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 2
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
Running head: PREVENTION PROGRAM PAPER 3
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:
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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
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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
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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
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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
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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).
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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.
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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
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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
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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.
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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
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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
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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:
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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
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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.
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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
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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
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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.
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