Reported willingness among adolescent nonsmokers to help parents, peers, and others to stop smoking

A pilot summer day camp cooking curriculum to influence family meals

Background

Efforts to combat the epidemic of childhood obesity have approached the issue from many different angles, with a family approach being the gold standard. While most efforts focus on the parents, few have viewed the child as the agent of change. In this study, we explored the feasibility of implementing a cooking curriculum into a summer day camp to determine its reception and explore the potential of home reach.

Methods

In partnership with a local YMCA, a child-focused cooking curriculum was developed, designed to be delivered to various age groups with key nutritional messages. Interviews were conducted with participating children and their parents to determine acceptability and potential to influence the home environment as well as explore children’s understanding of nutrition and cooking topics.

Results

Children in the study ranged from 7 to 15 years of age. Children overwhelmingly enjoyed the cooking camp and talked about it with their parents at home. Almost all parents had plans to try the recipes at home, and many had already made one or more of the recipes.

Conclusions

It is feasible to incorporate cooking lessons into a children’s summer day camp, with some evidence of reach into the home. Future studies should evaluate children as agents of change in cooking and meal preparation, and assess if this could increase the number and quality of family meals.

Systematic review of mentoring to prevent or reduce tobacco use by adolescents

BACKGROUND

Surveys conducted 1998 to 2008 (530,849 13- to 15-year-olds, 100 countries) by the World Health Organization and the Centers for Disease Control and Prevention found increased tobacco use.

OBJECTIVES

To conduct a systematic review of mentoring to prevent/reduce youth smoking.

DATA SOURCES

Eight electronic peer-reviewed databases and gray literature searched through January 2013.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

Studies were included if they were randomized controlled trials, included children or adolescents, employed mentoring (consistent companionship, support, guidance to develop youth competence and character), and reported tobacco use.

STUDY APPRAISAL/SYNTHESIS METHODS

Two reviewers independently assessed abstracts and full-text studies. Disagreements were resolved through consensus.

RESULTS

Four randomized controlled trials were identified. Two studies focused exclusively on tobacco outcomes; the other 2 reported on both drug and tobacco use reductions. Only 1 study reported that mentoring (by peers) reduced adolescent smoking. Heterogeneity of both participants and outcome measures did not permit meta-analysis.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

There is limited literature on this topic. Further research achieving sample sizes required by power computations, minimizing attrition, and ascertaining mentoring content and achievements from mentor and mentee perspectives is needed.

Web-based intervention for adolescent nonsmokers to help parents stop smoking: a pilot feasibility study

A novel approach to tobacco control is to engage adolescent nonsmokers in support roles to encourage and help their parents stop smoking. This pilot study examined the feasibility and potential efficacy of a web-based support skills training (SST) intervention for adolescents to help a parent stop smoking. Forty nonsmoking adolescents 13-19 years of age (70% female, 93% White) were enrolled and randomly assigned to a health education (HE) control group (n=20) or SST (n=20). Both consisted of written materials and five weekly, 30 min, web-based, counselor-facilitated group sessions. Parents were enrolled for assessments only. Adolescents and parents completed assessments at baseline, week 6 (post-treatment), week 12 and 6-months follow-up. Both interventions were feasible based on treatment acceptability ratings, study retention and treatment compliance. The biochemically confirmed 6-month smoking abstinence rate was higher for parents linked to teens in HE (35%, 7/20) than in SST (10%, 2/20), p=0.13. About half of parents in each group reported a quit attempt since study enrollment. Teens can be engaged to help parents stop smoking. Future research is warranted on determining effective intervention approaches.

Targeting African American nonsmokers to motivate smokers to quit: a qualitative inquiry

African Americans bear a disproportionate health burden from smoking but are less likely than other populations to engage in cessation treatment. Intervening on adult nonsmokers residing with a smoker might represent an innovative approach to motivate smokers to engage in smoking behavior change. Twelve focus groups were conducted with African American smokers (four groups, n = 27), nonsmokers (four groups, n = 26) and pairs of cohabitating smokers and nonsmokers (four groups, n = 22) to assess attitudes and/or beliefs regarding engaging a nonsmoker in the home in smoking behavior change efforts. Participants ( N = 75) were middle-aged (45.1 ±3.7 years) females (68.0%) with 11.8 ±1.5 years of education. Smokers smoked 14.9 ±11.3 cigarettes per day, made 3.0 ±4.4 quit attempts in the past year, and are interested in receiving cessation assistance from a nonsmoker in their home. African American nonsmokers living with a smoker may be an appropriate target group to motivate smoking behavior change in the smoker. Suggestions for future research considerations are provided.

