Thesis on "Smoking Cessation Among Adolescents"

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Adolescent Smoking Cessation

Smoking Cessation among Adolescents

"ADOLLESCENT SMOKING CESSATION…"

Adolescent Smoking Cessation: Secondary Health Prevention Plan Using ALAs N-O-T Program

This nursing project proposal supports the development of a smoking cessation program in local high schools using the American Lung Association Not On Tobacco (N-O-T) program. The literature supports the success of long-term/cognitive secondary intervention plans for the development of the goal of decreased smoking behaviors among teens in grades 9-12, and the N-O-T program has marked statistical success in the development of reduced smoking rates among teens. The program is voluntary and consists of 10 one hour sessions and three follow up sessions where they are needed. The program also requires ALA training for teachers of it. Smoking cessation among this age group is essential to secondary prevention of disease, as many (80%) adult smokers report beginning smoking when they are in their teens and smoking behaviors among teens often lead to long-term smoking in adults, which requires tertiary prevention and often results in long-term/lifetime smoking related disease and even death.

Community Diagnosis

"Smoking cessation among adolescents in grades 9-12 who indicate that they are smokers and attempts to quit, if made, were unsuccessful related to denial of effects of smoking, lack of support or strategies for smoking withdrawal as evidenced by 588 cases of lung cancer and 427 deaths from lung cancer in Orange County in 2005 and Health People 2010 objective 27-2a to reduce tobacco use by students

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in grades 9-12 (Baseline:40% and Target:21%) (Florida Charts, 2007; U.S. Department of Health and Human Services, 2001)."

Review of Literature

In adolescents is long-term cognitive/skills based intervention more effective for smoking cessation than brief intervention? Secondary prevention of disease via smoking cessation in adolescence is essential as the majority of people who become adult long-term or lifetime smokers begin smoking behaviors while in their teens. While adolescents often show early signs of smoking health related behaviors, reduced physical activity, reduced lung capacity and reduced immune function they rarely show the signs of disease associated with long-term smoking including but not limited to increased risk of cardiovascular disease, emphysema and cancer but are likely to if they become lifelong smokers. (Nabors, Iobst & Mcgrady, 2007, p. 331) Another issue that is often stressed with regard to smoking and adolescents is the fact that smoking behaviors and other drug and alcohol use behaviors occur concurrently and while smoking has a greater risk of long-term health related issues and a lesser risk of alcohol and drug induced behavior impairment because they tend to all go together they work progressively against the individual teen and can impede social and real progress in life, not to mention health. Smoking cessation can then contribute to a reduction in these other behaviors as the skills one needs to stop smoking, as taught through appropriate intervention can greatly improve the skills one might need to refuse other more behaviorally damaging and risk taking behaviors. (Myers & Kelly, 2006, p. 221) (Seo, Torabi & Weaver, 2008, p. 328) It is for these reasons and others that early secondary prevention is essential in this age group with regard to smoking cessation.

Current nursing interventions are school-based brief interventions as well as cognitive/skills-based programs such as those designed by the American Lung Association (e.g. N-O-T, Not On Tobacco a 10 session gender specific lesson plan). (Horn et. al. 2004, pp.181-184) A great deal of evidence suggests that cognitive/skills-based long-term interventions such as N-O-T are much more effective than other brief interventions and/or sanctions such as smoking tickets issued via school-based law enforcement or simple single visits to school nurse or other administrative staff informing the individual of the need to stop smoking. N-O-T is also thought to be more effective because it is gender specific, with varied lessons and formats as well as locations for girls and boys who are known to have different reasons and motivations for beginning smoking behaviors and for quitting smoking. (Horn et. al. 2004, pp.181-184) Though, the current 2009 inception of the program does not stress the gender separation standards of the program but instead focuses on training a single presenter to offer classes to a larger number of students, especially where only a single trainer is available for each school. (ALA N-O-T website http://www.notontobacco.com/)

According to Nabors, Iobst & Mcgrady, in their evaluation of smoking cessation programs for this population the most important aspects of successful programs are:

