The TOBg Tobacco Treatment Guidelines for Adolescents: A real-world pilot study
More details
Hide details
University Mental Health Research Institute (UMHRI), Athens, Greece
Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
Faculty of Medicine, University of Ottawa, Ottawa, Canada
George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
Institute of Public Health, American College of Greece, Athens, Greece
PYXIDA Prevention Centre, Thessaloniki, Greece
PRONOI Prevention Centre, Athens, Greece
Department of Psychiatry, National & Kapodistrian University of Athens, Medical School, Athens, Greece
Publish date: 2018-07-13
Submission date: 2018-03-26
Final revision date: 2018-06-15
Acceptance date: 2018-07-06
Tob. Prev. Cessation 2018;4(July):27
We conducted a pilot study to: 1) obtain feedback from prevention practitioners in terms of their satisfaction, knowledge, and self-efficacy following exposure to the Tobacco Treatment Guidelines for Adolescents (TOBg Guidelines); and 2) examine the effectiveness of a school-based intervention based on the TOBg Guidelines on quit rates among a sample of adolescent tobacco users.

Two parallel studies were conducted. In Study 1, prevention practitioners were exposed to a 1-day training in the TOBg Guidelines with assessment occurring before, immediately after, and at 6 months following the training. In Study 2, participating adolescent smokers were exposed to a 3-session group-based smoking cessation intervention that drew on the TOBg Guidelines and was delivered by practitioners trained in Study 1. The primary outcome measure was self-reported smoking status assessed at 1 month and at 6 months following baseline.

A total of 18 prevention practitioners and 65 adolescent tobacco users participated in the pilot study. The majority of practitioners reported high rates of satisfaction with the TOBg Guidelines and indicated that the guidelines positively influenced the manner in which they addressed tobacco use with adolescents. Prevention practitioners’ self-efficacy for intervening with adolescent smokers was also significantly increased following exposure to the TOBg Guidelines and training. Among adolescents exposed to the school-based intervention, 62.5% and 23.1% had reduced smoking by 50% or more at 1 month and at 6 months follow-up, respectively. No significant change in smoking abstinence was documented.

The TOBg Guidelines for adolescent smokers were well received by prevention practitioners and were feasible to implement in a real-world school setting.

