Quit the Stick Program Plan

Learning Team 9:

Jaylene Arvizu, Kelsey Camps, Sarah Leahy, Alison Johnson,

Ashleigh Pendleton, Francesca Scardino

University of Arizona

December 4, 2018
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Table of Contents

Introduction……………………………………………………………………………………... 3

Literature Review………………………………………………………………………………. 5

The Problem Statement……………………………………………………………………..… 12

Figure 1…………………………………………. 14

Theoretical Framework for the Program Plan……………………………………………… 14

Table 1 …………………………………………. 15

Program Description…………………………………………………………………….……. 15

Table 2 …………………………………………. 18

Program Implementation Plan……………………………………………………………..… 26

Program Evaluation Plan …………………………………………………………………….. 29

Figure 2………………………………………… 37

Figure 3……………………………………........ 38

References……………………………………………………………………………………… 40

Appendices……………………………………………………………………………………... 43
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Introduction

Quit the Stick’s overall findings from the Pima County Community Health Needs

Assessment of 2015 found that the quality of life of Pima County ranks the best among

Arizona’s 15 counties. Pima County ranks high in areas of health behaviors, clinical care, social,

economic, and environment factors. These factors can impact the overall and future health within

the county. The health status of Pima County can be considered healthy, however, Pima County

does struggled in areas of substance abuse and dependency. In fact, Pima County has the highest

drug induced deaths when compared to statewide statistics. Substance abuse and dependency

have become a prioritized health need. Pima County still has great medically underserved areas

such as in the Northeast and Northwest parts of Tucson where the ratio of physicians to patient is

1:315-1:1,000. However, health status of adults in Pima County is higher than other US counties

with 62% of the adults meeting CDC’s physical activities guidelines and only 20-25% reporting

as inactive outside of work. Unfortunately, for children, only 45% meet these CDC guidelines

with 15% not performing physical activity (Pima County, 2018)

Health needs that have been found in Pima County and that are considered priorities are

anxiety and depression spectrum disorders, substance abuse and dependency, injuries and

accidents and diabetes (Pima County, 2018). Quit the Stick is looking to address the health needs

of dependency among the target population. Resources for the general population within Pima

County varies throughout the county, the community health resources ranges from private

resources, community-based, and non-profit organizations. Non-profit organizations include the

Community Food Bank of Tucson and Child & Family Resources which offer 31 programs

throughout Southern Arizona (City of Tucson, 2018).

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The Quit the Stick program assessed adolescent smoking in Central and Northeast

Tucson, focusing on high school students ages 14-18 years old. Quit the Stick will be

implementing the smoking cessation program within Tucson Unified School District which has a

total of 14,337 students. Quit the Stick chose Sabino High School representing Northeast Tucson

and Tucson Magnet High School representing Central Tucson. Sabino High School consist of

947 enrolled students, 42% being minority and Tucson Magnet High School consist of 3,181

enrolled students, 87% being minority. (U.S. News, 2015).

For the Quit the Stick’s target population, the staff of the program decided to address the

health issue of nicotine usage in high school students ages 14-18 years old. The Quit the Stick

staff felt that this health issue should be further defined to include cigarettes and e-cigarettes as

well as juuls. The staff feels that by encompassing these forms of nicotine, they are able to gain

more of a response from the desired target population. Overall, Quit the Stick wants to lessen the

use of nicotine within this age group in order to ensure our society a healthier future.

Within the total population of Pima county, Tucson has 1.02 million people. After doing

some research, the staff of Quit the Stick found that the median household income for Pima

county is $47,560 with a poverty rate of 18.4%. 36.8% of the population is Hispanic and 52.4%

is white. Spanish is the most spoken foreign language at 22% of the population (Data USA,

2018). The large presence of Hispanic culture in Pima county explains the percentage of the

population who speak Spanish. Hispanic households on average tend to be a lower income

household. Lower income households are less willing to seek medical attention due to their

financial status. Therefore, the staff of Quit the Stick has seen a higher prevalence of negative

health outcomes among that population. There is also a language barrier that can prevent itself

when healthcare providers don’t speak Spanish and 22% of the population are Spanish speakers.
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Similarly the language barrier Spanish speakers is another contributing factor to the Hispanic

population not seeking medical help. There is a high national percent of adolescents who

participate in the use of nicotine products. The CDC states that, “nearly 9 out of 10 cigarette

smokers first tried smoking by age 18” (Smoking & Tobacco Use, 2018). Thus, there is a great

need for smoking interventions among adolescents. It has been also found that smoking

behaviors in adolescents are enticed by the different flavors that electronic cigarettes offer. The

CDC reported that, “73% of high school students and 56% of middle school students who

reported using tobacco products in the last 30 days reported using a flavored tobacco product”

(Smoking & Tobacco Use, 2018). The availability of tobacco products, the marketed flavors, and

smoking behaviors that their peers have influence the experimentation of tobacco at a younger

age. The percentage of teens who smoke tobacco in Arizona in 2011 was 17.4% and Arizona

ranked 23rd among 44 states (Tobacco Control State Highlights 2012, 2014). Since, there is a

high prevalence of adolescent smoking in Arizona it is important for the state to implement

prevention programs. 31 percent of adolescents in pima county have tried cigarettes compared to

the average in Arizona which is 28.8% (Arizona Department of Health Services, 2012). The use

of nicotine products increase with grade at 8% in 8th grade to 22% in 12th grade. This data

shows a higher use of nicotine use among adolescents in specifically pima county. This is why

pima county is a good area to implement a new smoking prevention program.

