Combating adolescent smoking in Texas: Tobacco cessation program harnesses participant interaction to teach teens to quit

Each day in the United States, more than 3,200 people younger than 18 years old smoke their first cigarette with little thought to the long-term health impacts. If smoking persists at the current rate among this age group, 5.6 million of today’s Americans are projected to die prematurely from a smoking-related illness.

Brian Colwell, Ph.D., professor at the Texas A&M Health Science Center School of Public Health, is passionate about helping young people quit using tobacco. He and research partners at the University of Houston and the University of Texas have developed an intervention used in virtually every Texas county over the past decade targeting tobacco cessation among adolescents.

Colwell and his partners Drs. Dennis Smith and Stacey Stevens-Manser developed the Texas Youth Tobacco Awareness Program (TYTAP) based on the need for resources to support adolescents in their attempts to quit smoking that were based on teens’ life situations, level of cognitive maturity, and motivations for initiation, maintenance and cessation of tobacco use. Originally designed as a voluntary program, the curriculum was modified to accommodate a Texas law passed in 1997 that required youth caught in possession of tobacco products to complete a mandatory tobacco awareness program.

“The program uses a cognitive-behavioral approach and incorporates motivational techniques designed to encourage youth to reconsider their current tobacco use behaviors,” Colwell said. “It is designed so that ‘preaching’ by a program facilitator is nearly impossible, with a variety of activities that require participant input rather than simple lectures from an instructor.”

The focus is on understanding their own motivations for using tobacco, the cues that tell them to use tobacco in their environment, how to manage moods in situations where they might normally use tobacco and ways to quit.

“So many young people think they are going to live forever and know little of the health consequences of tobacco use,” said Eric Wallace, coordinator of intervention programs for Amarillo College. “Having taught Dr. Colwell’s program for 10 years to hundreds of adolescents, I have seen first-hand the benefits of the program.”

The Texas Department of State Health Services (DSHS) does as well, having awarded Colwell yearly contracts since 2003. The program has been successfully conducted throughout the state not only in public schools, but also by local and regional councils on substance abuse and by mental health/counseling professionals. Self-reports from youth who have completed the program indicate that approximately 40 percent indicate they quit using tobacco at three months post-intervention and 30 percent at six months.

“Most are not addicted yet, and getting information to them that they would not otherwise have before they are addicted is critical,” Wallace said.

Recently, Colwell’s focus turned to tobacco cessation programs for college students working in collaboration with researchers at M.D. Anderson Cancer Center on the National Cancer Institute funded, “Enhanced Smoking Cessation for University Students (SUCCESS).”

According to Colwell, working with college students has some similarities with the youth work, but there are major differences as well. The environment in which college students live is very different than home, with different stressors and environmental cues to use substances. Additionally, tobacco is a legal product for them. This makes addressing the issue much different.

“We always try to leave folks – regardless of their age – with the thought that quitting today is easier than it will be tomorrow, so every day you delay makes it just a bit more difficult,” Colwell said. “But in the end, everybody can quit if they want to do so.”