Innovative approaches to prevention and cessation of youth tobacco use.

CS05-01 Smoking among youth remains a major public health concern. It is estimated that 3,000 adolescents begin using tobacco each day and, although many of these smokers express the desire to quit, many find it difficult to do so. Feasible and effective interventions to decrease smoking initiation and increase cessation among adolescents and young adults are an important public health challenge. Over the past several years, our group has designed smoking prevention and cessation programs utilizing state-of-the-art theoretical concepts and computer technologies which, we believe, hold considerable promise. Traditional smoking cessation interventions range from the individualized health care provider- or educator-delivered group counseling, to the broader, population-based pamphlets and public service campaigns. A major drawback to these methods is a lack of tailoring to the smoker9s individual needs. Another problem is that the existing methods lack consistency in the intervention delivery. We believe that computer-assisted smoking prevention and cessation interventions can deliver the desired fidelity of implementation. The messages within such interventions can be tailored to developmental, psychosocial, behavioral, and cultural needs of the user. Here we present results from two federally funded studies, aimed at designing and testing interventions utilizing interactive computer technologies to identify effective and feasible approaches to prevent smoking and promote cessation among high-risk adolescents and young adults. The first study is a smoking prevention and cessation CD-ROM-based classroom curriculum for predominantly minority high-school students (Project ASPIRE). ASPIRE was evaluated in a group-randomized control trial of 16 Houston-area urban high schools compromising 1,608 mostly minority students (mean age is 15.7 ± .9 years; 58.8% female). The program consisted of five sessions and two booster sessions which provided eight educational "tracks" tailored to student characteristics. The extent to which the program decreased smoking initiation and increased cessation between intervention and control groups was estimated. Follow-up assessments were performed at 12 and 18 months to examine the program9s impact on smoking behavior and progression through the stages of smoking acquisition or cessation, and to examine whether well-established predictors of smoking mediate or moderate the effect of the intervention on both acquisition and cessation. At 12-month follow-up, significant favorable changes in decisional balance and temptations to smoking in the intervention versus the control group were identified. At 18-month follow-up, the primary aim was to examine smoking initiation rates among baseline nonsmokers and smokers. As a secondary aim, the efficacy of the program with respect to changing the determinants of smoking and quitting behavior was also evaluated at 18 months and for baseline nonsmokers. The analyses were done with linear mixed model regression and mixed model ANCOVA, stratified by gender and ethnicity. A total of 1,160 participants completed the 18-month survey; 610 in the intervention and 550 in the control group. Among baseline nonsmokers (n= 1, 080), there were significantly fewer students who initiated smoking in the intervention group compared to the control (2% vs. 6%, p .05), and the cotinine validated quit rates (17% vs. 10%, two-sided p