Literature Review

The health educational specialist team in Pima County, AZ conducted a literature review

in order to evaluate the available resources related to nicotine use through smoking behaviors in

adolescence. Smoking behaviors can be impacted by different influential factors. This is essential

to understand in order to create an effective adolescent smoking cessation program. The Quit the
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Stick staff assembled the chain of circumstances existing and related to nicotine use among

Northeast and Central Tucson youth.

Target Population/Health Problem

In regards to the prompt given, the Quit the Stick team noticed the common target

population amongst studies was middle school to high school aged students ranging from 14-18

years old (Balch, 1998). The population found within most studies was a larger sample size of

approximately 400 individuals (Prokhorov, 2000). This way, both genders were equally

represented within the studies, helping us understand the culture behind adolescent smoking. The

racial background behind most of the studies included all races, however, a dominance within the

white races was found within some studies (Balch, 1998). In regards to a common health issue

amongst these studies, it appeared that smoking cessation along with nicotine use in adolescents

is a common theme. The health issues suggested within all of the studies reveal that adolescents

faced with underlying challenges often surround themselves within environments that contain

nicotine or have easy access to nicotine.

Health Resources Applied to the Problem

There have been numerous policies and programs implemented in Arizona and Pima

County. Arizona’s Tobacco Education and Prevention Program (AZTEPP) hoped to reduce the

access youth have to tobacco (Siegel, 2006). This intervention was able to use a variety of factors

such as increased law enforcement, warning signs, a media campaign, and merchant education.

The media’s campaign goals were able to help change the community norms as well as increase

the probability of community members stepping in when viewing underage tobacco sales.

CounterActs was a program administered by the AZTEPP which sought to increase identification
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checking policies that would consequently lessen adolescents tobacco access. This program also

included “We Card” signs that would help decrease underage access to tobacco and identify

adolescents access to tobacco as a societal problem (Siegel, 2006).

Definition/Description

Most adults who are current smokers, began when they were adolescents and in recent

years smoking has continued to increase for adolescent smokers. Many who don’t seek

assistance with quitting at a young age will continue into their adulthood (CDC, 2018). From the

Quit the Stick team’s collected data, they reviewed different effective and ineffective studies

based on smoking cessation intervention programs, which expanded throughout the United

States, for example, in Baltimore City, Tucson, Southern California, Los Angeles, Southeastern

Connecticut, Chicago, Massachusetts and District of Columbia. There were also some studies

implemented outside of the United states in Auckland, New Zealand.

While conducting the literature review, the target population for adolescents attempting

to quit the use of nicotine smoking ranges from 14 to 18 years old. Most adolescents reported

attempting to quit or thought of quitting; in one particular study adolescents were asked a series

of questions related to the frequency of their smoking use and determining if they are former or

current smokers (American Academy of Pediatrics, 2018). Another study focused on adolescents

but found that smoking was indeed high in recent years, in 1991 the rate of smoking among

adolescents was 27.5% and four years later it increased to 34.8%. In this study, adolescent girls

reported to have higher symptoms of nicotine dependence (Nichet et al., 1997). Based on our

research there has been an increase in adolescent nicotine use, but also there is a low probability

of adolescents successfully quitting which leads into developing a higher nicotine dependence in

their adulthood.
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Precursors

Adolescents begin to participate in high nicotine use through smoking behaviors for

various reasons. While conducting the literature review, the research team found that the most

common precursor for adolescents is stress (Adelman et al., 2001). Stress was shown to be a

strong indicator in multiple studies. Since the target population was identified as being high

school students aged 14-19 in Pima County, academic stress was a major contributor. Along with

stressors from school, a study among adolescent girls found that stressors with peers, family, and

friends also had an impact in taking up nicotine use through smoking behaviors (Nichter et al.,

1997). Another strong precursor that leads teens to participate in smoking behaviors is the

individual’s susceptibility to nicotine dependence (Difranza et al., 2000). In a study focused on

nicotine dependence, researchers found that nicotine had the ability to outperform drugs and had

a vulnerability to certain individuals to become addicted (Prokhorov, 1996). In regards to

nicotine use through e-cigarettes, the precursors varied from traditional smoking. For e-

cigarettes, the main reason behind why adolescents started using them was because e-cigarettes

were more appealing to those who have not tried any type of tobacco product (American

Academy of Pediatrics, 2018).

Consequences

After assessing multiple interventions regarding cessation of nicotine use among

adolescents, the results found that there are many health associated consequences. One of the

biggest problems among adolescents was that they were not identifying themselves as smokers.

