Effectiveness of a School Nurse–Del

Effectiveness of a School Nurse–Delivered Smoking-
Cessation Intervention for Adolescents
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
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
.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
.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
AUTHORS: Lori Pbert, PhD,a Susan Druker, MA,a Joseph R.
DiFranza, MD,b Diane Gorak, RN, BSN, MEd,c George Reed,
PhD,a Robert Magner, MPH,a Anne H. Sheetz, RN, BSN,
MPN, CNAA,c and Stavroula Osganian, MD, ScD, MPHd
aDivision of Preventive and Behavioral Medicine and
bDepartment of Family Medicine and Community Health,
University of Massachusetts Medical School, Worcester,
Massachusetts; cSchool Health Services, Massachusetts
Department of Public Health, Boston, Massachusetts; and
dClinical Research Program, Children’s Hospital Boston, Boston,
Massachusetts
KEY WORDS
adolescents, smoking cessation, intervention, school nurse
ABBREVIATIONS
GEE—generalized estimating equation
OR—odds ratio
CI—confidence interval
All authors participated in study conception and design, analysis
and interpretation of data, and drafting and revising of the
manuscript; and all authors approved the manuscript as
submitted.
This trial has been registered at www.clinicaltrials.gov (identifier
NCT00682474).
www.pediatrics.org/cgi/doi/10.1542/peds.2011-0520
doi:10.1542/peds.2011-0520
Accepted for publication Jul 6, 2011
Address correspondence to Lori Pbert, PhD, Division of
Preventive and Behavioral Medicine, University of Massachusetts
Medical School, 55 Lake Ave N, Worcester, MA 01655. E-mail: lori.
pbert@umassmed.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2011 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
Funded by the National Institutes of Health (NIH).
926 PBERT et al