Young Adult Utilization of a Smoking Cessation Website: An Observational Study Comparing Young and Older Adult Patterns of Use.

BACKGROUND: There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users. OBJECTIVE: This study examines utilization of the BecomeAnEX.org smoking cessation website among young adults and young adult subgroups compared with older adults to identify patterns of use by age, gender, and race/ethnicity. METHODS: Study participants were 5983 new registered users on a free smoking cessation website who were aged 18 to 70 years. Website utilization was tracked for 6 months; metrics of use included website visits, pages per visit, length of visit, and interaction with specific website features. Differences in website use by age were examined via bivariate analyses and multivariate logistic regression adjusted for age, gender, and race/ethnicity. Interactions were examined to determine differences by gender and race/ethnicity within young (18- to 24-year-olds and 25- to 34-year-olds) and older (35 years and older) adult segments. RESULTS: A greater percentage of young adults aged 18 to 34 years visited the site only once compared with older adults aged 35 years and older (72.05% vs 56.59%, respectively; P<.001). Young adults also spent less time on the site and viewed fewer pages than older adults. In adjusted analyses, young adults were significantly less likely than older adults to visit the site more than once (18-24 years: adjusted odds ratio [AOR] 0.58, 95% CI 0.49-0.68, P<.001; 25-34 years: AOR 0.56, 95% CI 0.50-0.64, P<.001), spend more than 3 minutes on the site (18-24 years: AOR 0.67, 95% CI 0.57-0.79, P<.001; 25-34 years: AOR 0.56, 95% CI 0.49-0.64, P<.001), view 12 or more pages (18-24 years: AOR 0.72, 95% CI 0.61-0.83; P<.001; 25-34 years: AOR 0.67, 95% CI 0.59-0.76, P<.001), utilize the BecomeAnEX.org community (18-24 years: AOR 0.61, 95% CI 0.48-0.79, P<.001; 25-34 years: AOR 0.73, 95% CI 0.60-0.88, P<.001), or utilize Separation Exercises (18-24 years: AOR 0.68, 95% CI 0.51-0.89, P<.01; 25-34 years: AOR 0.77, 95% CI 0.63-0.94, P<.01). Gender differences in utilization were more pronounced among young adults compared with older adults, with lower levels of utilization among young men than young women. For all age groups, utilization was higher among whites and African Americans than among Hispanics and other racial minorities, with one exception-BecomeAnEX.org community utilization was significantly higher among Hispanic young adults compared with white and African American young adults. CONCLUSIONS: Results point to important areas of inquiry for future research and development efforts. Research should focus on enhancing demand and increasing engagement among younger adults and men, examining strategies for capitalizing on young adult developmental needs, and increasing utilization of effective site features among diverse young adult users.

Sustainability of Community-Based Youth Smoking Cessation Programs: Results From a 3-Year Follow-Up.

A national survey of 591 community-based youth smoking cessation programs provided an opportunity to assess the sustainability of health promotion programming over a 3-year period. Initial survey questions were mapped to five sustainability domains (local ownership, organizational alignment, resources, demand, and standard operating procedures) and examined to identify correlates of sustained operation. Follow-up surveys were completed with 305 programs. Assuming loss to follow-up indicated failure to sustain, the overall rate of program continuation was 32%. Baseline correlates of sustaining operation included the following: serving more youth, training staff in smoking cessation, longer time in operation at the initial survey, and receiving state funding as a sole source of support. Primary reasons for discontinuation related to lack of funding, insufficient enrollment, change of focus from tobacco cessation, and scheduling difficulty. Replication of studies like this survey of youth smoking cessation programs with other types of health promotion and public health programming can further test sustainability frameworks, provide validated measures, and ultimately inform a robust and replicable array of lasting, effective, evidence-based public health programs.

A national evaluation of community-based youth cessation programs: end of program and twelve-month outcomes.

Most youth cessation treatment research consists of efficacy studies in which treatments are evaluated under optimal conditions of delivery. Less is known about the effectiveness of youth cessation treatments delivered in real-world, community based settings. A national sample of 41 community-based youth cessation programs participated in a longitudinal evaluation to identify site, program, and participant characteristics associated with successful cessation. Validated quit rates were comparable to those in randomized controlled trials; 7-day abstinence at the end of program averaged 14% and 30-day abstinence at 12 months averaged 12%. Multivariate GEE models explored predictors of smoking cessation at the end of the programs and at 12 months. Results showed correlates of both short- and long-term cessation. Findings point to the importance of both individual and community-level variables, including motivation, opportunities for and encouragement to engage in activities outside of academics, having youth participate in treatment before they become highly dependent smokers, and community norms and ordinances that discourage youth purchase, use and possession of tobacco. Providing evidence-based treatment to youth in community-based settings results in successful cessation.