Lack of identity as a smoker can lead teens to dismiss cessation as a whole; therefore greatly

affecting their health in the long run (Mermelstein, 2003). Some of the many consequences
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related to health, found in the studies, were heart disease, cancer, overdose effects, and cardiac

arrhythmias (Niaura, 1996). In addition, adolescents are not properly equipped with the right

knowledge in regards to nicotine. With this, many students did not take into consideration the

long term health effects of smoking. A majority of the students believed that smoking for

approximately 1-2 years would not cause any detrimental health effects over time (Nichter et al.,

1997). In addition, many students associate smoking as a trend. The teens thought that a

temporary fad would not cause addictive nor chronic behaviors (American Academy of

Pediatrics, 2018). Furthermore, some of the smokers who identified themselves as smokers,

disregarded harmful health effects when the smoking product included flavors marketed towards

their age: fruit, dessert, and menthol (American Academy of Pediatrics, 2018). As for programs

aimed at cessation, adolescents did not take them seriously. One of the studies implemented a

cessation program but the students only attended the program to avoid class time (Balch, 1998).

In addition, one study had a focus on multimedia and adolescents in order to teach the teens the

negatives of smoking. Yet again, the adolescents did not take the program seriously and or did

not fully participate in the program for cessation (Rodgers, 2008).

Successful Interventions

The effective interventions that surfaced the most within the research, were school based

programs. Implementing an in-class curriculum was proven to be one of the most effective

interventions due to them being implemented during school hours and being short-term.

Adelman et al. (2001) states that they implemented a successful 6-week and 8- week cessation

program into a school that consisted of eight sessions. One session was introduction and team

building skills while session 2 was recognizing personal habits with smoking and possible

obstacles that could be in their way when they decide to quit. Session 3 consisted of developing
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personal and group strategies on how to quit while session 4 and 5 were focused on them

practicing these strategies. Session 6 focused on physical and mental preparedness and sessions 7

and 8 were devoted to relapse interventions and how to deal with these symptoms (Adelman et

al., 2001). The CDC offered a similar in-class curriculum that was based off the social cognitive

theory. This program was deemed successful due to its use of 10 similar sessions for the students

that focused on life skills, stress management, and healthy behaviors (CDC, 2018). Another

program researched how to create a possible effective intervention for a smoking cessation

program by interviewing focus groups of students who are smokers (Balch, 1998). These focus

groups were located in different states along with one focus groups consisting of a primary care

provider. The research results showed that students were most likely to stop smoking through use

of enticements, shorter lessons, money, or being able to speak to a personal physician (Balch,

1998). The use of an enticement was discussed by Nitcher et al. (1997) as girls participating in a

physical education class were told they did not have to attend the class if they attended an initial

presentation for the proposed cessation program instead. 80% of these girls then chose to

participate in the intervention (Nitcher et al., 1997)

Aside from school-based programs, programs that are easily accessible to students have

been proven effective as well. These programs are mobile phone and media based. Whittaker et

al. (2008) states that not all students have the proper access to these support groups and students

liked when the intervention was brought to them via mobile devices. They saved time and effort

through this method. 9 of the 15 students reported liking the program stating that they enjoyed

watching the videos on their own devices and the text messages containing motivational and

informational content. These 9 had also quit smoking while the rest of the students reported
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limiting their use. They also reported saving the videos on their mobile devices, so they could

play them back when they needed it (Whittaker et al., 2008).

Unsuccessful Interventions

After assessing multiple interventions focused on adolescent nicotine use cessation, the

results found that using an informational pamphlet alone is not enough to influence the change

of smoking behaviors. Adelman et al. (2001) performed a study on high school programs

comparing the effectiveness of informational pamphlets versus text messaging information in

their success on reducing adolescent nicotine use. The study concluded that the informational

pamphlets were not as successful and did not reduce the rate of cigarette use among the

participants (Adelman et al., 2001). Some programs which relied on information sessions that

the adolescents would attend did not successfully relay the information. Some students, after

the program, still did not think that nicotine smoking would lead to addiction (Difranza,

2000). While students in another program did not believe that smoking was as bad as doing

other drugs, so they did not understand the importance of changing their smoking behaviors .

Therefore, it will be important to successfully engage and inform the students about the risks

they face with nicotine use, so that the program goal of reducing adolescent nicotine use in

Central and Northeast Tucson can be successfully reached.

Summary of Findings Applying to Quit the Stick

An important finding stated that without intervention, adolescents have a very low rate of

spontaneous quitting (Mermelstein, 2003). This makes it clear that there is not only a need for

adolescent cessation interventions, but a demand for them. It was also found that a multi session

classroom-based curriculum aiding in smoking cessation is a successful method in smoking

intervention and prevention. These in person classes are more effective than sending out an
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informational pamphlet because the students will be able to receive in person information and

guidance (Adelman et al., 2001). On a national level, a study found that flavored e-cigarette use

correlated with a higher chance of intention to begin tobacco use among the youth population

that had never used tobacco products (American Academy of Pediatrics, 2018). As quitting is not

seen as an important issue among adolescents, researchers have identified high rates of

adolescent smoking and low rates of quitting (Mermelstein, 2003).

After assessing all the information presented by various sources, the research group

found it most beneficial to implement a Quit the Stick cessation program. This program will be

held during normal school hours as it has been shown to be more effective in comparison to after

school (Mermelstein, 2003). After considering different options, the research team concluded

that this program will be targeted at 14-18 year old students that attend a public high school in

the Tucson Unified School District or Tanque Verde Unified School District. The information

presented in the literature review will help the research group implement the best smoking

cessation program that will exhibit the most effective results.