Validation of the support provided measure among spouses of smokers receiving a clinical smoking cessation intervention

Studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions designed to increase social support have had limited success. Most studies have relied on only the smoker's perceptions of support received while few have assessed the support provider's report of support delivered. Understanding supportive interactions between support providers and recipients may assist in developing effective support interventions for cessation. The current investigation examined the perceptions of smoking-specific support provided by the spouse of a partner who smokes and was seen for a nicotine dependence consultation. Specifically, we examined spouse reported willingness to help their spouse quit, interest in learning ways to help their spouse quit, and characteristics associated with the provision of smoking-specific supportive behaviors (as assessed via the Support Provided Measure, SPM), in the 2-weeks prior to the consultation. The current investigation also examined the concurrent validity of the SPM with a validated measure of support provided to a smoker, the Partner Interaction Questionnaire (PIQ), accounting for social desirability bias and smoker readiness to change. The sample comprised 84 adult cigarette smokers seen for a clinical smoking cessation intervention and their spouses (N = 84). Results indicate that a high percentage of spouses are willing to help their partner who smokes and interested in learning way to help. As expected, spouses who were females and had never smoked had higher scores on the SPM than males or current smokers. The SPM was significantly correlated with the PIQ positive (r = 0.50, p < 0.01) and negative (r = 0.44, p <0.01) item scales overall and for spouses whose partners reported higher levels of readiness to quit smoking (r = 0.54, p < 0.01; r = 0.50, p < 0.01, respectively). Suggestions for future research are offered.

Do researcher-derived classifications of youths' smoking behavior correspond with youths' characterizations of their behavior?

AIMS

To describe the categories employed by researchers to describe adolescents' smoking behavior and to determine how these various categorizations compare with youths' self-defined smoking status.

STUDY SELECTION

A search of the PubMed and Science Direct databases, limited to articles in the English language, published between January 2002 and November 2007.

DATA EXTRACTION

Employing a mixed methods approach, several categories of youths' smoking status were obtained from a literature review and subsequently reproduced by using responses to detailed questionnaire items. Associations between the researcher-derived smoking categories (from the literature review) and the youths' self-reported smoking status, from survey data, were determined.

RESULTS

The categories of smoking status, from the literature review, varied in definition and in the number of categories. The associations between the literature-based categories and the youths' self-reported smoking status were modest.

CONCLUSIONS

Researcher-derived categories of youths' smoking status may not adequately encapsulate youths' perceptions of their own smoking behavior. There is a need to better describe adolescents' smoking behavior with special consideration of the ways in which adolescents characterize their own smoking behavior.

Group-randomized trial of a proactive, personalized telephone counseling intervention for adolescent smoking cessation

BACKGROUND

The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation.

METHODS

Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided.

RESULTS

The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers.

CONCLUSIONS

Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.

Design and implementation of an effective telephone counseling intervention for adolescent smoking cessation

BACKGROUND

Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST).

METHODS

We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor's calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code.

RESULTS

Among identified smokers, 948 (89.6%) were eligible for intervention by age (> or =18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors' calls demonstrated that more than 85% of counselors' calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%).

CONCLUSION

An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers.

Daughter-initiated health advice to mothers: perceptions of African-American and Latina daughters

The prevailing paradigm of health exchange within the family is for health advice to flow from parent to child. Consistent with this pattern of exchange, most research has focused on the one-directional influence of the parent on the child and there is thus an absence of literature that explores the ability of adolescents to influence their parents' health behaviors. This qualitative study addressed this gap by exploring the feasibility of daughters providing health advice to their mothers. Twelve focus groups were conducted with 78 African-American and Latina daughters between the ages of 12 and 17 from low-income neighborhoods in a Mid-Western city in the United States. This study utilized a grounded theory approach to examine the focus group data. The findings indicate that many daughters report that they are already giving their mothers a wide spectrum of advice, including health advice. Differences were found in the reported willingness of African-American daughters when compared to Latina daughters to provide their mothers with specific cancer advice. These data suggest that some of these daughters have the potential to be valuable health education conveyers in the family.

Adolescent protective behavior to reduce drug and alcohol use, alcohol-related harm and interpersonal violence

Typically adolescents' friends are considered a risk factor for adolescent engagement in risk-taking. This study took a more novel approach, by examining adolescent friendship as a protective factor. In particular it investigated friends' potential to intervene to reduce risk-taking. Five-hundred-forty adolescents (mean age 13.47 years) were asked about their intention to intervene to reduce friends' alcohol, drug and alcohol-related harms and about psychosocial factors potentially associated with intervening. More than half indicated that they would intervene in friends' alcohol, drug use, alcohol-related harms and interpersonal violence. Intervening was associated with being female, having friends engage in overall less risk-taking and having greater school connectedness. The findings provide an important understanding of increasing adolescent protective behavior as a potential strategy to reduce alcohol and drug related harms.