(1) focusing on skills training (eg, learning how to refuse cigarettes), (2) involving the community in developing the program and disseminating program messages, and (3) developing long-term programming to ensure adequate delivery of prevention messages. (Nabors, Iobst & Mcgrady, 2007, p. 331)

When discussing what "skills training" entails the authors also stress that components of such are specific to adolescents and involve the following:

(1) cigarette refusal skills, (2) coping with peer pressure to smoke, and (3) avoiding or coping with cues for smoking behavior. (5-7) Skills training to teach strategies for quitting smoking for those adolescents who are already smoking should also be incorporated into the program. (Nabors, Iobst & Mcgrady, 2007, p. 331)

The reason that skills training as well as cognitive training are essential is in great part due to the fact that many of these individuals, according to the community diagnosis have tried to quit smoking independently and failed. The population might have a greater or lesser desire to stop smoking but may be lacking in the skills and support needed to do so.

Plan: "Secondary Health Prevention Plan Using ALAs N-O-T Program"

Target Group

The health promotion plan associated with smoking cessation education for teens will begin with a small target group. The first step in the process would be to provide a proposal to the local school board to implement the American Lung Association N-O-T Program. After this is completed the goal will be to train a single student nurse to teach the program to students at all the regional high schools making teen smokers the primary target group of the plan. The program training is essential and is offered by the ALA for a nominal fee. From this training the individual will learn how to administer the program and be given all the materials needed to do so. The training manual contains a packet of material that is intended for photocopying to distribute to student learners. The packet also contains all the marketing material that will be needed to promote the voluntary program within schools. School administrators will be contacted and encouraged to refer students, where anonymity permits, for the program based on the historical data regarding student citations for smoking within the current school year and promotional material will be distributed. Administrators will also be asked to provide some incentive for completion of the course, which consists of 10 sessions and a few supplemental sessions where needed.

Specific Measurable Goal

The goal of the program will be to help reduce the rate of smokers in the grade range of 9-12 from the current HP baseline of 40% to the target of 21%, by providing both information that negates the effects of finial of the health risks of smoking and offers students skill sets to say no to smoking. The course intake will set the percentage for the intake data (based on total school population vs. percentage of participants) and a follow up with each student will occur at 6 weeks past the close of the course which will take a total of 10 weeks, first to determine if follow up sessions are needed and second to reevaluate the percentage of smokers in the group for the measurable outcome percentage calculation. Though the total number of teen smokers cannot be assumed simply by intake of a voluntary smoking cessation course but what can be assumed from this information… READ MORE

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Quoted Instructions for "Smoking Cessation Among Adolescents" Assignment:

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Individual Health Promotion Plan Paper

This is an INDIVIDUAL assignment is based on a Community Nursing Diagnosis listed in the Syllabus, submitted to course faculty on the due date and time. The problems/needs/risks are drawn from the list of Community Nursing Diagnosis List (not your community assessment). Complete the paper according to APA 5th Edition Guidelines as a word processed document. Secondly, the paper must be uploaded in Assignments for grading purposes by the Due Date listed in the Schedule. Make sure that you check your paper thoroughly before submitting in Assignments since you can only submit it one time.

The paper must have citations and references.The citations and references must match. The paper is limited to Eight (8) pages including the title page, abstract and references pages. Do not exceed the eight page total as only eight pages will be read! The paper is double-spaced with the exception of the grid which is completed in landscape format with single spacing (note that the Grid is NOT in APA format). Include Title Page with a running head and a page header. Page one begins on the title page. Abstract is page two; first page of narrative is page three. Please review the example provided.

The Health Promotion Plan paper is derived from the problems/needs/risks in the Community Nursing Diagnosis List that is provided in this Syllabus. Content outline below (use headers for each section)

Select ONE problem/need/risk identified in the Community Nursing Diagnosis List.

Copy the problem/need/risk that you selected EXACTLY as is written in the Community Nursing Diagnosis List.

Develop a health promotion plan "as if" the plan would be implemented for a target group within the community. Make sure that you understand the differences between a primary prevention and a secondary prevention (as discussed in your text) when developing your interventions that are placed in the grid. You will submit the plan to faculty via Assignments. Submit the plan by the due date - see course calendar for due date and time.