Problem Statement

The problem the research team identified in Pima County was that adolescents

demonstrated high nicotine use through smoking behaviors. In Arizona, 10% of female and male

high school students reportedly smoked cigarettes at least once within a 30 day period (U.S

Department of Health and Human Services, 2015). Within this 10%, 46% of males and 51% of

females have attempted to quit smoking . As for electronic cigarettes (e-cigarettes), 16.1% of

high school students utilized this device (Truth Initiative, 2018). Also, 5.5% of high school

students smoked cigars within a 30 day period. These high percentage rates have a strong
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correlation with a direct consequence and a variety of precursors. Some indirect precursors

include: social influence, community environment, and lack of parental care. Demographic risks

that relate to these indirect precursors include: race, gender, and age. The research team found

that Blacks alone are most likely to intake nicotine through smoking behaviors. Also, males who

were within the age group of 18-24 are most likely to adhere to these behaviors. These

precursors lead to the direct problem of nicotine use through smoking behavior. Following this

problem were several consequences: morbidity and mortality. Morbidity and mortality

consequences included: cancer, emotional stress, cardiovascular disease, and stroke (Center for

Disease Control and Prevention, 2017). If these precursors are not addressed, the rate of nicotine

use through smoking behavior among adolescents will continue to increase with time.

The research group hypothesizes that the Pima County teens who are involved in Quit the

Stick Cessation Program will be able to demonstrate safe and responsible decisions regarding

nicotine use through smoking behaviors leading to an overall decrease throughout the target

population.
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Figure 1. Problem Map: Nicotine use through Smoking Behavior

Theoretical Framework

The theoretical framework that Quit the Stick selected as the basis of the intervention

program, is the Lewin’s Field Theory, which will guide the planning of each of the components

of the program plan by utilizing the force-field analysis of change forces and resisting forces.

Change forces are those that can push the target population or individual towards a specific goal

while the resisting forces are those that prevent the individual or group from making a change.

This theory was chosen in order to guide the development of the goals and objectives because
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resisting forces are highly prevalent in cessation programs for nicotine users. These forces never

align and in order for there to be successful change, the change forces need to be greater than the

resisting forces. Health educators will utilize the force-field analysis in developing the

intervention methods. This analysis is done by increasing the impact of the change forces that

will promote understanding the health risks related to smoking and strategies of quitting smoking

through guest speakers, cooperative learning and group work, peer education, and improvement

projects to include reflection journaling. Healthy coping mechanisms can be used through

intervention methods of problem solving and self appraisal. An external health education

specialists who has had previous experience working with adolescents in smoking cessation

programs in the community will be able to evaluate the influence of change forces and resisting

forces based on the adolescents understanding of these health risks and using these strategies at

the end of Quit the Stick’s 20 week program (Parkers, 2013).

Table 1. Force-Field analysis for Quit the Stick

Change Forces Resisting Forces

● Knowledge of the health risks ● Peer pressure

● Peer support ● Stressors related to smoking cessation
● Self reflection through journaling ● Relapse and withdrawal symptoms
● Healthy coping mechanisms ● Personal environment

Program Description

This program was developed by the research team after completing and analyzing the

literature review. The purpose of this program is to address the growing rate of adolescents

nicotine use through smoking behavior in Central and Northeast Tucson. Quit the Stick will be a

20 week program implemented in both Sabino High School and Tucson Magnet High School
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that will consist of an introductory presentation the first week, 8 sessions, and 11 discussion

sessions. This program will be implemented from August 2020 to December 2020. Quit the Stick

will focus on providing the participants with basic background information on nicotine use

through smoking behaviors, while offering them different coping mechanisms. After each

session, the research team will follow up with a discussion where students can practice and

implement different strategies to quit nicotine use through smoking behaviors. Discussions will

offer opportunities to implement a social media platform that allows for media interaction

through online videos and photos. The social media platform such as Instagram includes weekly

inspirational quotes and activities related to smoking cessation which will aim to create a healthy

support system in which participants can go to when in need of guidance.

Mission Statement

Tucson Unified School Districts and Tanque Verde School District in Central and

Northeast Tucson recognizes the importance of promoting a healthy environment for

adolescents. Healthy environments for adolescents promotes security, access to resources, and

positive community interactions. Quit the Stick will help encourage adolescents to seek healthy

coping mechanisms through guided discussions, counseling, along with advice from mentors in

order to adopt a healthy lifestyle including nicotine cessation.

Goal
By December 21, 2020, the rate of nicotine use among adolescents 14-18 years old in

Central and Northeast Tucson will decline.

Objectives

Administrative Objectives
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● By June 2020, the research group will receive feedback from the pilot program that will

be assessed by a program evaluator and will be incorporated into Quit the Stick.

● By July 31, 2020, certified health educators will be hired for Quit the Stick.

● By August 1, 2020, all guest lecturers for Quit the Stick will be recruited and scheduled.

● By the first week of August 2020, Quit The Stick will have recruited a minimum of 60

students per school district to participate in the program.

Impact Objective

Learning Objectives

● By August 21, 2020, participants involved with Quit the Stick will be able to identify the

common health outcomes associated with nicotine use through smoking behaviors.

● By August 21, 2020, 75% of participants will be able to define characteristics of

nicotine dependence.

