Quit 4 Life Helping Youth Quit Smoking Original Reviewed: March 2006 Last Updated: March 2006 INTERVENTION This summary is based on a program developed and revised by: Health Canada in 2005 and pilot tested and evaluated in 2004 in partnership with Mission, British Columbia (Fraser House Society); Winnipeg, Manitoba (Manitoba Lung Association); Garden Village, Ontario (Nipissing First Nations Health Centre); Fredericton, New Brunswick (Canadian Research Institute for Social Policy, UNB); and New Glasgow, Nova Scotia (Pictou County Women s Centre). Intervention Categories Children Prevention Cessaton Protection Community Action Latest Project Updates Project updates are currently being collected (April 2006). Youth General Population Special Population Intermediaries Quit 4 Life Helping Youth Quit Smoking 1 IMPLEMENTATION SUMMARY PTCC S BETTER WWW.PTCC-CFC.ON.CA
Objective: To objective for the Quit4Life program is to help teenagers quit smoking by increasing motivation and self-confidence in quitting. The objective for the pilot site project directed at youth age 12 18 was: To produce a final evaluation report on the pilot sites detailing methodology, process, outcomes, impacts and providing recommendations for adapting the program based on pilot site findings. To develop evaluation tools to be used by Health Canada and pilot sites at 6 and 12 month intervals postprogram delivery. To develop an evaluation tool to be used on the Quit4Life website to gauge the program s effectiveness as a self-help program. Program Description: Almost all persons who have ever smoked had their first cigarette sometime in their teens, and at least half of all ever-smokers have tried smoking by age 15. Smoking by youth in Canada is a critical health issue. In 2002, 22% of Canadian teens aged 15 to 19 were smokers, down from 28% in 1999. Adolescence presents a crucial window of opportunity to intervene with smoking cessation programs. 70% of current smokers aged 15 to 19 reported one or more attempts to quit in the previous 12 months. To address this need, Quit4Life has been re-designed in accordance with the principles of social cognitive theory, using cognitive-behavioural techniques to promote individual behaviour change. The Quit 4 Life (Q4L)/Vie 100 Fumer program originated in 1993: It began with Health Canada in partnership with the Canadian Lung Association and Ciba-Geigy Ltd. as a self-help, quit smoking kit for teens ages 15 to 19 year-olds. The materials were packaged in a CD-Rom jewel box that was appealing to youth. Kits were promoted and distributed through Health Canada and public health and voluntary agencies such as local offices of The Lung Association. During the late1990 s Q4L was converted to a self-help via the web format. The popularity of the program and the emergence of new information about best practices on youth cessation from international researchers, including the effectiveness of cognitive behavioural approaches with adolescents led Health Canada to update the Q4L program in 2002 once more, incorporate group sessions, and aim it at a younger age group (12 to 18 year-old). In 2003/2004, Health Canada piloted and evaluated the revised Q4L group program in partnership with five organizations at five sites across the country. Our review is based upon an assessment of the revised Q4L group program. The program is currently offered in a group format lead by a facilitator, or a self-help program on-line. Quit 4 Life Helping Youth Quit Smoking 2 IMPLEMENTATION SUMMARY PTCC S BETTER WWW.PTCC-CFC.ON.CA
Resources Developed Q4L Web-site All information about how to use or run the Quit4Life program is posted on the web-site www.quit4life.ca and can be downloaded or ordered on-line. Practitioners can promote the web-site as a self-directed program, or order materials to implement http://www.quit4life.com/handbook_e.asp#01 At the time of the pilot, the website focused on communicating the four steps to quitting outlined in the Participants Booklet. The site contained some of the same activities that are found in the Participants Booklet (e.g., values listing), but did not echo the same structure and format as in the group program. The Q4L website included stories from four fictional characters representing youth who are quitting smoking. The site was designed to encourage users to move between different sections according to their own interests and needs, rather than in a structured program format. It displayed some interactive features (e.g., a cost calculator), and was very welllinked to other HC sites and information, (e.g., on second hand smoke; on using nicotine replacement). The main components of Quit4Life are described below. Supporting materials such as posters, magnets, table cards, notebooks, and floor stickers can be ordered on line. Main program elements include: Quit 4 Life Handbook The Quit 4 Life Handbook for youth who want to quit is a colourful 64-page booklet small enough (9 by 5 ) to fit easily into a bag. It describes four different steps to quitting: Get Psyched motivate yourself to quit and stay smoke-free Get Smart Know what to expect when you quit Get Support Create a positive environment for yourself Get On With It Know what to do when you quit There are excellent graphics along with a tear-out sheet to track smoking behaviour, a support pledge card, and a worksheet in which youth can write down their own goals and values. The booklet is illustrated with full and halfpage colour photographs of young people, and includes references with web addresses for more information. Quit 4 Life Helping Youth Quit Smoking 3 IMPLEMENTATION SUMMARY PTCC S BETTER WWW.PTCC-CFC.ON.CA
