2009 Model Practice Application (Public)

HiTOPS iQuit Smoking Cessation Program

HiTOPS

Nationwide, 27 percent of college students and 32 percent of young adults who do not attend college are smokers. Most smokers of any age group indicate the desire to quit, but only a small percentage succeeds in quitting for three months or more. Research shows that many youth aged 16–24 years are trying to quit smoking but often underestimate the rapid progression to tobacco dependence. The younger a person is when they do quit, the greater the number of years they add back to their life expectancy. It is imperative that smokers quit—the younger, the better. HiTOPS’ Health Center staff noted, from health history intake data, that a significant number of their clients smoked. When tobacco dependence treatment models were researched, there were no successful approaches targeted for youth. Staff developed the iQuit! program, which integrates strategies for treating tobacco dependence (from the Public Health Service (PHS), published 1996, updated 2000), into HiTOPS’ successful peer-to-peer format, and delivered through current technology, that is, podcasting, text messaging, and an interactive Web site (www.iquitathitops.com). iQuit! is free, available 24/7, and provides immediately attainable information and resources through a forum that most young adults enjoy, trust, and navigate with ease. A successful kick-off concert was held in 2007 in collaboration with Corner House Behavioral Health Program and the Princeton Public Library, and more than 250 teens attended. Fifty-six youths enrolled, aged 18–24, from HiTOPS’ Health Center. Enrolling stipulates at least two visits to the HiTOPS Health Clinic to complete questionnaires and have their carbon monoxide levels monitored by one of our on-site health care professionals. Daily text messages and email support (Ask the Expert) are provided by a HiTOPS health care professional/smoking cessation specialist. Staff addressed client questions/concerns about smoking cessation and tobacco dependence, and provided encouragement and support to the clients. Surveys were created in English and Spanish (using Survey Monkey technology) to evaluate services and collect data from new and existing clients. From these, staff could assess a new client’s readiness to quit smoking, and assess an existing client’s progress in the iQuit! program. An interactive Web site was created in collaboration with HG Media (www.iquitathitops.com) and linked to NJ Quitnet (www.nj.quitnet.com). There were a total of 712 hits to the iQuit! Web site; 88 percent from the United States. Of the total hits, 75 percent were unique, with an average time of 2:45; 30 percent were referred from another site, whereas 16 percent were referred from a search engine. Six audio podcasts, in English and Spanish, were developed on the following topics: Setting a Quit Date, Avoiding Triggers, Managing Cravings, Using NRT and other Medications, Managing Stress, and Relapse Prevention. Each podcast is approximately 3–4 minutes long and features voices of young adults. iQuit! became a part of an online blogging network for community service providers and nonprofits (www.nj.com/helping hands.com). Thirty days of support text messages using SMS (short message service) technology is available to clients in English and Spanish. If requested, service can be extended 30 days. We distributed 5,000 boxes of candy mints with the iQuit! logo and contact information, along with iQuit! posters and postcards, to the following: HiTOPS Health Center (all clients); Princeton Youth Services Committee (representing 20 youth-serving local nonprofits); The Princeton Chamber of Commerce; 10 youth-oriented health fairs; Training for New Jersey Nurse Practitioners and Psychiatrists; local chapter of Society for Adolescent Medicine Conference and their national conference in Greensboro, NC. We promoted iQuit! on a national Hispanic radio show, Prevenir Es Salud, and through public service announcements on local radio stations: WMGK (98.3 FM) and Tech Talk (12

We researched the level of tobacco dependence by using information from the Youth Risk Behavior Survey, the Centers for Disease Contol Web site Healthy People 2010, information from the American Legacy Foundation Web site. At our health clinic we ask about smoking and saw that 10–15 percent of our clients smoked. We provided face to face counseling for tobacco dependence in our health center and directed our clients to the iQuit Web site. We searched the Internet and tobacco Web sites such as the New Jersey Quitnet, Tobacco Free Kids, CDC.gov, the American Legacy Foundation, etc., to see if there were any online smoking cessation programs that specifically targeted adolescents and found none. Our program removes the barrier of access to care for adolescents who lack resources to seek professional help to quit smoking. It provides evidence-based smoking cessation treatment in a form that is available to adolescents using a peer-to-peer education format and incorporates text messaging and podcasting technologies that are appealing to adolescents and young adults.

At the state level we have participated in meetings with other agencies to develop the strategic plan for tobacco control in New Jersey. At the local level we have participated in our local Youth Concerns Committee, partnered with a local behavioral health agency called Corner House, linked to our Princeton Regional Health Commission Web site, and partnered with our local smoking quitcenter. We at HiTOPS are in total control of planning and implementation of the iQuit program. The director of our health center, Sandra Friedman, is the vice president of the Princeton Borough Board of Health. We frequently partner with schools and community agencies to participate in health fairs and other community events. The local health department has enabled us to present our program to members of the Youth Concerns commission. By linking our program to their Web site it allows providers and community members to have access to our program.

With start-up funds from American Legacy, iQuit! had a successful first year meeting objectives and effecting a modest decrease in smoking for youth ages 18 to 24. HiTOPS was also awarded a second year of partial funding from American Legacy in the amount of $38,805 to enable HiTOPS to implement Year 2 objectives (September 1, 2008 to August 31, 2009).

The content for our iQuit Web site includes six podcasts, each addressing a topic in smoking cessation, and a seventh podcast that addresses information about Hookah use. All pages of the Web site and the podcasts were translated into Spanish. We hired a media company to assist us with recording the podcasts and designing the Web site. We conceived of the content of text messages and engaged a short code phone service to deliver the 30 days of text messages to our clients. All text messages were also tranlated into Spanish. We used Survey Monkey technology to provide the surveys on our Web site to track the data from our clients. All surveys were also translated into Spanish. We are currently pursuing marketing strategies using the social networking sites Facebook and My Space to promote the iQuit program. We also used our media company to design a music video ad that played for nine weeks at two local multiplex cinemas during the December holiday season and will repeat for another nine weeks for the summer movie season. It has taken two years from conception to launching the Web site. Data collection has been ongoing since the program started. Our media company uses Google informatics to track the traffic to our Web site. As of this application we have had approximately 2,000 visitors to our site.

We are currently in our second year of funding from the American Legacy Foundation and are in the process of seeking matching funds from corporate and grant sponsors. We are presenting our program at the national conference of the Society of Adolescent Medicine at the end of this month. We have developed a version of our program that can be replicated at other adolescent health centers and plan to offer these for sale to other providers. We also have submitted a proposal to a pharmaceutical company for funding in exchange for advertisement space on our Web site. Currently clients in our center receive counseling on a fee-for-service basis.

Young adults and adolescents need counseling about smoking cessation. People in this dempographic use technology for health information. Six months was a long time to keep incontact with this population. Some changed their addresses or phone numbers or email addresses.

Information was not provided in 2009