● By October 30, 2020 at least 50% of adolescent nicotine users participating in the weekly

cessation program will be able to recognize at least three more effective stress coping

mechanisms instead of the use of nicotine products.

● By the completion of the program in December 2020, 80% of participants will be able to

develop two group and individual strategies to quit smoking.

Behavioral Objectives

● By December 2020, 75% of participants in Quit the Stick program will demonstrate

specific stress mechanisms implemented into their daily routine.

● By October 2020, 90% of participants in Quit the Stick will demonstrate 3-5 journal

entries per week.

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● By October 2020, 80% of participants will demonstrate reducing their monthly costs

spent on nicotine products by at least 50%.

Environmental Objectives

● By September 30, 2020, 90% of the students attending Sabino High School and Tucson

Magnet High School will have access to recreational activities as stress outlets.

● By October 2020, 70% of the participants can identify a support system within their

social environment.

Outcome Objectives

● By January 1, 2020, the rate of nicotine use among adolescents participating in Quit the

Stick will decline by 65%.

Intervention Method

Table 2. Listing of Health Education Methods

Social Media Problem Solving

Theater Storytelling

Brainstorming Guest Speakers

Cooperative Learning and Group Work Self-Appraisal

Peer Education Personal Improvement Projects

(Parker, 2013)

By utilizing the Lewin’s Field Theory, the research team will develop intervention

methods that promote the force field analysis of increasing change factors, decreasing resisting

forces, and a combination of both of these factors together (Parker, 2013). Quit the Stick

intervention methods include: social media, theater, brainstorming, cooperative learning/group

work, peer education, problem solving, storytelling, guest speakers, self-appraisal, and personal

improvement projects. As for social media, Quit the Stick has a focus on Instagram, Facebook,
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and text messages. Theater includes situational scenarios and role playing. This allows the

adolescents to correct and improve their behaviors. Brainstorming includes strategizing possible

obstacles that they will encounter and how they should overcome them. In addition, cooperative

learning and group work includes discussions and sessions held weekly. Peer education includes

bringing peer advocates that have successfully quit nicotine. Problem solving includes

implementing the brainstormed strategies into their daily routines. Storytelling includes sharing

thoughts, past experiences, fears, and or anything in relation to nicotine during discussion and

sessions. As for guest speakers, Quit the Stick will bring in physicians and counselors to

communicate with the program’s adolescents. Self appraisal is acknowledged during graduation

in Session 8. Adolescents are appraised for finishing and or improving their smoking behaviors.

Lastly, personal improvement projects include self reflection through weekly journal entries that

the participants will do on their own time.

Session 1

Session 1 of Quit the Stick will take place a week after the presentation was given in

class. The educational session will involve a pre-program survey about smoking habits and any

prior knowledge they have about cessation, as well as an introduction to what the course will

look like over the following 19 sessions. The pre-survey will consist of their current smoking

behaviors, how often they smoke, how much they spend monthly on nicotine products, why they

smoke, and what they are looking to learn or identifying their goal through completing the

program. There will also be a variety of icebreakers and team building activities to begin the

building of friendships and supports systems to help each other through the process of quitting.

Quit the Stick staff will also hand out personal journals that will be used later in the program to

write about personal strategies for quitting, obstacles faced during the process and thoughts
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throughout as well. These journals will be an important tool used in discussion sections to reflect

on improvements made. Lastly, the research team will share our social media accounts and have

the participants sign up for the text messaging system. These are going to be very important tools

used throughout the program to bring the necessary information, as well as uplifting quotes to the

students outside of the weekly meeting times. This will give students a way to engage with

health educational specialists and continually receive information on how to successfully change

their smoking behaviors and make healthier lifestyle decisions.

Discussion 1

In Discussion 1, following Session 1, the research team will review the survey results

and compare the averages among all responses. These averages will be reevaluated at the end of

the program in order to show areas of improvement within the program. The research team will

discuss these results and the initial feelings that participants had about the program. After

completing this, Quit the Stick participants will engage a team bonding activity, where each

participants will write down a struggle or struggles that they have felt while trying to quit

smoking, or what caused them to smoke initially. An example of this is could be, “I feel stressed

with school so I smoke”. These statements will be identified anonymously within our program.

After drafting their struggles, each participant will receive a string. With the string, students will

tie a knot every time they relate to a particular statement read aloud by one of the health

education specialists. At the end of the activity, students will have a visual representation

showcasing how they face similar struggles and how they are not alone. The remainder of the

time within this discussion will be spent reflecting on the activity. The research team finds that

the first session and discussion are important for building a strong team among the participants
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of the program and establishing an environment where participants feel safe as well open to talk

about their feeling throughout the course of the program.

Session 2

Participants will listen to a presentation regarding the health effects of using nicotine

through smoking behaviors and will be able to analyze their own smoking behaviors. During this

presentation, a speaker will introduce the smoking health outcomes that one may face if they

continue to participate in this behavior. These will be presented with acute and chronic effects

regarding smoking, along with some of the risk factors. Images related to each disease or

physical change due to smoking will be incorporated into the overall presentation. Considering

that not all our participants are smokers, there will be information given in regards to the effects

that second-hand smoking can have on the body. Participants will also be given the opportunity

to participate in the presentation by naming some of the effects they believe smoking has on the

body.