Differences among Black and White young adults on prior attempts and motivation to help a smoker quit

This study assessed differences between Black and White young adults on prior attempts and motivation to help a smoker quit. A total of 1,621 undergraduates (912 Black, 709 White; 63% female) ages 18-24 years completed a cross-sectional survey. Overall, 54% reported they had previously tried to help someone else stop smoking (52% among Blacks vs. 58% among Whites, p=0.016). Among nonsmokers who indicated they were close to a smoker whom they thought should quit, Blacks were most often concerned about a family member whereas Whites endorsed concern most often for a friend (p<0.001). Blacks were more likely than Whites to indicate interest in learning ways to help this smoker to quit (p<0.001) but there was no significant differences on motivation level (46% of Blacks and 42% of Whites reported they were "very" or "extremely" motivated to help this person quit). After adjusting for gender, the results remained unchanged. Tobacco control efforts could focus on optimizing these supportive behaviors as well as expressed motivation and interest in helping a smoker to quit among young adult nonsmokers.

Addressing challenges in adolescent smoking cessation: design and baseline characteristics of the HS Group-Randomized trial

OBJECTIVE

Well-documented challenges have hampered both intervention development and research in teen smoking cessation. Addressing these challenges, the Hutchinson Study of High School Smoking (HS Study), the largest group-randomized trial in adolescent smoking cessation to date, incorporates several design innovations to investigate the effect of a counselor-initiated, individually tailored telephone counseling smoking cessation intervention for older adolescents. This paper presents and discusses these innovative design features, and baseline findings on the resulting study population.

METHOD

The trial used a population-based survey to proactively identify and recruit all high school juniors who had smoked in the past month - potentially expanding intervention reach to all smokers, even those who smoked less than daily and those not motivated to quit. For ethical and intervention reasons, some nonsmokers were enrolled in the intervention, also. Other important design features included the random allocation of schools into experimental conditions (intervention vs. no-intervention control) and a multi-wave design.

RESULTS AND CONCLUSION

The design innovations address problems and challenges identified in adolescent smoking cessation literature. The heterogeneous baseline characteristics of the study population, well-balanced between the two arms, have three significant implications: They (1) demonstrate the effectiveness of the trial's design features, (2) highlight several intervention-related issues, and (3) provide assurance that the trial's evaluation of intervention effectiveness will be unbiased.

Which sociodemographic factors are important on smoking behaviour of high school students? The contribution of classification and regression tree methodology in a broad epidemiological survey

BACKGROUND

The purpose of this study is to evaluate the most important sociodemographic factors on smoking status of high school students using a broad randomised epidemiological survey.

METHODS

Using in-class, self administered questionnaire about their sociodemographic variables and smoking behaviour, a representative sample of total 3304 students of preparatory, 9th, 10th, and 11th grades, from 22 randomly selected schools of Mersin, were evaluated and discriminative factors have been determined using appropriate statistics. In addition to binary logistic regression analysis, the study evaluated combined effects of these factors using classification and regression tree methodology, as a new statistical method.

RESULTS

The data showed that 38% of the students reported lifetime smoking and 16.9% of them reported current smoking with a male predominancy and increasing prevalence by age. Second hand smoking was reported at a 74.3% frequency with father predominance (56.6%). The significantly important factors that affect current smoking in these age groups were increased by household size, late birth rank, certain school types, low academic performance, increased second hand smoking, and stress (especially reported as separation from a close friend or because of violence at home). Classification and regression tree methodology showed the importance of some neglected sociodemographic factors with a good classification capacity.

CONCLUSIONS

It was concluded that, as closely related with sociocultural factors, smoking was a common problem in this young population, generating important academic and social burden in youth life and with increasing data about this behaviour and using new statistical methods, effective coping strategies could be composed.

Development and preliminary evaluation of a measure of support provided to a smoker among young adults

Most studies indicate a positive association between social support and smoking cessation. However, clinic-based interventions to increase support for stopping smoking have had limited success. Prior research has emphasized the smoker's perceptions of support received for smoking cessation while less attention has focused on support persons' reports of supportive behaviors provided to a smoker. This study examined select psychometric properties of the Support Provided Measure (SPM), a self-report questionnaire designed by the investigative team to assess supportive behaviors provided to a smoker. The SPM was administered to a college sample (N=771; 67% female) of young adults, aged 18 to 24 years, who reported knowing a smoker whom they thought should quit smoking. Results indicate that, in this sample, the SPM has a two-factor structure with good internal consistency reliability (Cronbach's alpha=0.77) and appears to assess a wide range of individual differences in the provision of support. Demographic correlates associated with SPM scores are described and suggestions for future research are offered.