Not-On-Tobacco Program (N-O-T)

Despite progress made over the last decade in reducing teen smoking, helping teen smokers kick the habit remains a challenge. Teens, like adults, can face significant obstacles when trying to quit, including high levels of dependence and addiction. Research suggests effective teen smoking cessation efforts are needed in addition to traditional prevention approaches. Not-On-Tobacco (N-O-T) is a school based smoking cessation program designed specifically for teens that has been implemented and extensively evaluated since 1998 in many states across the country. Evaluations indicate that N-O-T is effective in increasing quit rates among teens who volunteer to participate, as well as encouraging other healthy behaviors that can support tobacco abstinence.

N-O-T was created by the American Lung Association (ALA) in collaboration with West Virginia University in response to both the growing number of teens addicted to tobacco and the lack of effective cessation interventions for teens. N-O-T is a group program designed for 14- to 19-year olds who are daily smokers (as opposed to experimenting smokers) and who demonstrate some motivation to quit. The protocol consists of 10 weekly 50 minute sessions plus 4 booster sessions, conducted in school or community settings, with 10 to 12 participants per group. N-O-T is gender tailored, delivered to males and females separately by same gender facilitators. The facilitators (usually teachers, school nurses, coaches, counselors, and other staff volunteers who are recruited based on specific criteria) undergo extensive training and follow a highly prescribed curriculum. Major program goals are to help teens (1) quit smoking, (2) reduce the number of cigarettes if unable to quit, (3) increase healthy lifestyle behaviors, and (4) improve life skills such as stress management, decision making, coping, and interpersonal skills.

Implementation of the N-O-T program requires advance preparation for (1) coordination with the schools or community organizations that plan to sponsor the sessions, (2) recruitment of facilitators and participants, and (3) training of facilitators. The N-O-T program is conducted over 10 consecutive weeks, with the option of 4 additional weeks of booster or follow up sessions. Facilitators generally receive 8-10 hours of highly prescribed N-O-T instruction and training in research protocol.

The program is suitable for all youth at the junior high and high school levels. N-O-T participants are generally between 14 and 19 years of age, with a mean age of 16 and a slightly higher representation of females (56 percent). 87.3% were White, 2.3% were Black, 1% were American Indian, 0.3% were Asian, 3.3% were Hispanic, 1% were Pacific Islander, and 4.7% were classified as "other". Students from all across the United States and parts of Europe and Canada have taken part in the program. The curriculum has been translated into Spanish, and development of culturally tailored versions for American Indian and rural youth is underway.

The intervention is suitable for implementation in school and community settings. It can be used as an educational, nonpunitive alternative to existing school tobacco enforcement policies (such as suspension) and a supplement to smoking prevention programs.

A facilitator instruction guide, surveys, and curriculum are available from the ALA.

Costs have been paid by state tobacco initiatives, state and local school systems, public and private research grants, and other sources of funding.

The N-O-T program has been implemented and evaluated in several states including Florida, North Carolina, Virginia, West Virginia, and Wisconsin. Multiyear, multistate results suggest it is an effective teen smoking cessation program. Key findings include:

• In the first published evaluation, both chemically validated and self-report measures found that at 8.5 months postbaseline, female N-O-T participants had significantly higher quit rates than females in the comparison group. There were no significant differences in quit rates for male participants.

• In a five-year review of the program including five states, 489 schools, and over 6,000 youth significant results were also found. This review included experimental and quasi-experimental evaluations. The field-based quasi-experimental evaluations found an end-of-program quit rate of 32 percent (n=3761). The controlled or experimental evaluations found an end-of-program N-O-T quit rate of 19 percent, compared to 9 percent in the comparison group. This difference was statistically significant. Over all states, quit rates were similar for both males and females.