Anastasios Fotiou   
University Mental Health Research Institute (UMHRI), 2, Soranou tou Efesiou str., P.O. Box 665 17, Papagou, GR-156 01 Athens, Greece
1. The ESPAD Group. ESPAD Report 2015. Results from the European School Survey Project on Alcohol and other Drugs. Luxembourg: Publications Office of the European Union; 2016.
2. Palmer R, Young S, Hopfer C, et al. Developmental epidemiology of drug use and abuse in adolescence and young adulthood: Evidence of generalized risk. Drug Alcohol Depend. 2009;102(1):78-87. doi:10.1016/j.drugalcdep.2009.01.012
3. Sims TH. The Committee on Substance Abuse. Technical Report—Tobacco as a substance of abuse. Pediatrics. 2009;124(5):e1045-1053. doi:10.1542/peds.2009-2121
4. Fidler J, Wardle J, Brodersen NH, Jarvis M, West R. Vulnerability to smoking after trying a single cigarette can lie dormant for three years or more. Tob. Control. 2006;15(3):205-209. doi:10.1136/tc.2005.014894
5. Williams PG, Holmbeck GN, Greenley RN. Adolescent health psychology. J. Consult. Clin. Psychol. 2002;70(3):828-842. doi:10.1037//0022-006x.70.3.828
6. Pbert L, Moolchan ET, Muramoto M, et al. The state of office-based interventions for youth tobacco use. Pediatrics. 2003;111(6):e650-e660. doi:10.1542/peds.111.6.e650
7. Fanshawe T, Halliwell W, Lindson N, Aveyard P, Livingstone-Banks J, Hartmann-Boyce J. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews 2017;11(Art. No.: CD003289).doi: 10.1002/14651858
8. Fotiou A, Stavrou M, Kokkevi A. Smoking Cessation among Adolescents. In: Behrakis PK, Vardavas CI, Papadakis S, eds. Tobacco Cessation Guidelines for High Risk Groups (TOB.g). Athens: European Network for Smoking Prevention; 2017.
9. Grimshaw GM, Stanton A. Tobacco cessation interventions for young people. Cochrane Database Syst Rev. 2006(4). doi:10.1002/14651858.cd003289.pub4
10. Sussman S, Sun P, Dent CW. A meta-analysis of teen cigarette smoking cessation. Health Psychol. 2006;25(5):549. doi:10.1037/0278-6133.25.5.549
11. Thomas RE, McLellan J, Perera R. Effectiveness of school-based smoking prevention curricula: systematic review and meta-analysis. BMJ Open. 2015;5(3):e006976.
12. Behrakis P, Vardavas C, Papadakis S, eds. Tobacco Cessation guidelines for High-risk Populations (TOB.g). Athens, Greece: European Network for Smoking Prevention; 2017.
13. Girvalaki C, Papadakis S, Vardavas CI, Pipe A, Lionis C. Tobacco treatment TrAining Network in Crete (TiTAN-Crete): protocol for a controlled before-after study. Tobacco Prevention & Cessation. 2016;2(June). doi:10.18332/tpc/63823
14. Papadakis S, Pipe AL, Reid RD, et al. Effectiveness of performance coaching for enhancing rates of smoking cessation treatment delivery by primary care providers: Study protocol for a cluster randomized controlled trial. Contemporary clinical trials. 2015;45:184-190. doi:10.1016/j.cct.2015.08.013
15. Ampt AJ, Amoroso C, Harris MF, McKenzie SH, Rose VK, Taggart JR. Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Practice. 2009;10(1):59. doi:10.1186/1471-2296-10-59
16. Delucchi KL, Tajima B, Guydish J. Development of the smoking knowledge, attitudes, and practices (S-KAP) instrument. Journal of drug issues. 2009;39(2):347-363. doi:10.1177/002204260903900207
17. West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. Mar 2005;100(3):299-303. doi:10.1111/j.1360-0443.2004.00995.x
18. Schnoll RA, Rukstalis M, Wileyto EP, Shields AE. Smoking cessation treatment by primary care physicians: an update and call for training. Am. J. Prev. Med. 2006;31(3):233-239. doi:10.1016/j.amepre.2006.05.001
19. O'Loughlin J, Makni H, Tremblay M, et al. Smoking cessation counseling practices of general practitioners in Montreal. Prev. Med. 2001;33(6):627-638. doi:10.1006/pmed.2001.0937
20. King JL, Merten JW, Wong T-J, Pomeranz JL. Applying a social–ecological framework to factors related to nicotine replacement therapy for adolescent smoking cessation. Am. J. Health Promot. 2017;32(5):1291-1303. doi:10.1177/0890117117718422
21. Filippidis FT, Vardavas CI, Loukopoulou A, Behrakis P, Connolly GN, Tountas Y. Prevalence and determinants of tobacco use among adults in Greece: 4 year trends. European Journal of Public Health. 2013;23(5):772-776. doi:10.1093/eurpub/cks148
22. Eurostat. Comparative price levels for food, beverages and tobacco. Eurostat statistics explained 2017; Accessed 7 June 2018, 2018.
23. Ferketich AK, Lugo A, La Vecchia C, et al. Relation between national-level tobacco control policies and individual-level voluntary home smoking bans in Europe. Tob. Control. 2016;25(1):60-65. doi:10.1136/tobaccocontrol-2014-051819
24. Faculty of the Harvard School of Public Health. The Greek Tobacco Epidemic: Center for Global Tobacco Control; Department of Society, Human Development and Health; Harvard School of Public Health; 2011.
25. Sussman S, Sun P. Youth tobacco use cessation: 2008 update. Tobacco Induced Diseases. 2009;5(1):3-3. doi:10.1186/1617-9625-5-3