Since the research team discovered through the literature review that nicotine dependence

is a main contributor to why adolescents struggle to quit smoking, part of the presentation will

focus on nicotine dependence (Mermelstein, 2003). During this section of the presentation,

participants will gain a better understanding of what nicotine dependence is and how they might

be exposed to it. At the end of the presentation, students will be given a clear definition of what

it means to be considered a smoker. This will help the students identify themselves as a smoker

and lead them to actively engage in cessation activities.

Discussion 2
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This discussion will build upon the previous session. There will be volunteer physicians

participating in the group discussion with students in regards to health outcomes associated with

smoking. This gives the students the opportunity to ask any questions that they may have had

during the presentation in a more intimate setting. After asking all lingering questions,

participants will have the opportunity to list possible obstacles that they feel could lie ahead and

fears that they have for upcoming sessions. These obstacles and fears will be recorded in their

personal journals and can be related to smoking or general struggles.

Session 3

In this session, participants will be able to utilize positive action planning in overcoming

obstacles they may face with quitting. Through this action planning, they will be able to

determine at least one alternative coping mechanism in a group setting and individual setting

which can involve peer pressure from friends or family, overall stress management from their

social environment and possible barriers based on an adolescents gender tendency. Various

positive coping mechanisms can include Meditating, Yoga (any form of desired exercise),

changing routines that can relate or lead to cravings, listening to music or seeking guidance from

a friend or family.

Discussion 3

During this discussion, participants will be divided into groups based on their background

obstacle they wish to overcome while trying to quit smoking, which include peer pressure, stress

management, and obstacles based on gender tendencies. During this discussion, Quit the Stick is

open to the idea of inviting guest speakers who are former smokers. Through their own
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experiences with smoking cessation, these former smokers are able to encourage adolescents and

motivate or inspire them to continue their path of quitting smoking.

Session 4

In this session, participants will be practicing strategies for overcoming obstacles that

were established in the previous session. This is a session that goes more into depth in regards to

developing the strategies and knowing how to recognize these obstacles beforehand.

This allows the adolescents to have a more positive outlook on quitting and become more aware

of the positives and negatives of their daily choices in lives that can lead to cravings or stress

related obstacles.

Discussion 4

In this discussion, adolescents will be able to discuss how these obstacles were presented

to them in Session 4 and what they did in the situation to overcome them. Through this, they are

able to analyze their action planning on areas they could improve on and how to recognize future

fears related to smoking cessation. This guided discussion will also have a panel from a guest

speaker who was a previous smoker who can talk about their own experiences in regards to

quitting and the obstacles they overcame.

Session 5

Within this session, Health Educators will work together in order to compose a skit to

depict the obstacles they’ve had to overcome in their lifetime. These obstacles can be related in

regards to peer pressure, current nicotine usage, influences, and their environment. Similarly,

health educators will dictate to their audience how they handled each obstacle within their life.

Whether that be with an outdoor activity, an alternative habit, or by having a positive

Quit the Stick Program Plan
24

influence/support system within their everyday life. Participants within Quit the Stick will then

evaluate the skits, acknowledging what each health educator did wrong and right within their

presentation. This way, students are able to identify obstacles as well as how to handle obstacles

in a positive way, rather than referring to nicotine or alternative negative methods.

Discussion 5

The discussion will be based on the previous session and contain more information for

participants on positive as well as negative solutions in regards to obstacles within their lives.

This enables students to not only ask questions in regards to obstacles, but to understand that

they are not alone. Everyone faces obstacles, due to the peer pressures from society, yet it is

ultimately an individual’s choice if they wish to give in. Student’s understanding of these

obstacles as well as their skit evaluations will be recorded within their personal journals in

relation to what they feel is an obstacle in their life.

Session 6

This session will focus on dealing with mental and physical health. Within this session

the research team would like to define what a healthy state of mind involves along with how to

become physically healthy. The desire to smoke can often stem from outside stressors or from

body image issues. Quit the Stick will focus on teaching participants how to recognize health

issues that can occur through this program or might already be present. The Quit the Stick team

will also discuss how participants can cope with these issues through physical health. Similarly,

the research team will also give tips in order to help participants strategize about how to maintain

a healthy state of mind and body.

Discussion 6
Quit the Stick Program Plan
25

In this discussion the program will discuss coping mechanisms that are considered

healthy when participants are presented with an obstacle or begin to feel symptoms such as

doubt. Participants will reflect on what they have been currently doing to cope. Quit the Stick

staff will hold group discussions so participants are able to gain insight in regards to new ideas as

well as coping in a healthy manner. Participants will also discuss how they will implement

physical activity as a way to cope with stressors. After this discussion, participants will set goals

on how they will respond when stressors or obstacles occur. Participants will strategize together

on what goals to set pertaining to specific scenarios that they could find themselves in.

Session 7

Session 7 has an overall focus on relapse and withdrawal as well as helping a friend quit

nicotine usage. This session stems off of previous sessions with applying coping mechanisms as

well as alternatives to smoking. This session allows adolescents within the program to discuss

possible symptoms: sweating, tingling in hands and feet, insomnia, cravings etc. and apply their

knowledge from Quit the Stick to their friends. The program participants can reflect on how

much they have learned throughout the program while attempting to inform their friends about

the harms of nicotine.

