Project EX is a school-based tobacco cessation program that targets high school youth between the ages of 14 and 19. The program is delivered in a clinical setting in school and involves motivational activities such as games, mock talk shows, and alternative activities such as yoga. The goal of the program is to encourage youths to stop or reduce cigarette smoking by providing information about environmental, social, physiological, and emotional consequences of tobacco use. Students participating in Project EX learn information about tobacco addiction and disease and gain an empathic understanding of the effects of tobacco use on friends. The curriculum emphasizes coping with stress, dealing with nicotine withdrawal, relaxation techniques, and how to avoid relapse. It aims to teach self-control, anger and mood management, and goal-setting techniques.
Teenagers who smoke usually fail to quit for three main reasons: social influences, chemical dependency, and lack of motivation (Sussman, Dent, and Lichtman 2001). Project EX uses these reasons as the theoretical framework for the design of the program. By teaching youth new skills to cope with or avoid tobacco use, giving them accurate information on how to manage withdrawal symptoms, and engaging youth in discussions on why they should discontinue their tobacco use, Project EX works to motivate youth to make positive changes to current behaviors and future life goals.
Students use an interactive curriculum to examine the difference between habits and addictions, how tobacco use actually increases stress, and how it is easier to quit at a younger age. Project EX consists of eight sessions that are delivered over 8 weeks—two sessions a week for 2 weeks, followed by one session a week for 4 weeks. Project EX uses a variety of exercises such as healthy breathing, yoga and meditation, relaxation, and motivational games and discussions. The motivational theory-driven “talk show” activity, patterned after television programs such as Dr. Phil and The Oprah Winfrey Show, is featured heavily throughout four of the eight sessions.
- Session 1 discusses the ground rules for the program and encourages students to think about the reasons why they use tobacco and how they can quit.
- Session 2 discusses how tobacco use can actually cause stress instead of relieving it. Guests, such as ex-smokers or psychologists, give presentations on the relationship between tobacco and stress, and teach students healthy alternatives to cope with stress.
- Session 3 discusses the harm in using tobacco by highlighting the damaging substances in tobacco products.
- Session 4 establishes the first step in breaking tobacco addiction and youth are given the chance to discuss ways of quitting.
- Session 5 focuses on managing withdrawal symptoms and developing strategies to cope with any symptoms that occur while quitting.
- Session 6 focuses on maintenance strategies, such as avoiding weight gain and learning yoga to maintain a sense of balance.
- In Session 7, students learn more maintenance strategies, such as anger management and meditation skills.
- The final meeting, Session 8, teaches students ways to avoid relapse and how the new skills they have learned can also be applied to other patterns of substance use.
During the first four sessions, students are not asked or required to quit immediately. They are instead prepared through the Project EX curricula to strengthen their attempt to quit. Students usually stop using tobacco around sessions 4 through 6.
14 to 19
At the 3-month follow-up, Sussman, Dent, and Lichtman (2001) found that students in the treatment groups (Project EX and Project EX plus the “school-as-community” [SAC] component) were significantly more likely to have not used tobacco products in the previous 30 days compared to those in the control group (17 percent versus 8 percent). Additional analyses indicate that the addition of the SAC component did not improve cessation rates over the clinic treatment group alone.
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