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Part I: Nursing Process: Community Diagnosis

Identify the community diagnosis for the problem/need/risk EXACTLY. Recall that this community diagnosis follows the three-part community diagnosis format.

I. Community Diagnosis:

A specific problem/need/health risk - actual or potential Among ______ (specific community/age/gender - include any other pertinent demographic data) Related to ____ (characteristics that are contributing factors) As Evidenced by _____ (supportive data: actual data from the community assessment and the matching Healthy People 2010 National Health Objective- you must include the reference citation for HP 2010) by Copy the diagnosis exactly as listed in the Community Health Diagnosis List.

II. Review of Literature:

Next, complete a brief review of the literature (using at least 3 current evidence-based sources from nursing journals) highlighting the health problem and the target group. You should answer these questions in your review: Use headers to organize this section of the paper. If you are unsure the reference is evidence-based, email the instructor with the title of the journal.

Write a question that you are trying to answer with the literature review using a PICO format. The information that you find in the literature will support your literature review and your plan for your intervention. The PICO format consists of identifying your population of interest (P), intervention that you are looking at (I), a comparison for intervention (I), and the outcome of interest. The paper example has an example in it. Remember

For example:

In adolescents (P), are diet and exercise (I) better in decreasing weight (O) instead of diet (C) alone?

Why is this diagnosis a health problem for this target group?

What are the current nursing interventions for this problem?

What interventions have been successful and what interventions have NOT been successful?

Students can use textbooks as limited use references; three additional evidence-based nursing references (within the last five years) must be outside of the current textbook list. Include citations in the body of the paper and the full citations of all sources in the References section of the paper. Remember citations and references must match or major point deduction will occur.

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III. Plan

Develop a health promotion plan as if the plan would be implemented for a target group within the community. The target group for your education effort may be residents, nurses, or policy makers. Describe the target audience (population). Specify how and where you will reach your audience. Develop an educationally and culturally sensitive intervention appropriate to your target audience.

Give the plan a title - this title must be consistent on the title page, on the second page, and here.

List one short-term goal that includes your population.

Write three measurable, time specific learner objectives

Consider all of the objectives together; write one paragraph addressing each of these areas.

Specific

Measurable

Reasonable/Feasible

Fit with philosophy of the community

Easily understood Time frame

IV Budget

Create a specific Budget (Put in Table-format with total added up)

Determine a budget for the project.

Time: Consider $14.00/hour for the student nurse rate

Materials: while brochures may be donated - in kind - there is still a cost.

List other resources needed for the project.

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Part V Nursing Process - Intervention and Evaluation

NOTE - FOR THIS PAPER - LANDSCAPE THIS TABLE for Display & Use SINGLE SPACING - points will be deducted if the student does not follow directions. This is where you describe your interventions for your desired outcome for the population. Think through how you will evaluate whether your intervention was successful or not.

Objectives Learning Domain Topical Outline for Each Objective - include timeline Plan for Evaluation

List each objective separately

1.

2.

3. For each objective- Address:

Cognitive

Affective

Psychomotor Write a topical outline for the plan

Include strategies at the levels of primary and secondary prevention:

Based on objectives (formative and summative)

Appraisal of the effects of activities or programs

To determine relevance, progress, efficiency, effectiveness & impact of program activities

I. Community Diagnosis

copy verbatim: "Smoking cessation among adolescents in grades 9-12 who indicate that they are smokers and attempts to quit, if made, were unsuccessful related to denial of effects of smoking, lack of support or strategies for smoking withdrawal as evidenced by 588 cases of lung cancer and 427 deaths from lung cancer in Orange County in 2005 and Health People 2010 objective 27-2a to reduce tobacco use by students in grades 9-12 (Baseline:40% and Target:21%) (Florida Charts, 2007; U.S. Department of Health and Human Services, 2001)."

section V

Objectives / Learning / Topical outline for / Plan for

/ Domain / each objective /Evaluation

/ / include timeline /

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