Abstract

In Spain, 44% of 14–18-year-olds have smoked, and 12.5% have smoked cigarettes in the last 30 days. Nicotine is one of the most addictive substances, and can lead to serious addiction in adulthood with adverse consequences to one’s health. School plays a relevant role in health promotion and preventing risk behaviors such as tobacco consumption. Despite the fact that some school-based tobacco cessation and prevention interventions prove to be effective for their purposes, there is a lack of understanding as to why these programs succeed or fail. This longitudinal study aims to test the nicotine dependence (ND) as a mediator of Project EX’s effect – a tobacco-use cessation program developed for high school youth to reduce tobacco consumption in scholars. Six high schools located in the Mediterranean coast were randomized for the participation of the program (Spanish version of Project EX) or a waiting-list group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 1,546 adolescents aged 14–21 years old (mean age: 15.28; SD = 1.20; 46% were women) were evaluated by self-administered tests on tobacco consumption and ND. A biomarker of smoke inhalation – a measurement of exhaled carbon monoxide (ECM) – was used. Participants who were smokers (N = 501; 32%) were selected for this study. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. The significant criterion was p ≤ 0.05, and 5,000 samples were used for bias-corrected bootstrap confidence intervals. Results indicated that Project EX indirectly decreased the number of cigarettes smoked in the last month, the number of cigarettes smoked within the last 7 days, the number of daily cigarettes, and ECM level at 12-month follow up through decreasing the level of ND in the short-term. This is the first Spanish study that explores ND as a mediator of the long-term efficacy of Project EX to reduce tobacco consumption in adolescents. Results suggest that interventions that reduce ND at short-term are more likely to be successful to decrease tobacco use at long-term.

Highlights

  • Tobacco consumption is the leading preventive cause of disease and early death in developed countries (World Health Organization [WHO], 2014)

  • Spanish Other Live with. . . (%) Both parents Mother Father School achievement Age of first cigarette smoked Number of daily cigarettes Number of cigarettes smoked within the last 7 days Number of cigarettes smoked in the last month Exhaled carbon monoxide (ECM) (CO) level Nicotine dependence (ND)

  • The intervention positively reduced the number of cigarettes smoked in the last month (ACI = –22.44, –1.14), number of cigarettes smoked within the last 7 days (ACI = –14.09, –1.65); number of daily cigarettes (ACI = –2.07, –0.25), and exhaled carbon monoxide (ECM) (CO) level (ACI = –1.29, –0.14) after 12-month period indirectly through reducing the level of nicotine dependence (ND)

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Summary

INTRODUCTION

Tobacco consumption is the leading preventive cause of disease and early death in developed countries (World Health Organization [WHO], 2014). McCuller et al (2006) analyzed the role of motivation to quit smoking as a mediator variable of Project EX; more evidence is needed on what mechanisms are underlying this intervention’s effects. This longitudinal study aims to test the ND as a mediator of Project EX’s effectiveness to reduce tobacco consumption in adolescents from Spain

MATERIALS AND METHODS
Participants
RESULTS
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