Discussion 7

During discussion seven, a guest counselor will attend in order to discuss possible relapse

symptoms and health issues. The counselor’s job is to inform and teach the adolescents the

negative health issues that nicotine has on the body. One main focus throughout this discussion is

to point out how dangerous a “slip” is in regards to a relapse. Also to point out the triggers of
Quit the Stick Program Plan
26

relapse: consuming alcohol, associating themselves with other smokers, sleep deprivation etc.

The counselor is prepared and ready to answer any health related issues stemmed from smoking.

Session 8

Session 8 has an overall focus on a post program survey and graduation ceremony.

Within this post survey, the adolescents are given the opportunity to compare their results and

recognize their personal improvements within their nicotine usage. Session eight will also hold a

graduation ceremony. The ceremony is held to congratulate and acknowledge adolescents for

completing the program and/or making improvements with their relationship to smoking.

Discussion 8

Discussion 8 is considered to be a graduation. This discussion will hold a potluck where

Quit the Stick staff and participants are able to celebrate and spend time with their fellow

graduates.

Program Implementation Plan

The Quit the Stick intervention program will utilize the specific target audience of ages

14-18 within both Sabino High School in Northeast Tucson as well as Tucson Magnet High

School in Central Tucson. Within both of these high schools, the research team will present the

program to both Physical Education classes and Health Education classes within the program.

During the initial presentation, Quit the Stick staff will provide consent forms for students to take

home in order for parents to sign so that students are able to participate and receive the necessary

course credit. After the presentation, the research team will encourage students to sign up for the

program as an alternative to Physical Education or Health Education classes.

Quit the Stick Program Plan
27

In regards to finding channels to advertise the program, the research team feels that they

can effectively recruit the target population by the use of social media. Accounts such as

Facebook and Instagram have a large impact on high school aged students, due to the tech-savvy

generation society has become. Quit the Stick feels that by establishing a social media presence

within the program, staff will have the ability to create content that is both inspirational and

informational for the program participants. Quit the Stick will set up a text message system in

order to send uplifting and inspirational messages to the participants, updates about

informational sessions, as well as reminders about their homework or ‘journaling’ assignments.

In order to distribute the health education services and benefits, Quit the Stick has decided to use

methods such as skits, PowerPoints, interactive activities, educational videos, a social media

presence, personal journals, and logs of smoking behavior.

From May to July of 2020, the Quit the Stick staff will need to be trained as well as

prepared for the launch of the program in August of 2020. Staff will need to have established

both a social media presence within the program as well as prepare the materials needed for the

initial presentation in the beginning of August 2020. In order to fulfill the programs objectives,

Quit the Stick staff will use a classroom as a facility as well as a projector for PowerPoint

presentations. Quit the Stick staff will also need a whiteboard within a classroom setting, due to

the nature of the program and the activities are set up for participants.

The Quit the Stick program will go through a pilot testing period in order to try out the

educational materials on the targeted audience. The research team will run a sample educational

session and discussion session at five schools within the two school districts of Central and

Northeast Tucson. This will be a two week pilot and participants will have the opportunity to

continually give feedback during both sessions. After completing the pilot session, students will
Quit the Stick Program Plan
28

be given the opportunity to fill out a post-pilot survey in regards to their thoughts and

experiences based on what they learned. The program will be piloted in one Physical Education

and one Health class at each school. With an average of 30 students per class, the pilot will

involve around 300 participants. This will give the research team a decent amount of feedback in

order for the program administrators to reevaluate and edit the program. This will ensure that the

program is tailored to the specific target audience by August 2020 when the program is set to be

implemented within Sabino High School and Tucson Magnet High School.

The timeline below gives a brief explanation of the dates for the program piloting and

preparation. Quit the Stick staff has written and edited this in order to help the staff accomplish

the set goals in regards to the program.

Program Piloting and Preparation Timeline

● January 2020 approval from TUSD and TVSD school board for program implementation

● May 2020 Pilot testing at 5 schools

● May 2020 create and market program social media

● June 2020 compile pilot results and edit program

● June-July 2020 Recruit health education specialists, physicians, and volunteers to

participate in the program

● June- July 2020 gather program materials and create all activities

● July 2020 finalize educational session and discussion course plans

● August 2020 finalize initial presentation for recruiting students

Programming

● August 2020 present at schools and market program/social media

● September 2020 program total implementation

Quit the Stick Program Plan
29

● December 2020 program completion

● January 2022 data collection and analysis

● February 2022 data analyzation complete

● February - May 2022 program editing and updating

Program Evaluation Plan

For Quit the Stick, a Pima County health education specialist will be responsible for

designing a cessation program for adolescents participating in nicotine use through smoking

behaviors. To document the success and effectiveness of our program, an external health

educational specialist evaluator who has worked with smoking cessation will be hired to report

all findings regarding the program and staff effectiveness. The research team wanted the most

accurate program evaluation and therefore, chose an external evaluator to eliminate any potential

bias. With the external evaluator being implemented in Quit the Stick, there are three main

evaluations that will be conducted: Process, Impact, and Outcome. These evaluations will be

engineered during the spring after Quit the Stick has been implemented for two years.

