Quality of Research
Review Date: February 2008
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Horn, K. A., Dino, G. A., Kalsekar, I. D., & Fernandes, A. W. (2004). Appalachian teen smokers: Not On Tobacco 15 months later. American Journal of Public Health, 94(2), 181-184.  Study 2Dino, G. A., Horn, K. A., Goldcamp, J., Maniar, S. D., Fernandez, A., & Massey, C. J. (2001). Statewide demonstration of Not On Tobacco: A gender-sensitive teen smoking cessation program. Journal of School Nursing, 17(2), 90-97.
Dino, G., Horn, K., Abdulkadri, A., Kalsekar, I., & Branstetter, S. (2008). Cost-effectiveness analysis of the Not On Tobacco program for adolescent smoking cessation. Prevention Science, 9(1), 38-46.
Dino, G., Horn, K., Goldcamp, J., Fernandes, A., Kalsekar, I., & Massey, C. (2001). A 2-year efficacy study of Not On Tobacco in Florida: An overview of program successes in changing teen smoking behavior. Preventive Medicine, 33(6), 600-605.
Dino, G., Kamal, K., Horn, K., Kalsekar, I., & Fernandes, A. (2004). Stage of change and smoking cessation outcomes among adolescents. Addictive Behaviors, 29(5), 935-940.
Supplementary Materials Horn, K., Dino, G., Kalsekar, I., & Mody, R. (2005). The impact of Not on Tobacco on teen smoking cessation: End-of-program evaluation results, 1998 to 2003. Journal of Adolescent Research, 20(6), 641-661.
Outcomes
| Outcome 1: Smoking cessation |
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Description of Measures
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Smoking cessation was measured using the Smoking History Form, a self-report instrument that assessed participants' smoking patterns, including age of onset, number of cigarettes smoked per day, and baseline stage of readiness to quit smoking. Carbon monoxide readings were used to validate self-reported smoking status.
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Key Findings
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Two studies compared teen smokers who received either N-O-T or a brief intervention (BI) on smoking cessation that included self-help brochures and a 10- to 15-minute presentation of scripted advice.
In the first study, conducted with Appalachian teens in North Carolina and West Virginia, 8.1% of N-O-T participants reported smoking cessation 3 months after the intervention, compared with only 2.2% of BI participants (p < .05). This difference, however, was largely accounted for by the female segment of the sample; 10.3% of females who received N-O-T reported smoking cessation, compared with only 2.6% of females who received BI (p < .05). Among males, 5.4% of N-O-T participants and 1.8% of BI participants reported cessation, a difference that was not statistically significant.
In the North Carolina sample, the percentage of students who reportedly quit smoking 15 months after the intervention was higher in the N-O-T group than in the BI group (9.8 vs. 1.6, p < .05).
In the second study, conducted in Florida, 21.7% of N-O-T participants reported smoking cessation 5 months after the intervention, compared with only 12.6% of BI participants (p < .05). Again, this difference was largely accounted for by the female segment of the sample; 33% of females who received N-O-T reported smoking cessation, compared with only 11.4% of the females who received BI (p < .05). Males did not report statistically significant differences in smoking cessation.
To determine if the interventions were more effective for students who were at different stages of readiness to quit smoking at baseline, students were classified as precontemplators (not planning to quit in the next 6 months), contemplators (planning to quit in the next 6 months), or preparers (planning to quit in the next 30 days). Among BI participants, preparers were more likely to quit smoking than precontemplators (p < .05), a finding associated with a large effect size (odds ratio = 25.51). In contrast, among N-O-T participants, there were no differences in cessation between precontemplators, contemplators, or preparers, indicating that the intervention was equally effective for smokers regardless of their stage of readiness.
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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3.6
(0.0-4.0 scale)
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| Outcome 2: Smoking reduction |
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Description of Measures
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Smoking reduction was measured using the Smoking History Form, a self-report instrument that assessed the number of cigarettes smoked on weekdays and weekends.
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Key Findings
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A study in Florida compared teen smokers who received either N-O-T or a brief intervention (BI) on smoking cessation that included self-help brochures and a 10- to 15-minute presentation of scripted advice. Among students who continued to smoke after the intervention, N-O-T participants had larger reductions in reported weekday smoking than BI participants (53.2% vs. 34.7%, p < .05). This difference was statistically significant among males (65.9% vs. 31.1%, p < .05), but not among females. Among students who continued to smoke, N-O-T participants also had larger reductions in reported weekend smoking than BI participants (74% vs. 41.2%, p < .05). This difference was statistically significant among both males (80% vs. 34.6%, p < .05) and females (73.2% vs. 36.6%, p < .05).
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Studies Measuring Outcome
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Study 2
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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| Outcome 3: Cost-effectiveness |
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Description of Measures
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The cost-effectiveness analysis was conducted using estimated life expectancies and school cost data. Due to the lack of data on the life expectancies of smokers and nonsmokers below the age of 25, Markov transition models were used to estimate participants' future smoking status at the age of 25 based on baseline and 7-month postbaseline data collected in a previous efficacy study. Costs in the analysis included those for relevant training and implementation and were measured in terms of dollars in the year 2000.
