AUG/SEPT 2005
Volume 11 - No. 3
SRNT Newsletter
Aug/Sept 2005, Volume 11, Number 3
Research Activities at a Featured Program:
Project ASPIRE
Despite recent declines in the prevalence of smoking among children and adolescents, tobacco use remains a major public health problem. Over the past 2-3 decades, numerous factors have been investigated for their impact on smoking initiation among adolescents. Less is known about the predictors for smoking cessation among teenagers; however, noteworthy progress has been made over the recent years. Tobacco prevention and cessation programs for teens remain a priority.
Alexander V. Prokhorov |
Project ASPIRE (A Smoking Prevention Interactive Experience), funded by the National Cancer Institute, was designed to create and evaluate an interactive, tailored CD-ROM-based smoking prevention and cessation program for high school students. Founded on theoretical and empirical evidence and developed using a systematic stepped intervention development framework (Intervention MappingTM), the ASPIRE program is an enhancement of traditional computer-based programs, providing adolescent learners with a state-of-the-art educational experience. ASPIRE is the result of meticulous production processes comprising detailed flow-charts that sequence program events (e.g., tailored branching and feedback loops); hundreds of screen maps describing screen design and layout, learner navigation, script and audio components; and a multitude of storyboards delineating animation and video sequences. The result is a program that is intrinsically motivating to adolescents, who, by "climbing" Mount ASPIRE, encounter a tapestry of characters, vicarious situations, and skill-training experiences that provide them with the cognitive skill-set to progress in their own smoking cessation or prevention. Features of the program include individualized assessment and tailored feedback on critical determinants of smoking behavior (i.e., readiness to quit or start smoking, depression, and nicotine dependence); an animated coach in the form of an older, experienced peer who provides guidance to the learner on his/her journey to cessation; numerous interactive games that cognitively challenge the learner regarding critical management concepts; richly drafted and executed animations that, using a cast of characters, simultaneously excite, educate, and entertain; and approximately 2 hours of high-quality video featuring peer opinions, expert facts, and modeled real-life scenarios. ASPIRE represents the confluence of a strong theoretical framework, operationalized through rigorous program development and inspirational multimedia strategies. These components make it a leader among the existing computer-based interventions for teens.
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Exposure to ASPIRE was particularly beneficial for those nonsmoking teens who were at highest risk for smoking initiation at baseline. Specifically, at 18 months, smoking initiation was significantly lower among those ASPIRE participants who exhibited high baseline levels of depression and temptations to try smoking, as compared with their control-group counterparts. Other key mediating variables, such as peer and parental smoking and low-resistance skills were influenced in a similar way. These findings signify that ASPIRE represents a promising approach in preventing smoking initiation among predominantly minority, high school students.
The ever-growing popularity and availability of the Internet among the young generation warrants the use of this versatile tool for tobacco prevention and cessation interventions within schools. In 2004, Dr. Prokhorov received additional funding through the George and Barbara Bush Endowment for Innovative Cancer Research to develop an Internet-based supplement to the ASPIRE classroom curriculum. The supplement can be accessed at http://www.mdanderson.org/aspireonline.
Future Directions: Dr. Prokhorov and his colleagues hope to expand the original Project ASPIRE to schools outside the urban areas. These schools will feature a different ethnic composition of students with higher rates of tobacco use. A key addition to the existing intervention program will be spit tobacco prevention and cessation modules _ a critical feature, given the high prevalence of this form of tobacco use in the target population. Newly established risk factors of smoking initiation, such as exposure to smoking in movies and propensity to risk behaviors, will be added to the program.