Drug & Alcohol Program Development Paper

Prevention Program Paper

Jason ClabaughDawn Ingram

Kiersten Talbot Brenda Shadding

Group: Red

REHB 6795: Prevention of Drug and Behavioral Addictions

East Carolina University

March 28, 2012

Dr. Mary K. Crozier

Running head: PREVENTION PROGRAM PAPER 1


Introduction and Rationale

The numbers are staggering: “Each day in the United States,

approximately 3,800 young people under 18 years of age smoke

their first cigarette, and an estimated 1,000 youth in that age

group become daily smokers” (CDC, 2011). “The percentage of high

school students who smoked one or more cigarettes in the previous

month in 2009 is 19.5%” (CDC, 2011). “The percentage of middle

school students who smoked one or more cigarettes in the previous

month in 2009 is 5.2%” (CDC, 2012).

According the surgeon general’s report comprehensive, sustained,

multi-component programs can cut youth tobacco use in half in 6

years. Prevention is critical and successful multi-component

programs prevent young people from starting to use tobacco in the

first place and more than pay for themselves in lives and health

care dollars saved. Comprehensive tobacco control programs are

most effective when funding for them is sustained at levels

recommended by the Centers for Disease Control and Prevention

(DHHS, 2012). The level of community readiness is stage six

initiation. All staff members are on board and excited about the


N-O-T program. Our administration has allotted a liberal budget

for the program.

Domain

Hogan et.al suggests that “the school setting is a proven

evidence based practice for program implementation. Programs

provided through the school increase protective factors and

decrease risk factors” The setting of the N-O-T program is at

Glenn Forrest Parochial School in Forest Park, GA. The makeup of

the school is a private school which houses grades 7-12 and it is

45% male and 55% female. The distribution of males and females in

approximately the same throughout all grade levels with total

enrollment totaling 1,200 students. The N-O-T task committee

headed by the N-O-T coordinator, Mr. Jason Clabaugh M.A. has been

given $1,000,000 to implement the program. All faculty and staff

are willing to cooperate and are excited to see this program

which has been developed from many hours of planning go into

effect with the start of the 2012-2103 academic year.

Population with Risk and Protective Factors:


The target population is male and female. The age range is

between 13-17 years old. The race/ethnicity groups will include

– African American, Caucasian, Hispanic, American Indian or

Alaska Native, Asian and bi-racial youth. The school setting is

appropriate for the prevention program. The geographic location

will be a moderately middle class suburban area.

The risk factors for this particular school include students with

low self-esteem, use of tobacco products by parents and peers,

the communities’ attitude towards the use of tobacco products,

and media campaigns promoting tobacco use in and around the

immediate area. Protective factors include socio-economic status,

Glenn Forrests no tolerance policy regarding tobacco use, and the

support of teachers and administrators in the new N-O-T program.

Prevention Program from the NREPP:

The Not on Tobacco Program (N-O-T) is a program created by

the American Lung Association (ALA) that is focused on smoking

cessation among students ages fourteen to nineteen who are

currently daily smokers (Not on Tobacco, 2011). The main focus of


the N-O-T program is to stop tobacco use among current users and

to prevent future tobacco use among adolescents who exhibit

similar risk factors as current users (NREPP, 2008). According to

the N-O-T website, this program is the most successful and useful

program in the United States. Reasons for this include the N-O-T

program is “research-based, effective, easy-to-use, and well

received by teens” (Not on Tobacco, 2011). In addition, the N-O-T

program does not discriminate, and is open to participation from

males and females, as well as all races including American Indian

or Alaska Native, Asian, Black or African American, Hispanic or

Latino, Native American or Pacific Islander, and White (NREPP,

2008). Another reason the N-O-T program is so effective is that

it can be adapted to any type of school setting including

suburban, rural, and urban populations (NREPP, 2008).