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Key Findings
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A study in Florida compared teen smokers who received either N-O-T or a brief intervention (BI) on smoking cessation that included self-help brochures and a 10- to 15-minute presentation of scripted advice. Compared with students who received BI, students who received N-O-T were predicted to have an increased life expectancy of 7.46 years. Best-case and worst-case scenarios found that this increased life expectancy ranged from 6.76 to 9.5 years. The average financial cost for each additional year of life expectancy for those completing N-O-T was $442.65. This estimate ranged from $273.60 to $1,028.90 per life-year saved.
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Studies Measuring Outcome
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Study 2
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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3.5
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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13-17 (Adolescent)
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56% Female
44% Male
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93.4% White
6.6% Race/ethnicity unspecified
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Study 2
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13-17 (Adolescent)
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56% Female
44% Male
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81.3% White
8.8% Hispanic or Latino
4.3% Race/ethnicity unspecified
1.8% Black or African American
1.6% American Indian or Alaska Native
1.1% Asian
1.1% Native Hawaiian or other Pacific Islander
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Smoking cessation
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4.0
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4.0
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3.5
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3.5
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3.3
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3.5
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3.6
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2: Smoking reduction
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3.5
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3.5
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3.5
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3.5
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3.3
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3.5
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3.5
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3: Cost-effectiveness
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3.5
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3.5
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3.5
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3.5
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3.3
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3.5
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3.5
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Study Strengths The researchers used reliable and valid measures; used well-developed procedures for training, implementation, and evaluation; tested for differential attrition consistently; and used generally appropriate analyses, including intent-to-treat and compliant sample analyses. The length of follow-up in the Appalachian study was unusually long and still found significant effects. Overall, the methodological quality was high in these studies.
Study Weaknesses Because neither study used a randomized design, potential confounds (e.g., preexisting group differences in nicotine dependence, motivation to quit smoking) may have biased results. Analyses did not account for potential intraclass correlation within schools or within groups but were otherwise appropriate.
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Readiness for Dissemination
Review Date: February 2008
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
American Lung Association. (2003). N-O-T: Not On Tobacco. The premier teen smoking cessation program. New York: Author.
Program Web site, http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39866
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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3.3
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2.3
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1.0
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2.2
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Dissemination Strengths Program materials recognize the importance of engaging school administrators and teachers to facilitate organizational implementation. Master trainers are available to train program implementers through the American Lung Association. Some tools are available to support quality assurance.
Dissemination Weaknesses Very little information is provided on ensuring organizational preparedness. It is unclear how facilitators are selected or trained. No formal support is available to program implementers. Quality assurance materials do not include guidance for assessing program delivery, training effectiveness, or facilitator competence.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Implementation materials
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Contact the developer
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Yes
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Training
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About $300 per participant
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Contact the developer
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Technical assistance/consultation and quality assurance information
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Contact the developer
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Contact the developer
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Additional Information Training costs vary by State and region. Cost information can be obtained by contacting the American Lung Association (1-800-LUNG-USA).
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
Dino, G. A., Horn, K. A., Goldcamp, J., Kemp-Rye, L., Westrate, S., & Monaco, K. (2001). Teen smoking cessation: Making it work through school and community partnerships. Journal of Public Health Management and Practice, 7(2), 71-80.
Dino, G. A., Horn, K. A., Zedosky, L., & Monaco, K. (1998). A positive response to teen smoking: Why N-O-T? NASSP Bulletin, 82(601), 46-58.
* Dino, G., Horn, K., Goldcamp, J., Fernandes, A., & Kalsekar, I. (2001). A 2-year efficacy study of Not On Tobacco in Florida: An overview of program successes in changing teen smoking behavior. Preventive Medicine, 33(6), 600-605.
Doll, L., Dino, G., Duetsch, C., Holmes, A., Mills, D., & Horn, K. (2001). Linking science and practice: Two academic/public health collaborations that are working. Health Promotion Practice, 2(4), 295-300.
Horn, K., Dino, G., Gao, X., & Momani, A. (1999). Feasibility evaluation of Not On Tobacco: ALA's new stop smoking program for adolescents. Journal of Health Education, 5, 192-206.
Horn, K., Dino, G., Kalsekar, I., Massey, C. J., Manzo-Tennant, K., & McGloin, T. (2004). Exploring the relationship between mental health and smoking cessation: A study of rural teens. Prevention Science, 5(2), 113-126.
Horn, K., Fernandes, A., Dino, G., Massey, C. J., & Kalsekar, I. (2003). Adolescent nicotine dependence and smoking cessation outcomes. Addictive Behaviors, 28(4), 769-776.
Horn, K., McCracken, L., Dino, G., & Brayboy, M. (2008). Applying community-based participatory research principles to the development of a smoking cessation program for American Indian teens: "Telling our story." Health Education and Behavior, 35(1), 44-69.
Horn, K., McGloin, T., Dino, G., Manzo, K., McCracken, L., Shorty, L., et al. (2005). Quit and reduction rates for a pilot study of the American Indian Not On Tobacco (N-O-T) program. Preventing Chronic Disease, 2(4), A13.
Massey, C. J., Dino, G. A., Horn, K. A., Lacey-McCracken, A., Goldcamp, J., & Kalsekar, I. (2003). Recruitment barriers and success of the American Lung Association's Not-On-Tobacco Program. Journal of School Health, 73(2), 58-63.
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