Milken Institute School of Public Health Poster Presentations (Marvin Center & Video)

Title

School-Level Disadvantage Moderates Individual-Level Tobacco Cessation Failure

Poster Number

91

Document Type

Poster

Status

Graduate Student - Doctoral

Abstract Category

Prevention and Community Health

Keywords

adolescent tobacco cessation; socio-ecological model; multi-level modelling

Publication Date

4-2017

Abstract

Background:

Over half of adolescent smokers desire to quit, but the majority fail. Most adolescent cessation programming conventionally focuses on individual-level factors and mainly highlight successful outcomes. While understanding factors that lead to successful individual smoking cessation outcomes is necessary in adolescents, it is also essential to determine factors and conditions that contribute to treatment, or cessation, failure. The present study posits that adolescents' proximal environments-such as schools-may influence cessation treatment outcomes.

Purpose/Objective:

The purpose of this study is two-fold: a) Determine the individual level (Level 1) predictors of tobacco cessation failure in adolescents, b) Determine how the school environment level (Level 2) moderates the influence of level 1 predictors of tobacco cessation failure.

Methods:

Using aggregated data from multi-year (1998-2010) school based cessation trials (Not on Tobacco (N-O-T)in 5 states, we created a socio-spatial database comprising of linked individual-level and school-level data. By applying a tobacco-specific socio-ecological framework and Hierarchical Linear Modeling, the present study examined the interplay of individual level (n=8,855) and school level (n=807) factors associated with cessation treatment failure among adolescent cigarette smokers. Treatment (participation in N-O-T) was deemed as failing to meet its primary goals if participants continued to smoke cigarettes, measured 3-months post baseline.

Results:

At the individual level, greater self-efficacy predicted a higher likelihood of cessation success and nicotine dependence predicted a greater likelihood of failure. Ten percent of the variation in individual tobacco cessation failure was attributable to school-level variables. Adolescent smokers were more likely to experience failed treatment in a) school districts with large percentages of the population having less than high school education and b) schools with a higher ratio of students to teachers. Moreover, the influence of individual level self-efficacy on cessation was weakened among adolescents attending schools with higher percentages of students eligible for free and reduce lunch program.

Conclusion:

Findings suggest school-level socio-economic disadvantage as a significant factor inhibiting cessation, regardless of adolescent motivations to quit smoking. Understanding such interplay of proximal environments, such as schools, and individual-level factors will provide insights to educators, policy makers, and practitioners into the complexities that inhibit or strengthen an adolescents' smoking cessation treatment experience. Cessation programming should consider the interplay between individuals and school-level socio-economic disadvantage. Tailored strategies that buffer the effects of disadvantage may enhance adolescent cessation treatment outcomes.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Poster to be presented at GW Annual Research Days 2017.

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School-Level Disadvantage Moderates Individual-Level Tobacco Cessation Failure

Background:

Over half of adolescent smokers desire to quit, but the majority fail. Most adolescent cessation programming conventionally focuses on individual-level factors and mainly highlight successful outcomes. While understanding factors that lead to successful individual smoking cessation outcomes is necessary in adolescents, it is also essential to determine factors and conditions that contribute to treatment, or cessation, failure. The present study posits that adolescents' proximal environments-such as schools-may influence cessation treatment outcomes.

Purpose/Objective:

The purpose of this study is two-fold: a) Determine the individual level (Level 1) predictors of tobacco cessation failure in adolescents, b) Determine how the school environment level (Level 2) moderates the influence of level 1 predictors of tobacco cessation failure.

Methods:

Using aggregated data from multi-year (1998-2010) school based cessation trials (Not on Tobacco (N-O-T)in 5 states, we created a socio-spatial database comprising of linked individual-level and school-level data. By applying a tobacco-specific socio-ecological framework and Hierarchical Linear Modeling, the present study examined the interplay of individual level (n=8,855) and school level (n=807) factors associated with cessation treatment failure among adolescent cigarette smokers. Treatment (participation in N-O-T) was deemed as failing to meet its primary goals if participants continued to smoke cigarettes, measured 3-months post baseline.

Results:

At the individual level, greater self-efficacy predicted a higher likelihood of cessation success and nicotine dependence predicted a greater likelihood of failure. Ten percent of the variation in individual tobacco cessation failure was attributable to school-level variables. Adolescent smokers were more likely to experience failed treatment in a) school districts with large percentages of the population having less than high school education and b) schools with a higher ratio of students to teachers. Moreover, the influence of individual level self-efficacy on cessation was weakened among adolescents attending schools with higher percentages of students eligible for free and reduce lunch program.

Conclusion:

Findings suggest school-level socio-economic disadvantage as a significant factor inhibiting cessation, regardless of adolescent motivations to quit smoking. Understanding such interplay of proximal environments, such as schools, and individual-level factors will provide insights to educators, policy makers, and practitioners into the complexities that inhibit or strengthen an adolescents' smoking cessation treatment experience. Cessation programming should consider the interplay between individuals and school-level socio-economic disadvantage. Tailored strategies that buffer the effects of disadvantage may enhance adolescent cessation treatment outcomes.