The Not on Tobacco Program is based on social-cognitive

theory that encourages a tobacco-free school environment (NREPP,

2008; Not on Tobacco, 2011). The program also stays away from

coercion techniques and allows students to participate as he or


she feels comfortable (Not on Tobacco, 2011). The sessions

include a variety of techniques including discussions,

journaling, role playing, and various group activities and are

facilitated by a group of trained individuals who may be

teachers, school counselors, coaches, school nurses, or anyone

else who has a positive interest in the subject (NREPP, 2008; Not

on Tobacco, 2011). Students are placed into groups of ten to

twelve students that are separated by gender. The sessions last

about fifty minutes and occur once a week for approximately ten

weeks. Administrators have the option to follow up with four

additional “booster sessions” that involve discussions about

improvements and concerns that may exist with future sessions

(NREPP, 2008; Not on Tobacco, 2011).

The N-O-T program is unique from other prevention programs

in that it caters specifically to teens. The issues that are

addressed during the group sessions are issues that all teens can

relate to such as weight control after quitting smoking,

effective communication tips, and ways to manage the stress that


comes with the withdrawal symptoms. Mental health, physical

fitness, nutrition, self-esteem, and overall attitude on life are

also discussed (Not on Tobacco, 2011). In addition, general

smoking related issues and concerns (such as withdrawal, peer

pressure, and tobacco cravings) are addressed (Not on Tobacco,

2011; NREPP, 2008). Another unique aspect of the N-O-T program

are the concerns that are discussed that are gender specific,

because research has shown that boys and girls often have

different reasons for quitting and staying sober (Not on Tobacco,

2011). By developing a “total health approach”, teens are able to

learn healthy behaviors, life skills, and stress management in a

peer infused, group setting (Not on Tobacco, 2011).

As previously mentioned, the Not on Tobacco program is the

most widely used tobacco cessation program in the United States

for schools (Not on Tobacco, 2011). In fact, the program prides

itself on having a twenty-one percent quit rate, which is higher

than any other comparable programs (Not on Tobacco, 2011).

Similarly, there are a number of benefits for schools to use the


N-O-T program. The Not on Tobacco program is based on ten years

of research and evaluation and is easy and inexpensive to use

(Not on Tobacco, 2011). The American Lung Association trains all

facilitators of the program and is constantly supportive via

their staff and the resources available via their website. In

addition, the N-O-T program qualifies as a health education

course and promotes a healthy school environment through a

tobacco-free approach (Not on Tobacco, 2011). Likewise, the N-O-T

program is beneficial for students in a number of ways. Aside

from the fact that students are extremely likely to quit smoking

after completing the N-O-T program, students involved in the

program develop meaningful friendships within the group and

develop a sense of trust among facilitators of the program (Not

on Tobacco, 2011). In addition, students and feel accomplished

and in turn, are more motivated to do well in school. Students

save money that would have been spent on tobacco products and

develop a better overall sense of health due to better stress

management learned through the program (Not on Tobacco, 2011).


As previously mentioned, the Not on Tobacco program can be

flexible with all genders, races, and geographic locations. In

order to address any cultural competence issues that may arise,

it would be important to be aware of the exact population that

one would be assisting. As mentioned in Hogan, Gabrielsen, Luna,

and Grothaus (2003), “an important aspect of cultural competency

is that prevention professionals and agencies must work with

communities in developing and implementing prevention programs,

instead of providing services to community members without

seeking their input” (pg 110). When developing a N-O-T program

for one’s community, it would be ideal to find people who are

interested in helping to develop the program and making sure

everyone’s opinion and ideas are heard and taken into account.

Making sure that all races, genders, and geographic locations of

the participants are accounted for is crucial. One way to do this

is to make sure that a spokesperson from each population group is

involved in the planning process, if that is possible.


