Social-Ecological Framework to Improve Youth Smoking Outcomes

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DESCRIPTION (provided by applicant): The proposed study is guided by a Social-Ecological Model, with the goal to rapidly uncover optimal conditions for effectiveness, reach, and adoption of the American Lung Association's Not On Tobacco teen smoking cessation program, the most widely used teen cessation program in the US. Our proposal capitalizes on existing data from multiple sources, forming a unique N-O-T Social Ecological Relational Database. Central to the relational database is our newly-formed N-O-T Master Dataset that aggregates 12 years (1998-2010) of N-O-T efficacy and effectiveness trials with a heterogeneous sample of N=11,000 teens from CO, FL, NC, NJ, WI, and WV. The overriding research question is: What factors favorably moderate the relationship between macro-level economic, political, and demographic conditions and N-O-T effectiveness, reach, and adoption outcomes as identified in the RE-AIM framework? As a theory-driven, cost effective program N-O-T has received multiple federal model designations for effectiveness and scalability. Yet, program reach is a significant problem, with hundreds of thousands of teen smokers left unserved. To illustrate, N-O-T reaches <1% of teen smokers in WV, where teen smoking rates are among the nation's highest. Addressing this gap requires research to identify policy and systems strategies that will enhance the reach, adoption, and effectiveness of cessation programs. Accordingly, we propose an intensive 3-year study intended to rapidly enhance widespread N-O-T use and thereby reduce US youth smoking prevalence. Our model builds on empirically-based factors associated with tobacco use. Applying Hierarchical Linear Modeling (HLM) and Structural Equation Modeling (SEM) and beginning with moderators having the most compelling scientific evidence (e.g., tobacco tax, CIA, access, norms, and readiness to quit), we propose to characterize the effects of moderators (e.g., tobacco tax, tobacco price, clean indoor air, and school environment) on the relation between political, economic, and demographic factors and N-O-T program effectiveness; to determine optimal conditions for N-O-T reach and adoption; and to translate findings into a set of practical action strategies that can be implemented immediately to substantially increase the number of US youths who receive N-O-T and achieve cessation.