of the study were to : (1) test the effects of the iMI on cognitive parameters of behavior regulation (psychological needs satisfaction, autonomous motivation, smoking self-efficacy, and readiness to quit) among college students who smoke, (2) evaluate the effect of the intervention on smoking behavior (number of cigarettes smoked per day and severity of nicotine addiction) between baseline and 2-week post-intervention follow-up, and (3) identify independent predictors of change in smoking behavior among college students, from baseline to 2-week post-intervention follow-up. Undergraduate students (N = 33) were recruited to participate in the study that lasted five weeks (3-week intervention program with 2-week post-intervention follow-up assessment). Data were analyzed to determine differences in behavior regulation and smoking behavior parameters from baseline to 2-week post-intervention follow-up and identify independent predictors of change in smoking behavior among study participants. Results: The findings indicated that intervention was successful in affecting positive changes in smoking behavior regulation (autonomy and relatedness needs satisfaction, autonomous motivation, and smoking cessation self-efficacy) and reducing smoking behavior (cigarettes smoked per day). Smoking cessation self-efficacy was the strongest behavior regulation predictor of smoking behavior in college students. Conclusions: The findings of this dissertation support current evidence of motivational interviewing efficacy in smoking behavior modification and contribute to a deeper understanding of the underlying predictors of smoking in college students. Since this is the first study to examine the effects of a text-based motivational interviewing intervention on college student smoking, replication studies are warranted

Motivational interviewing for smoking cessation.

BACKGROUND: Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to stop smoking. OBJECTIVES: To evaluate the efficacy of MI for smoking cessation compared with no treatment, in addition to another form of smoking cessation treatment, and compared with other types of smoking cessation treatment. We also investigated whether more intensive MI is more effective than less intensive MI for smoking cessation. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialised Register for studies using the term motivat* NEAR2 (interview* OR enhanc* OR session* OR counsel* OR practi* OR behav*) in the title or abstract, or motivation* as a keyword. We also searched trial registries to identify unpublished studies. Date of the most recent search: August 2018. SELECTION CRITERIA: Randomised controlled trials in which MI or its variants were offered to smokers to assist smoking cessation. We excluded trials that did not assess cessation as an outcome, with follow-up less than six months, and with additional non-MI intervention components not matched between arms. We excluded trials in pregnant women as these are covered elsewhere. DATA COLLECTION AND ANALYSIS: We followed standard Cochrane methods. Smoking cessation was measured after at least six months, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RR) and 95% confidence intervals (CI) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of comparison. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We extracted data on mental health outcomes and quality of life and summarised these narratively. MAIN RESULTS: We identified 37 eligible studies involving over 15,000 participants who smoked tobacco. The majority of studies recruited participants with particular characteristics, often from groups of people who are less likely to seek support to stop smoking than the general population. Although a few studies recruited participants who intended to stop smoking soon or had no intentions to quit, most recruited a population without regard to their intention to quit. MI was conducted in one to 12 sessions, with the total duration of MI ranging from five to 315 minutes across studies. We judged four of the 37 studies to be at low risk of bias, and 11 to be at high risk, but restricting the analysis only to those studies at low or unclear risk did not significantly alter results, apart from in one case - our analysis comparing higher to lower intensity MI.We found low-certainty evidence, limited by risk of bias and imprecision, comparing the effect of MI to no treatment for smoking cessation (RR = 0.84, 95% CI 0.63 to 1.12; I2 = 0%; adjusted N = 684). One study was excluded from this analysis as the participants recruited (incarcerated men) were not comparable to the other participants included in the analysis, resulting in substantial statistical heterogeneity when all studies were pooled (I2 = 87%). Enhancing existing smoking cessation support with additional MI, compared with existing support alone, gave an RR of 1.07 (95% CI 0.85 to 1.36; adjusted N = 4167; I2 = 47%), and MI compared with other forms of smoking cessation support gave an RR of 1.24 (95% CI 0.91 to 1.69; I2 = 54%; N = 5192). We judged both of these estimates to be of low certainty due to heterogeneity and imprecision. Low-certainty evidence detected a benefit of higher intensity MI when compared with lower intensity MI (RR 1.23, 95% CI 1.11 to 1.37; adjusted N = 5620; I2 = 0%). The evidence was limited because three of the five studies in this comparison were at risk of bias. Excluding them gave an RR of 1.00 (95% CI 0.65 to 1.54; I2 = n/a; N = 482), changing the interpretation of the results.Mental health and quality of life outcomes were reported in only one study, providing little evidence on whether MI improves mental well-being. AUTHORS' CONCLUSIONS: There is insufficient evidence to show whether or not MI helps people to stop smoking compared with no intervention, as an addition to other types of behavioural support for smoking cessation, or compared with other types of behavioural support for smoking cessation. It is also unclear whether more intensive MI is more effective than less intensive MI. All estimates of treatment effect were of low certainty because of concerns about bias in the trials, imprecision and inconsistency. Consequently, future trials are likely to change these conclusions. There is almost no evidence on whether MI for smoking cessation improves mental well-being

CAN INTERACTIVITY MAKE A DIFFERENCE? EFFECTS OF INTERACTIVITY ON YOUNG ADULTS\u27 COMPREHENSION OF ONLINE HEALTH CONTENT

The Internet is growing in popularity as a health information sourceespecially among young adults. Interactivity has been pinpointed as the keyfeature that makes the Internet a potentially powerful health communicationtool. It is being heralded as a hybrid channel that has the capacity not only todisseminate health information to mass audiences both asynchronously andsynchronously, but also has the capacity to provide an engaging and stimulatingenvironment that can promote exploratory learning and active processing ofinformation. Despite these exciting claims, there is still a dearth of theoreticallydrivenempirical studies providing support for or against these assumptions. Westill know very little about how interactive technologies actually influenceinformation use, learning and motivational processes.A popular view is that the communicative efficacy of interactivetechnologies is influenced more with their match with comprehension processesand individual differences than with the level of interactivity itself. This studywas designed to tease out the potential effects of different levels of interactivityon comprehension and to determine whether individual differences in need forcognition would moderate such effects. About 441 young adults (ages 18-26)from the University of Kentucky participated in a 2 by 2 factorial experimentdesigned to test the effects of two levels of interactivity and two levels of needfor cognition on the comprehension of a health website on skin cancer.Results showed a significant main effect for level of interactivity oncomprehension scores holding the covariates, time on task and reading style,constant. Those exposed to the high interactivity site had significantly highercomprehension scores than those exposed to the low interactivity site. Therewas, however, no significant main effect for need for cognition, neither was therea significant interaction effect between level of interactivity and need forcognition on comprehension scores. Implications of these results and suggestionsfor future research are also discussed