One must also be careful to not discriminate against anyone

in the population. Participants must be able to see everyone as

an equal and put his or her own bias to the side for the purpose

of the study (Hogan et al., 2003). In addition, one must respect

individual boundaries and strive to improve group facilitation

and communication skills among the group in an effort to learn

more about the community and to teach others about prevention

within the community. The most important factor in making the N-

O-T program culturally competent is to make sure that the program

staff and administrators remain positive and have high

expectations towards everyone in the group, no matter what one’s

cultural or background are. In addition, group members must be

able to value, build on, recognize, and respect the diversity

that occurs within the community (Hogan et al., 2003).

It is imperative to ensure that any program being utilized

is done so with fidelity to the model. The N-O-T program is

a program that is used to stop and prevent tobacco use. This

program is based on 10 years of research and evaluation


utilizing proven techniques. Another important goal is to

promote compliance and support adequate enforcement of

federal, state, and local tobacco laws. Some ways to confirm

that fidelity will be upheld is through trainings with

parents, staff, teachers, community leaders, and students.

The evaluations of the program also provide evidence that

the program is functioning as needed and that fidelity is

being upheld to the standards of the program.

“School-based health programs should enable and

encourage children and adolescents who have not

experimented with tobacco to continue to abstain from

any use” (CDC, 1994). The N-O-T program facilitators

must go through a structured training in order to learn

how to conduct sessions and group activities, learn

what challenges may arise, and learn how to handle

potential challenges (Not on Tobacco, 2011). These

programs are conducted in person to ensure that

facilitators understand the importance of specific


skills and can demonstrate their ability to follow

curriculum (Not on Tobacco, 2011). The training

requirements to become a facilitator differ depending

on the facilitator, the participating teens, and the

region of the country” (Not on Tobacco, 2011).

Following N-O-T 2011, the committee has established the

following timeline

Friday August 24, 2012: 8 – hour workshop for

faculty and staff

From August 27 – October 8 2012: Faculty and staff

will spend 1-2 hours per week recruiting

participants.

From October 15 2011 – January 21, 2013 there will

be 50-minutes per week of the N-O-T on tobacco

program presented.

Booster sessions for facilitators will be held on

a bi-annual basis.


In order to get an N-O-T program started it is

imperative to gain resources and funding for the programs.

Some places to gain support for this program include school

staff, parents, community organizations, board members, and

other professional organizations.

“Prevention programs should be more aggressive during

the first 2 years of the program. Considerable numbers of

students begin using tobacco at or after age 15 therefore,

tobacco-prevention education must be continued throughout

high school. Among high school seniors surveyed in 1991 who

had ever smoked a whole cigarette, 37% initiated smoking at

age 15 or older (grades 10-12). (As cited in Hogan…et.al,

2003).

This statistic shows the importance of providing

tobacco prevention based programs early in school. Tobacco

in any form is also known to many as the gateway drug.

Gateway drugs are thus called because their use typically

precedes the use of illicit drugs such as heroin, cocaine


and LSD (As cited in Hogan…et.al, 2003). It is important for

facilitators in the program to be sensitive to the

perspective of others, be non judgmental, comfortable

helping teens deal with issues related to self-esteem,

relationships and stress. It is also imperative for them to

be able to relate to others and also assertive and

persuasive when leading group discussions and in handling

conflicts that arise during group sessions (Not on Tobacco,

2011).

Prevention programs offered can be infused into other

services and programs. Many of these programs increase

effectiveness when working with the families of the young people.

Some of the major benefits of prevention of tobacco products are

not only the health benefits but children and young adults that

don’t smoke learn better and are more likely to not drop out of

school. These programs can also be infused into athletics,

academics, and other important aspects of a young person’s life.

Some ways for the N-O-T program to be infused into other services


is to assist the teens with understanding the full effects of

tobacco usage on their total health including their physical,

mental, and emotional well being. At Glenn Forrest school there

is an existing program entitled Supporting Teens at Risk (STAR).

It is a group of faculty and staff that meet to discuss and

support an indicated population of students with problems ranging

from drug use to family problems and everything in between.

