Subjects were comparable across the two condi-
128 Sussman S, McCuller WJ, Zheng H, Pfingston YM, Miyano J, Dent CW
tions at baseline. Seventy-five percent of subjects completed
the sessions and 87% were followed-up sixmonths
post-program. At two-months follow-up, the
intent-to-treat 30-day quit rates for all tobacco products
were 11% in the Nicorette condition and 13% in the
CigArrest condition. At six-months follow-up, the intent-to-treat
30-day quit-rates were 16% in the Nicorette
condition and 15% in the CigArrest condition.
PROJECT EX-4: CLASSROOM BASED
PREVENTION-CESSATION PROGRAM
Project EX thus far is being delivered as a schoolbased
clinic. While this school-based clinic version of
Project EX is effective, its reach is limited to those who
attend the clinic. Both tobacco users and nonusers are
found in the classroom setting. However, there are four
reasons to bring cessation education material into the
continuation high school classroom setting. First, continuation
high school youth are at very high risk for
regular tobacco use. A total of 85% of these youth have
tried tobacco, 71% have an intention to try tobacco in
the future or are monthly users, 57% are monthly users,
and 48% are daily users. Among the monthly users,
approximately 50% only smoke cigarettes, whereas
50% smoked cigarettes and use another tobacco product
as well (mostly cigars). Youth at CHSs who do not
smoke are confronted with smoking among their peers
on a daily basis. This would seem an appropriate context
to reach all its youth with tobacco use education
programming. Second, this modality greatly increases
the reach of programming and, therefore, may increase
the total numbers of quitters.
Third, such programming can be framed so as to
exert a preventive function among youth who are not
current tobacco users. Comprehensive social influence
programming is relatively unlikely to be effective for
older, high-risk teens [6]. Motivation enhancement,
social skills, and life skills material, contained in Project
EX, is likely to be more relevant. In fact, program
development studies for Project EX took place in the
CHS classroom setting, composed of users and nonusers.
The nonusers enjoyed the programming as much as,
or more than, the tobacco users. Also, they perceived
that the activities developed would help them to not use
tobacco in the future.
Finally, cessation as classroom programming can
be a useful practical health science educational tool in
the high school classroom setting. Tobacco use addiction
and cessation is an important topic to be instructed
by the time a youth graduates high school, because
of intrinsic academic importance in health behavior
science and to appreciate the practical, societal costs
of addiction.
This newest study has three main aims. The first
goal has been to adapt Project EX clinic program to the
classroom context in continuation high schools (CHSs).
Material has been edited and piloted in classrooms, and
has been made appropriate as a means of cessation and
indicated prevention. In EX-4, the prevention changes
included adding experiments in Session 1 for nonsmokers
to try. Non-smokers choose one situation in
which they are around people smoking tobacco and
notice how they feel (e.g., does the second hand smoke
bother them). Non-smokers who are never around
smokers notice where any evidence of tobacco is (e.g.,
corner store, advertisements, cigarette butts on the
street, etc.) and discuss how they feel about it. We also
added reasons why youth should remain tobacco-free.
In Session 2, information was added on tobacco industry
marketing tactics and how they target youth. More
information about secondhand smoke was added in
Session 3. In Session 4 non-smokers can make personal
commitments to remain tobacco-free or serve as a “listening
ear” to assist those who may be trying to quit. In
Session 5 non-smokers are given suggestions on what
one should and should not do to serve as a “listening
ear” to assist those who may be trying to quit. Also,
non-smokers and smokers are given exercise tips and
general information on food groups and serving sizes in
Session 6.
The second goal has been to implement and assess
effects of the classroom program at seven CHSs.
This eight-session program is now being compared to a
standard care control condition (classroom assessments
only) at seven other CHSs, with immediate pretests,
immediate posttests, six and 12-month follow-ups, in a
two-group experimental design. We expect the quit rates
achieved will be at least as high as those previously
obtained with the Project EX clinic-based program. The
overall number of youth who quit smoking will be
higher in the classroom delivery context by reaching
most tobacco users at the school. Also, we expect that
those who do not report smoking in the last 30 days
who are exposed to the classroom program will exhibit
lower levels of smoking six and 12 months later compared
to those in the standard care control condition.