Efficacy of smoking-cessation interventions for young adults: a meta-analysis.

CONTEXT: Approximately 22% of U.S. young adults (aged 18-24 years) are smokers. Young adults typically display an interest in quitting, but it is unknown whether the evidence-based cessation programs designed for adults will be equally effective for young adults. This meta-analysis investigated the efficacy of smoking-cessation programs for this population. EVIDENCE ACQUISITION: In 2009-2011, studies published between 2004 and 2008 that investigated smoking cessation were first found through the DHHS Clinical Practice Guidelines for Treating Tobacco Use and Dependence as well as a PubMed search (2009-2010) and were then subjected to a rigorous inclusion process. Authors were contacted to glean raw data for young adults. Fourteen studies provided data that were coded for descriptive information and aggregated using the Comprehensive Meta-Analysis, version 2.0. EVIDENCE SYNTHESIS: Among young adults, any type of intervention was more effective in producing successful smoking cessation than the control. This was the case for intent-to-treat analyses as well as complete cases. When interventions were effective for the larger adult sample, they were also effective for the younger adult sample. CONCLUSIONS: Although young adults tend to underutilize evidence-based cessation treatments, the current meta-analysis showed that these treatments should be as effective for young adults as they are for the general adult population. Thus, it may be useful to focus on motivating young adults to seek cessation treatment to increase utilization.

Finding needles in a haystack: a methodology for identifying and sampling community-based youth smoking cessation programs.

BACKGROUND: Surveys of community-based programs are difficult to conduct when there is virtually no information about the number or locations of the programs of interest. This article describes the methodology used by the Helping Young Smokers Quit (HYSQ) initiative to identify and profile community-based youth smoking cessation programs in the absence of a defined sample frame. METHODS: We developed a two-stage sampling design, with counties as the first-stage probability sampling units. The second stage used snowball sampling to saturation, to identify individuals who administered youth smoking cessation programs across three economic sectors in each county. Multivariate analyses modeled the relationship between program screening, eligibility, and response rates and economic sector and stratification criteria. Cumulative logit models analyzed the relationship between the number of contacts in a county and the number of programs screened, eligible, or profiled in a county. RESULTS: The snowball process yielded 9,983 unique and traceable contacts. Urban and high-income counties yielded significantly more screened program administrators; urban counties produced significantly more eligible programs, but there was no significant association between the county characteristics and program response rate. There is a positive relationship between the number of informants initially located and the number of programs screened, eligible, and profiled in a county. DISCUSSION: Our strategy to identify youth tobacco cessation programs could be used to create a sample frame for other nonprofit organizations that are difficult to identify due to a lack of existing directories, lists, or other traditional sample frames.

A national evaluation of community-based youth cessation programs: design and implementation.

Although widely available, little is known about the effectiveness of youth cessation treatments delivered in real-world settings. The authors recruited a nonprobability sample of 41 community-based group-format programs that treated at least 15 youth per year and included evidence-based treatment components. Data collection included longitudinal surveys of youth participants (n = 878); posttreatment surveys of program leaders (n = 77); and one-time surveys of organizational leaders (n = 64)and community leaders in education, health, and juvenile justice (n = 94). Information about smoking-related ordinances was collected at the state and local levels. The framework, evaluation design, and implementation strategies described in this article provide a template for large-scale real-world program evaluations.

Use of program evaluation in community youth tobacco cessation programs.

OBJECTIVE: To examine the inclusion of program evaluation components in a national sample of youth tobacco cessation programs. METHODS: Program administrators were interviewed to ascertain program characteristics associated with the inclusion of program evaluation components. RESULTS: Two thirds of all surveyed programs (n=591) had an evaluation component; most included attendance, user satisfaction, and quitting measures. Programs with an evaluation component were significantly more likely to report annual funding greater than the median and to conduct a follow-up with participants. CONCLUSION: Program characteristics and associated evaluation components are summarized, and recommendations are given for a minimal level of program evaluation planning.

Implementation fidelity of packaged teen smoking cessation treatments delivered in community-based settings.