Program Evaluation

Glenn Forrest Parochial Schools evaluation of the Not On

Tobacco program will follow logic model. This model is described

as “the logic model lays out what the program is expected to

achieve and how it is expected to work – essentially forming a

map linking together a projects goals, activities, services, and

assumptions. In turn, evaluation questions, designs, and methods

are developed out of the programs logic model” (Hogan et.al,

2003, p.211). The first part of the model will be the goals which

the program seeks to achieve. Our goals for the N-O-T program

include:


To help teens quit smoking

To reduce their smoking

To increase healthy lifestyle behaviors

Improve life management skills

(as cited on Not on Tobaccos website, 2011)

The evaluation questions associated with these goals are How many

students quit smoking after going through the Not On Tobacco

education, What percentage of students reduced their smoking

habit?, How many students reported an increase in healthy

lifestyle behaviors?, and what feedback has been received from

students regarding improved life management skills?

The administrative team at Glenn Forrest has developed pre-post

surveys conducted with the student participants in the program.

The program content includes:

10 weekly sessions

o First five sessions – preparation

o Quit day – after session five

o Sessions 6-10 – Relapse prevention and reinforcement

Four optional booster sessions


Each program session lasting approximately 50 minutes

The evaluation question for this section is “How many students

participated for 50-minutes per week for the full ten weeks? The

method of collecting this data will be attendance logs from the

facilitator.

The target group is an indicated population of teen smokers ages

13-17, who are:

Regular teen smokers who are addicted to nicotine

Youth who want a group program

Those who volunteer to participate

(as cited on Not on Tobaccos website)

The evaluation question for this section would look at how many

students from the Glenn Forrest school volunteered to participate

in the program? This information will again be gathered from the

attendance roster from the program facilitator.

If then statements for the program include:

If the program is offered then a certain percentage of the

student population will stop smoking.


If a certain percentage of the student population stops

smoking then their health will improve.

If the student populations’ health improves overall

healthcare costs in the community will decrease.

The evaluation questions would ask what percentage of the student

population stopped smoking, what percentage of the student

population decreased their smoking, and what percentage of the

students that started the program finish the program. The

administrator will evaluate this by attendance records from the

program facilitator and pre-post surveys of student participants.

Short term outcomes of the program would have students either

quit smoking or reduce their smoking. The evaluation questions

would be how many students quit smoking after participating in

the program and how many students reduced their smoking after

participating in the program? Evaluation methods will include an

exit survey.

Long term outcomes will include increasing healthy lifestyle

behaviors and improving life management skills. Evaluation

questions will be What feedback regarding healthy lifestyles did


the administrator receive and what feedback did the administrator

receive on life management skills? Method of gathering the data

will be a survey at three months, six months, and a year.

In evaluating the program the data collected indicates after

completing the N-O-T program 57% of teens stopped smoking; 85% of

teens reduced or stopped smoking on weekdays; 80% of teens

reduced or stopped smoking on weekend days. Regarding healthier

lifestyles 49% exercised more; 45% ate healthier. Regarding life

management skills 53% felt better about themselves; 52% were

better able to deal with stress and 39% were better able to deal

with friends and family.

The final step is reporting the data. Three main points that the

administrators felt most import to report from the findings were:

Slightly over half (57%) of teens stopped smoking

Almost half of the participants (49%) exercised more

About half of the participants (53%) felt better about

themselves

Recommendations which follow the findings include:

Continuing the program on an annual basis


Providing anti-tobacco literature at an earlier age

Educating parents (especially those that smoke themselves)

on the risks and bad habits they are passing down to their

children.

In conclusion the administration, faculty, and staff at Glenn

Forrest Parochial School were extremely pleased to have

implemented the N-O-T on Tobacco program during the 2012-2013

academic year. As with any program there were trials and

tribulations but overall the assessment and evaluation of the

data showed a positive outcome for our students in their lives

and it is believed by all that this program truly made a

difference not only in our school but in our community as a

whole.

Drug & Alcohol Program Development Paper

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