The relative effectiveness of a peer-led and adult-led smoking intervention program

Adolescence, Spring, 1995 by Fountiene Prince

Most individuals who choose to smoke begin this behavior during adolescence, and peer influence is a known factor in the initiation of smoking behavior (Chassin, Presson, Sherman, & Edwards, 1990; Dusenbury, Botvin, & James-Ortiz, 1990; Flay, d'Avernas, Best, Kersell, & Ryan, 1983; van Roosmalen & McDaniels, 1989; Volkan & Fetro, 1980). One prevention approach aimed at confronting multiple problems of adolescence has included the development of peer leadership programs on secondary school campuses throughout the country. Students in such programs are trained in self-awareness, communication skills, and techniques in assisting peers with specific problems encountered in adolescence. Though research seems to indicate that the most effective smoking intervention programs are those which use adult leaders assisted by peers (Glynn, 1989), more research has been recommended to aid in the development of programs involving varied approaches, models, and messages in the delivery of school-based smoking intervention programs (Perry, Telch, Killen, Burke, & Maccoby, 1983; Glynn, Anderson, & Schwartz, 1991). Chassin, Presson, Sherman, and Edwards (1984) suggested that older adolescents may be more influenced by strategies involving peers when attempting to change smoking behavior. Glynn (1989) also noted the need for adolescents to be involved in the identification of essential elements of tobacco-use cessation programs.

The purpose of this study was to evaluate the effectiveness of a peerled smoking intervention program and to determine which aspects of the program were most helpful. Using a combination of materials from other current programs, a six-session program was developed to be delivered on high school campuses in southern California. The program was called Tobacco, No Thanks! (TNT). A manual was assembled with specific directions aimed at assisting high school-age leaders in presenting the sessions. An adult advisor was present in the classroom, but the program was led entirely by the students who were recruited from peer leadership programs on their campuses. Student leaders and peer advisors attended a two-day training in group leadership and program content before commencing the six sessions. Effectiveness of the program was measured by comparing the results achieved by students in peer-led groups with those of students in adult-led groups using the same program. Adult leaders were invited to attend the same training session as that of the peer leaders and their advisors. The results from both groups were compared to a control group which experienced no treatment.

METHOD

Subjects

A total of 93 students on seven high school campuses participated in the program. Schools were located in Ventura and Los Angeles counties. Students volunteered for the program and were recruited through bulletin announcements, encouragement from teachers and friends, and referral by school nurses.

Procedure

Students were divided into groups of 6-12 participants. Control group students were represented on all but one campus. The Tobacco Use Survey, indicating how many cigarettes each student smoked per day, and the Tobacco Experience Survey, which showed a student's dominant reason for smoking, were given as a pretest to students in all groups before the beginning of the program. The Program Participant Feedback Form and The Smoking Self-Efficacy Questionnaire (Coletti, Supnick, & Payne, 1985) were administered to all students at the completion of the program as the posttest, and the same instruments were administered again as a one-month follow-up measure.

RESULTS

Initially, 110 students took the pretest measures; 93 students were still participating at the final follow-up measure one month after completion of the program. Groups were similar in size (30 in the peer-led group, 31 in the adult-led group, and 32 in the control group). Data were analyzed using analysis of variance and t tests for the three groups and the 93 students who completed the program along with all the instruments used.

It was not possible to use random assignment on all campuses. However, smoking rate was established to be equivalent among all groups at the beginning of the study.

The three groups were comprised of 54 males and 46 females. Most subjects were in the 11th or 12th grades. Self-reported smoking levels at the pretest showed that all subjects smoked at least 1-3 cigarettes per day. Number of cigarettes smoked was expressed in range categories on the Tobacco Use Survey and the Program Participation Feedback Form. The Mean range for all students participating was 11-13 cigarettes per day at the pretest measure. By completion of the six-session intervention program, 17% of all subjects reported that they had quit smoking. At the one-month follow-up measure, 18.1% reported that they had quit smoking. Approximately one-fourth of the sample reported that they had no family members who smoke. The mean number of family members who smoke was 1.76. Some change in family members was noted through personal interviews of students. In some cases students reported changing homes during the study. Ninety percent of the students in the study reported that they had eight or more friends who smoke.