Effectiveness of a School Nurse–Delivered Smoking-Cessation Intervention for Adolescents

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Most adolescent smokers want to quit and make serious attempts to quit. However, few seek medical assistance, and most are unsuccessful in their efforts to stop. Therefore, accessible, effective treatment approaches are needed for adolescents who want to quit smoking. WHAT THIS STUDY ADDS:Results demonstrate that a brief smoking-cessation intervention delivered by school nurses in the school health setting is feasible and moderately effective in helping adolescents to stop smoking. abstract OBJECTIVE: To evaluate the effectiveness of a school nurse-delivered smoking-cessation intervention in increasing abstinence among adolescent smokers. METHODS:Thirty-five high schools were pair-matched and randomly assigned to 1 of 2 conditions, each of which consisted of 4 visits with the school nurse: (1) counseling intervention using the 5 A's model and cognitive-behavioral techniques; or (2) an information-attention control condition. Adolescents (n ϭ 1068) who reported past 30-day smoking and interest in quitting completed surveys at baseline and at 3 and 12 months and provided saliva samples for biochemical validation of reported smoking abstinence. RESULTS:Intervention condition participants were almost twice as likely to be abstinent per self-report at 3 months (odds ratio: 1.90 [95% confidence interval: 1.12-3.24]; P ϭ .017) compared with control participants; at 12 months there were no differences. The difference at 3 months was driven by quit rates in male students (15.0% [intervention] vs 4.9% [control]; odds ratio: 3.23 [95% confidence interval: 1.63-6.43]; P ϭ .001); there was no intervention effect in female students at either time point (6.6% vs 7.0% at 3 months and 16.6% vs 15.5% at 12 months) and no intervention effect in male students at 12 months (13.9% vs 13.2%). Smoking amount and frequency decreased significantly in intervention compared with control schools at 3 but not at 12 months. CONCLUSIONS:A school nurse-delivered smoking-cessation intervention proved feasible and effective in improving short-term abstinence among adolescent boys and short-term reductions in smoking amount and frequency in both genders. Additional research is needed to enhance both cessation and maintained abstinence. Pediatrics 2011;128: 926-936

Primary Care–Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force

“…The pooled absolute RD was Ϫ0.04 (CI, Ϫ0.09 to 0.01). A sensitivity analysis that included the 4 trials that involved tailored intervention components for baseline smokers, 12-month follow-up, and similar definitions of baseline smoking (15,16,29,33) yielded a consistent result. …”

“…No primary care-relevant trials were identified that assessed health outcomes or examined subsequent rates of adult smoking. We identified 18 trials (reported in 22 publications) that examined the efficacy of primary carerelevant interventions in preventing tobacco use initiation or promoting cessation among young persons (Appendix Table 1, available at www.annals.org) (15)(16)(17)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). We examined all 18 trials for harms related to the intervention and 1 additional trial (37) that reported the harms of bupropion.…”

“…For instance, 1 trial (25) required that the adolescent reported smoking daily (for the past 30 days), whereas another trial (16) enrolled adolescents who reported any smoking during the past 30 days and were interested in quitting. In terms of outcomes, 2 studies (25, 38) used 7-day abstinence, 4 studies (16, 22,29,33) used 30-day abstinence, and the remaining trial reported "occasional or regular" smoking at follow-up (15).…”

“…We entered the raw number of smokers and the total number of participants in the analysis to calculate pooled risk ratio (RR) estimates by using Stata, version 11.2 (StataCorp, College Station, Texas). The metaanalysis was adjusted for the cluster randomization of 3 trials (15)(16)(17) by dividing the sample sizes in these studies by a design effect based on average cluster size and an estimated intraclass correlation (18). We did not conduct statistical analyses for small study effects (an indicator of publication bias) because we had fewer than 10 trials in all analyses (19).…”

“…We minimized the risk for selective reporting by requiring that reducing tobacco use was a primary aim of included studies. Fourth, all of the included studies were published in 2007 or earlier, with the exception of 3 trials (2 by the same author) (15,16,38). In recent years, substantial emphasis has been placed on tobacco-related legislation, environmental changes, and countermarketing.…”