Facilitators Guide Here you will find everything that an adult used to working with youth needs to run a smoking cessation group program for teenagers. The Facilitators Guide was created to help teachers, nurses, and health professionals run Q4L as a group program. The Facilitators Guide has been piloted and evaluated across Canada, and the updated version provides comprehensive information on everything from recruiting and retaining participants, to adapting and evaluating your personal group. New features have been added including 4 optional follow-up sessions, a facts and figures quiz for facilitators to test their smoking cessation knowledge and step-by-step plans for the 10 core sessions. There are black line masters to accompany each session, and general tips for facilitating the course included in an appendix. References are listed throughout, so those requiring more information can easily find it. Implementation Steps and Activities: 1) Order or download the materials from the Health Canada website and follow the steps outlined in the Facilitators Guide. The easy to follow instructions describe how to run Quit4Life as a group program of 10 sessions, with each session lasting about an hour. 2) Quit4Life facilitators are responsible for: a. Marketing the program b. Recruiting participants c. Securing a meeting location d. Inviting Peer Assistants to help deliver the program (optional) e. Managing all the organizational details f. Facilitating each session g. Providing follow-up and guidance for participants h. Establishing a secure environment in which participants feel free to express themselves honestly i. For the pilot sites, conducting an evaluation: collecting baseline and post-program evaluation data (nb even though the formal pilot site and evaluation component of Health Canada s Q4L is over, the Guide contains useful survey tools that you may find useful to collect data for your own evaluation purposes). 3) Because the target group is teenagers who want to quit smoking, recruiting them is easiest at schools and community agencies catering to youth under age 19. Meet with principals, counselors, community youth leaders and any other local agencies sharing a mandate to reduce tobacco use to present Quit4Life and solicit their cooperation and involvement in promoting and implementing the program. 4) Secure your location. Consider running the sessions in locations that are easy to access like schools (maybe over lunch hour), community centres or shopping malls. 5) Seek permission to market and promote the program through all relevant channels such as school PA announcements, guidance and physical education classes, bulletin boards in the shopping mall, local youth-related websites and any areas where youth congregate. Quit 4 Life Helping Youth Quit Smoking 4 IMPLEMENTATION SUMMARY PTCC S BETTER WWW.PTCC-CFC.ON.CA
6) Consider involving Peer Assistants if possible, recruit 2 youth that have quit smoking (one female and one male) who are willing to act as part of the cessation team by providing valuable advice, support and their perspectives on quitting. 7) Register participants (try to aim for between 15 and 20 youth), and it is not uncommon for some registrants to not show up. Prepare for each session as outlined in the Facilitators Guide. This includes ensuring that the participants accept their responsibilities for attending sessions, arrive on time, attempt to quit and develop and follow their own group guidelines as described in Session One. Discuss issues about privacy and confidentiality so that all members feel secure that their candid discussions remain within the group. 8) Facilitate the sessions. 9) Participants are welcome to continuing to meet to provide mutual support to one another after the formal 10-session program is over. Suggestions for four optional sessions can be used as needed. The format can be informal and may take place with or without the facilitator or peer assistants, but can help to provide a structure for additional support that some groups prefer. 10) Review feedback from participants and evaluation results, keep partnering organizations and agencies informed of results, and modify plans for future tobacco control activities and programs based on feedback from all events. Evaluation: Process evaluation Track program implemented as anticipated. Track the number of participants that attend each session, and include the drop outs in the final survey. Track facilitator response to the Q4L program. Track participant response to the Q4L program, including satisfaction with the facilitator. Outcome evaluation Track and monitor change (pre and post) in attitudes, knowledge and beliefs about tobacco. Track and monitor change (pre and post) in smoking behavior (e.g. quit attempts, quit rate). Summarize results from questionnaires, tracking forms and evaluations, and use them to inform future activities and events. Share data with participating schools, community agencies and the health unit staff epidemiologist, who may wish to compile a report showing changes in youth quit rates over time. Prepare charts and tables to illustrate these results and to show who used the services. Use evaluation data in media releases to promote the benefits and results of increasing smoking cessation supports tailored to reach youth. Quit 4 Life Helping Youth Quit Smoking 5 IMPLEMENTATION SUMMARY PTCC S BETTER WWW.PTCC-CFC.ON.CA
Reflections/Implications: Providing smoking cessation supports to youth is critical because both the risks to health and the difficulty in quitting increase over time. Young people get hooked on smoking more easily than older people, and many teens find it difficult to quit. Health Canada is addressing this need by ensuring that Quit4Life continues to incorporate revisions based upon the evaluation of this program, in addition to considering new research findings to better match the needs of youth. Support for smoking cessation for all community members is an important component of tobacco use reduction programming. To achieve the most effective results, such initiatives should be implemented as part of a comprehensive tobacco control program that includes a mix of activities aimed at smoking prevention, support for smoking cessation, and protection from exposure to secondhand smoke. This program guide has been adapted by the PTCC for community use as part of the Best Practices in Tobacco Control Project Quit 4 Life Helping Youth Quit Smoking 6 IMPLEMENTATION SUMMARY PTCC S BETTER WWW.PTCC-CFC.ON.CA