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Not on Tobacco (NOT) is a youth-centered smoking cessation program developed by the American Lung Association. NOT is based on social cognitive theory and incorporates training in self-management and stimulus control, which has been shown to significantly decrease smoking and increased smoking cessation among 13 to 19 year olds who identify as daily smokers. When delivered appropriately, by counselors/teachers/school-staff, NOT has been proven to be effective in a variety of settings and across diverse populations of students. In America, most of the 45 million adult smokers began smoking during adolescence, having their first cigarette by the age of 11-12. Without interventions, such as NOT, this trend towards starting to smoke at such an early age will likely continue, as practically one-in-four teens report smoking cigarettes as of 2012.

NOT is comprised of 10 sessions, each lasting 50 minutes, of gender-specific groups, typically held in schools, even during school hours. These sessions are led by trained implementers and expressed in a teen-friendly manner, such that the participants don’t feel intimidated by language that is unfamiliar to them or by a facilitator that they might not know. A typical session in the NOT program consists of the following topics: motivation, stress management, the effects of smoking, preparing to quit, relapse prevention, dealing with peer pressure, media awareness, support networks, and health lifestyles, just to name a few. These areas are deemed as the most developmentally appropriate for the age range of the participants.

NOT was evaluated in six studies conducted in North Carolina, West Virginia, and Florida, between 1997 and 2002; these studies compared 44 schools which implemented the NOT intervention, to 44 schools who offered a standard brief intervention instead. Of the 1,131 youth participants, finding showed that the NOT program had an intervention quit rate of 15%, compared to the standard intervention’s success rate of only 8%. Recognized as an effective program by the National Registry of Effective Programs (NREP), Not on Tobacco has a realistic quit rate of about one of every six participants of the program, yielding a very good return on investment and relatively high cost effectiveness.

One of NOT’s biggest strengths is its effect on its participants; even among those participants who continued to smoke after participation, NOT participants smoked significantly fewer cigarettes per day than their peers who were not in the program. And even though the reported quit rate for the study above was only 15%, 96% of NOT participants enjoyed their sessions and 80% found them relevant and helpful for cessation. The fact that there is such a high satisfaction rate for a program designed to initiate a behavior change in a client, a rather personal process, says innumerable things about the potential use of NOT in settings beyond that of the United States.

I believe NOT to be a program with an incredible amount of potential, but lacks crucial items that might increase engagement, participation, or simply provide more participants. In a day-and-age of technology and being connected, everyone wants to be connected at all times, especially teens that are known to have their phones surgically attached to them at times. What better way to do this than to provide students the opportunity to use their time in their NOT sessions in coordination with a phone application designed to aid in smoking cessation?

Rated in at 4.5/5 stars with over one thousand reviews, Cessation Nation is an extremely polished application that has achievements, denoting major milestones in a person’s progress towards cessation, and also tracks a number interesting statistics, such as time since last cigarette, money saved, and cigarettes not smoked, just to name a few. With the incorporation of Cessation Nation into NOT’s already stellar track record, participants would be more engaged than ever, especially with the dynamic tracking that Cessation Nation provides to program participants.

It would be foolish not to point out some issues faced with attempting to incorporate an application (which is Android only, mind you) into a smoking cessation program aimed at such a young age group. This incorporation presents a major barrier of entry into experiencing the full cessation program, such as the dependency on an external device, which the participant may or may not own. An aid to this would be program-provided tracking devices for the participants which are a suitable replacement for an Android device, though given the low-SES factors associated with the tobacco smoking population, having such a device accessible to children presents its own inherent risks and weaknesses.

References Dino G, Horn K, Goldcamp J, Fernandes A, Kalsekar I, Massey C. A 2-year efficacy study of Not On Tobacco in Florida: an overview of program successes in changing teen smoking behavior. Preventive Medicine. 2001;33:600–5. Dino GA, Horn KA, Goldcamp J, Kemp-Rye L, Westrate S, Monaco K. Teen smoking cessation: making it work through school and community partnerships. Journal of Public Health Management and Practice 2001;7:71–80. Horn K, Dino G, Kalsekar I, Mody R. The impact of Not On Tobacco on teen smoking cessation: End-of-program evaluation results, 1998 to 2003. Journal of Adolescent Research 2005;20:640–61. Horn K, Dino G, Gao X, Momani A. Feasibility evaluation of Not On Tobacco: the American Lung Association’s new stop smoking programme for adolescents. Health Education 1999;5:192–206. Horn KA, Dino GA, Kalsekar ID, Fernandes AW. Appalachian teen smokers: not on tobacco 15 months later. American Journal of Public Health 2004;94:181–4. Horn K, Fernandes A, Dino G, Massey CJ, Kalsekar I. Adolescent nicotine dependence and smoking cessation outcomes. Addictive Behaviors 2003;28:769–76.