Striking Back Against Teen Smoking in New Haven
Every day more than 6,000 persons under age 18 try their first cigarette, and every day more than 3,000 youth become daily smokers. According to the Centers for Disease Control (CDC), at least 4.5 million adolescents in the United States currently smoke cigarettes. Most youth who use tobacco continue to do so into adulthood, increasing their risk of lung cancer and heart disease more than if they had started smoking later in life. Although adults generally are aware of the health consequences of cigarette smoking, many adolescents appear not to know about the long-term consequences or ignore them. In Connecticut, almost one-third of high school students and 13.1 % of middle school student currently use some form of tobacco, with inner city youth at an ever greater risk for becoming addicted to tobacco before the age of 18. While the national and state statistics are grim, there is a silver lining. According to the U.S. Surgeon General's Report on Reducing Tobacco Use, implementing effective educational programs for preventing tobacco use could postpone or prevent smoking onset in 20% to 40% of U.S. adolescents.
Recognizing that area youth are constantly vulnerable to the initiation of tobacco use and that minimizing such possibility requires a systematic prevention strategy, two Yale nurses have joined forces with students at Career High School to curb tobacco use among teens in New Haven's public schools. In 2001, Alison Moriarty-Daley, assistant professor at YSN, and Sandy Hurd, Smoking Cessation Counselor in the Women's Center at Yale New Haven Hospital, launched "Career Against Tobacco (C.A.T.)", a peer leadership program focused on tobacco use prevention, counter marketing and tobacco free lifestyles.
Both Sandy and Alison had strengths that would contribute to the success of the program. Since 1996, Sandy has been helping pregnant smokers realize the risks of smoking to their fetus and working with these women to plan methods to stop or reduce smoking. She is also the liaison to the state initiative- STATIC- Students Teaching Against Tobacco in Connecticut. "Over the years, I have been struck by the number of women and their family members who had started smoking as early as age nine," said Sandy. "I began to realize that if we are to affect change in the health of our community and our nation, health educators need to find ways to reach youth before they become addicted to tobacco."
Connecticut Department of Public Health Youth Tobacco Survey 2000 found that positive role modeling reduces the risk of tobacco use by teens. These findings provided the direction for C.A.T. -- to engage high school youth as peer education counselors who would assist in designing and implementing the program. Alison, as coordinator and nurse practitioner at Career's School Based Clinic, was expert at developing teen-friendly health education projects. "Having a close relationship with these kids throughout their four years at Career High School, I quickly realized that Sandy and I had access to a diverse and talented pool of students to recruit as peer leaders," Alison said.
In the late spring of 2001, a group of Career High School students were approached by Alison to participate in designing an educational program for middle schools students. "There was great enthusiasm among the students to become peer leaders," she said. "In addition to brainstorming about the general program content that would be appealing to middle school students, peer leaders were extremely helpful in presenting ideas specifically aimed at addressing the needs of students in the middle schools that they had once attended."
As part of the program design, peer leaders conducted research on the internet about existing peer-lead prevention initiatives, and compiled resources to incorporate into their program. The group met bi-weekly throughout the fall of 2001. Sandy provided the educational curriculum for the meetings that emphasized five areas: tobacco facts; psychological effects of tobacco; second-hand smoke; advertising/counter marketing strategies of tobacco companies; and myths about tobacco use. Once the peer leaders had a solid education foundation in each of these areas, they were put to the task of designing a one-hour presentation for middle-school students that was to be developmentally appropriate, educational, and fun. "The peer leaders came up with some really interesting ideas," said Sandy.
The program developed into three parts: an educational video, an interactive game, and a question and answer session. The video, "Smoking Truth or Dare," challenged teens to find out the truth about tobacco, particularly the effect of smoking on their bodies. The interactive game, titled "Tobacco Challenge," was based on a Jeopardy format and had five categories with five questions of increasing difficulty in each. Each question, developed by the peer leaders, was assigned a point value of 10 to 50. The middle school student who had the most points at the end of the game was awarded a certificate and a pair of movie tickets. "Our hope in using the game format was that the students would learn the essential information as part of a fun activity that encouraged their participation," said Alison. In concluding the one-hour presentation, peer leaders engaged the middle school students in a question and answer session, using props such as A Jar of Tar, (representing the tar collected in the lungs of a person who has smoked one pack of cigarettes per day for one year), Mr. Yuk Mouth (pointing to mouth cancer, gingivitis, tooth decay and tooth loss as a few of the health risks of tobacco use), and Tarboro Pack (a larger than life pack of cigarettes that identifies all chemicals found in cigarettes).
Peer leaders practiced weekly in the winter of 2001, and presented the program in April 2002 to approximately 150 6th grade students at Sheridan Middle School in New Haven. "The program was well received by participating students," said Alison. "The students interacted well, were kept engaged because of the fun, visual nature of the presentation, and enjoyed the fact that the presentations were made by peers from a neighboring high school." Teachers also found the presentations useful. On their request, education materials developed by the peer leaders were shared with the middle school as models for future class exercises and exams. "On the whole, it was an extremely successful first year," Alison said.
All the original peer leaders graduated in the spring of 2002. "We thought we would be faced with a significant challenge of recruiting a new group of high school students, but that was not the case," said Alison. "Because freshmen and sophomore students at Career had heard a great deal about C.A.T. from the older students, many of them expressed a strong interest in keeping the program going once the original peer leaders had graduated."
At the initial informational session for new students that took place in the fall of 2002, 12 students expressed interest in becoming peer leaders. "This was a very energetic and self-motivated group who quickly learned the program and began making modifications to the game questions," said Alison. The group wrote presentation scripts to be memorized by each peer leader, "so that any one of us can present on a variety of subjects at a given moment," one participant explained. Another effective technique involved a peer leader who had once been addicted to cigarettes and dip incorporating that personal experience into the presentation. "This group of students made C.A.T. their own," said Alison, "and this really showed during their presentations to 6th graders."
"Probably the greatest strength of C.A.T. was the enthusiastic response of high school students to playing a major role in the program's design and implementation," said Alison. "Given the chance to participate and the responsibility to make this program work, the students truly excelled."
Sandy and Alison hope that the C.A.T. model will help curb teen tobacco experimentation in New Haven, and continue to provide Career High School students with the opportunity to role model a healthy lifestyle to their peers. With continued support from the Connecticut Department of Public Health and the Connecticut Area Health Education Center (AHEC), and a strong endorsement from Career High School Principal, Charles Williams, the program is likely to do just that. "The Career Against Tobacco Program is a very effective approach to teaching young people about the health risks of tobacco use," said Principal Williams. "Alison and Sandy continue to do an outstanding job in mobilizing our students to help lead this effort."
C.A.T. began providing the program to other 5th and 6th graders in the community again in the fall of 2003.
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