ABSTRACT: This paper presents the Project EX research program. The historical background
for Project EX is presented, including a brief summary of reasons youth fail to quit
tobacco use, the disappointing status of previous cessation research, and the teen cessation
trial that provided the template for the current project (Project TNT). Next, program development
studies for Project EX are described. Through use of focus groups, a theme study
(concept evaluation of written activity descriptions), a component study, and pilot studies,
an eight-session program was developed. This program involves novel activities (e.g., “talk
show enactments,” games, and alternative medicine-type activities such as yoga and meditation)
in combination with motivation enhancement and cognitive-behavioral strategies to
motivate and instruct in cessation initiation and maintenance efforts. The outcomes of the
first experimental trial of Project EX, a school-based clinic program, are described, followed
by a posthoc analysis of its effects mediation. A second EX study, a multiple baseline single
group pilot study design in Wuhan, China, is described next. Description of a second experimental
trial follows, which tested EX with nicotine gum versus a natural herb. A third
experimental trial that tests a classroom prevention/cessation version of EX is then introduced.
Finally, the implications of this work are discussed. The intent-to-treat quit rate for
Project EX is approximately 15% across studies, double that of a standard care comparison.
Effects last up to a six-month post-program at regular and alternative high schools. Through
a systematic protocol of empirical program development and field trials, an effective and
replicable model teen tobacco use cessation program is established. Future cessation work
might expand on this work.