Efficacious 'packaged' teen smoking cessation treatment programs, those developed by national organizations, are widely disseminated to local communities to help teens quit smoking. The implementation fidelity of these programs in community settings has not been documented. The efficacy of these programs could be lessened if they are not implemented as intended. Data from Helping Young Smokers Quit describe the frequency and types of modifications made to packaged teen cessation treatment programs for community delivery. A national sample of 591 community-based teen tobacco cessation treatment programs was profiled and 59% used a single packaged treatment program. Bivariate analyses found that 63% of program administrators reported implementing their program as planned; 37% modified their selected program. The most frequently reported modifications were made to the length and format of the program. Of those who modified their programs, >90% reported multiple program modifications (e.g. length and content). Administrators modified their programs to accommodate implementation barriers, such as time constraints and low participant enrollment, and to address the needs of participants with multiple risk behaviors that are co-morbid with tobacco use.

Internally-developed teen smoking cessation programs: characterizing the unique features of programs developed by community-based organizations.

We have compared the unique features of teen tobacco cessation programs developed internally by community-based organizations (N=75) to prepackaged programs disseminated nationally (N=234) to expand our knowledge of treatment options for teen smokers. Internally-developed programs were more likely offered in response to the sponsoring organization's initiative (OR=2.16, p<0.05); had fewer trained cessation counselors (OR=0.31, p<0.01); and were more likely found in urban areas (OR=2.89, p=0.01). Internally-developed programs more often provided other substance-abuse treatment services than prepackaged programs and addressed other youth-specific problem behaviors (p< or =0.05). Studies that examine the effectiveness of internally-developed programs in reducing smoking and maintaining cessation for teen smokers are warranted.

Therapy for specific problems: youth tobacco cessation.

Cigarette smoking is the leading cause of premature morbidity and mortality in the United States. The majority of children smoke their first cigarette in early adolescence, and many older teens have well-established dependence on nicotine. Efforts to promote and support smoking cessation among these youth smokers are critical. The available experimental studies of youth cessation interventions find that behavioral interventions increase the chances of youth smokers achieving successful cessation. Currently there is insufficient evidence for the effectiveness of pharmacological treatments with youth smokers. Many innovative studies have been compromised by challenges in recruiting sufficient numbers of youth, obtaining approval for waivers of parental consent, and high attrition in longitudinal studies. Key areas for future work include bridging the fields of adolescent development and treatment design, matching treatments to developmental trajectories of smoking behavior, better understanding treatment processes and treatment moderators, and building demand for evidence-based cessation treatments.

Use of tobacco cessation treatments among young adult smokers: 2005 National Health Interview Survey.

OBJECTIVES: We compared use of smoking cessation treatments and factors associated with treatment use among young adult smokers and other adult smokers. METHODS: We used data from the 2005 National Health Interview Survey core and cancer control supplement. The sample consisted of 6511 current smokers, of whom 759 were aged 18-24 years. Our analyses were weighted to account for differential sampling probabilities and nonresponse rates. We compared continuous measures using the t test; logistic regression was used to obtain odds ratios and confidence intervals. Multiple logistic regression was used to identify correlates of treatment use. RESULTS: Behavioral treatment use was infrequent among all smokers (4%-5%). Young adult smokers were less likely than other smokers to use pharmacotherapy (18% vs 32%). Correlates of pharmacotherapy use for young adult smokers were receiving advice from a health care provider, heavier smoking, and higher educational attainment. Compared with other smokers, young adult smokers were less likely to have received advice to quit from a health care provider (49% vs 60%). CONCLUSIONS: Evidence-based tobacco cessation treatments are underused by young adult smokers.

A national survey of tobacco cessation programs for youths.

OBJECTIVES: We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. METHODS: We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. RESULTS: We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was 2000 dollars. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. CONCLUSIONS: There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

Human participants challenges in youth-focused research: perspectives and practices of IRB administrators.

The purpose of this research was to understand institutional review board (IRB) challenges regarding youth-focused research submissions and to present advice from administrators. Semistructured self-report questionnaires were sent via e-mail to administrators identified using published lists of universities and hospitals an Internet searches. Of 183 eligible institutions, 49 responded. One half indicated they never granted parental waivers. Among those considering waivers, decision factors included research risks, survey content, and feasibility. Smoking and substance abuse research among children was generally considered more than minimal risk. These findings are consistent with those from a study conducted by Mammel and Kaplan (1995), which investigated IRB practices concerning protocols involving adolescent participants. IRBs and investigators need to become aware of regulations' flexibility to ensure adequate participant protection. Investigators need to limit jargon and assumptions about participants' understanding of research objectives.