Numerous rewards of quitting were discussed
among participants. These included: feeling better emotionally,
receiving more social support after quitting,
saving money, and feeling more respected by others/accomplished.
Also discussed as rewards were having
more energy; feeling less stressed; having fewer or
no mood swings; having higher self-esteem; achieving
more self-control; appearing cleaner, more attractive,
healthier; being able to live longer and be more active;
and achieving greater peace of mind.
Several of the focus group discussions led to activity
development. The suggestion of use of nonsmoking/healthy
activities and mention of yoga led to the
development of a theme study activity, which was studied
in the next stage of Project EX program development.
The focus group participants saw mood as improving
in a number of positive ways six months after
quitting. This notion led to creation of another theme
122 Sussman S, McCuller WJ, Zheng H, Pfingston YM, Miyano J, Dent CW
study activity that illustrates mood improvement at
different time points after quitting. Ex-smokers were
perceived as strong individuals; that influenced development
of yet another theme study activity. This focus
group study is described in more detail elsewhere [14].
Theme Study. A theme study consists of brief
written descriptions of several hypothetical activities
that are rated by students in the target population for the
purpose of determining their potential interest, likeability,
and perceived helpfulness. The theme study is an
important step in the process of empirical program development
because it allows the a priori ascertainment
of subject preferences regarding potentially applicable
activities. A theme study elicits information regarding
the appropriateness of using certain topics in specific
populations. The activities that yield high subject preference
may then confidently be developed further into
complete activities or sessions for immediate impact
testing through component and pilot studies [23].
As an EX-1 program development study, the
goals were twofold. First, there was an interest to determine
which among two alternative presentation modalities,
“game” or “talk show,” of nine "traditional
motivation enhanced" smoking cessation themes [13]
were most acceptable to older teens. The game-type
activities were those that involved team competition to
learn material (e.g., board games). The talk show-type
activities were those that involved a group facilitator,
guests, and audience members to replicate such shows
as “Oprah” while learning material. Second, there was
an interest to determine which in a set of eight "novel"
activities, derived from eight unique alternativemedicine-related
themes, were as acceptable or more
acceptable to continuation high school (CHS) students
than the best activities derived from traditional motivation
themes. A total of 26 activities were contrasted
(total n=391, half tobacco users), with the use of randomized
orders of activities for different groups of
raters. Details on the study design are provided elsewhere
[24].
Talk show and game modalities were equally
liked. The most highly rated activity was a talk show
that emphasized quitting while one is young. Other
highly rated activities tapped romantic choices when
being tobacco free and not being a victim of tobacco
company advertisements. Instruction in yoga also was
preferred [24].
Component Study. A component study protocol
involves actually exposing youth to an activity or session
for its effects on measures of immediate impact
[20]. The products of this type of study are the building
blocks of a complete tobacco use cessation program. A
total of 327 students participated in the EX-1 component
study [25]. About half of the surveyed students
were self-reported smokers, and these students were the
focus of the analysis. The 14 most favorably rated activities
from the theme study were retained for testing
in the component study.