Evaluation Objectives

Process Evaluation

Administrative Objective A

● By June 2020, the research group will receive feedback from the pilot program that will

be assessed by a program evaluator and will be incorporated into Quit the Stick.

Administrative Objective A Evaluation

Depending on the program evaluation, Quit the Stick specialists will administer and alter the

program as needed. The external program evaluator will use the surveys implemented in the

program to identify the impact on their behavior.

Quit the Stick Program Plan
30

● The external program evaluator will gather all relevant data from the program to confirm

that Quit the Stick has attracted adolescents between ages 14-18 and has had an impact

on their behavior.

Administrative Objective B

● By July 31, 2020, certified health educators will be hired for Quit the Stick.

Administration Objective B Evaluation

This conference will discuss the health educator’s experience with nicotine and have them

explain why they are suitable educators for adolescents ages 14-18. From there, the program

creators will pick eligible health educator’s.

● The external program evaluator will assess certified health educators by confirming

credentials as health educators as well as scheduling a conference.

Administrative Objective C

● By August 1, 2020, all guest lecturers for Quit the Stick will be recruited and scheduled.

Administrative Objective C Evaluation

The content provided by the guest lecturers will be approved to assure that it is appropriate for

adolescents age 14-18. When all guest lecturers are recruited, the program creators will cross

reference their personal schedules with Quit the Stick.

● The external program evaluator will assess the content provided by the guest lecturers

and discuss any scheduling conflicts. If conflicts arise, alternative scheduling dates will

be administered within Quit The Stick.

Administrative Objective D

● By the first week of August 2020, Quit The Stick will have recruited a minimum of 60

students per school district to participate in the program.

Quit the Stick Program Plan
31

Administrative Objective D Evaluation

Quit the Stick will post flyers around the school along with host a pilot program in order to

recruit students to participate in the program. Students will sign up on a sheet during the pilot

program so the number of participants can be approved by the evaluator.

● The external program evaluator will approve that 60 students is a sufficient sample size to

implement Quit the Stick in both Sabino High School and Tucson Magnet High School.

Once the sample size is approved, the external program evaluator will examine if Quit the

Stick offers an appropriate amount of materials.

Impact Objective

Learning Objective A

● By August 21, 2020, participants involved with Quit the Stick will be able to identify the

common health outcomes associated with nicotine use through smoking behaviors.

Learning Objective A Evaluation

The Quit the Stick program will incorporate a pre and post program survey that shows the

improvement of education and smoking behaviors among its participants. During the biweekly

discussion sections there will also be guided conversations. In the survey and the discussion, the

health education specialists will be able to monitor the participants’ understanding of health

outcomes through these methods. The evaluator will review Quit the Stick’s discussions and

approve that the staff has gained adequate knowledge for the students to do so.

● The external program evaluator will approve that August 21, 2020 is a sufficient amount

of time for the program’s adolescents to identify the common health outcomes associated

with nicotine use through smoking behaviors.

Learning Objective B
Quit the Stick Program Plan
32

● By August 21, 2020, 75% of participants will be able to define characteristics of

nicotine dependence.

Learning Objective B Evaluation

In order to track the characteristic of nicotine dependence, Quit the Stick staff will hold guided

discussions followed by Q&A’s on adolescents knowledge of main factors of nicotine

dependence including discussion on physical and mood altering effects nicotine has on the brain

and body.

● The external program evaluator will approve that Quit the Stick has provided adolescents

with sufficient information in order to change nicotine dependent habits.

Learning Objective C

● By October 30, 2020 at least 50% of adolescent nicotine users participating in the weekly

cessation program will be able to recognize at least three more effective stress coping

mechanisms instead of the use of nicotine products.

Learning Objective C Evaluation

In order to track the participation of adolescent nicotine users within the program, participants

will have to comprehend as well as understand effective stress coping mechanisms. Health

education instructors will present these mechanisms as well as help students further understand

that there are multiple ways to cope with stressful scenarios in their everyday lives.

● The external program evaluator will determine if Quit the Stick health specialist are

aware of affective stress coping mechanisms when informing the adolescents.

Learning Objective D

● By the completion of the program in December 2020, 80% of participants will be able to

develop two group and individual strategies to quit smoking.

Quit the Stick Program Plan
33

Learning Objective D Evaluation

The health education specialists will be able to identify how many of the participants will be able

to develop strategies for smoking cessation by the end of the program through the use of the post

program survey. This survey will help identify the level of participant’s understanding and

application into their personal smoking behaviors.

● By the end of the program, the external program evaluator will be able to measure if the

completion date is an adequate amount of time for participants to develop two group

strategies as well as individual strategies to quit smoking.

Behavioral Objective A

● By December 2020, 75% of participants in Quit the Stick program will report specific

stress mechanisms implemented into their daily routine.

Behavioral Objective A Evaluation

The external program evaluator will address if the stress mechanisms taught during class

acknowledges various lifestyles among the program’s adolescents. This information will be

gathered through the post and pre surveys given throughout the program.

● The external program evaluator will address if the stress mechanisms taught are realistic

and attainable to fulfill within a daily routine.

Behavioral Objective B

● By October 2020, 90% of participants in Quit the Stick will report 3-5 journal entries per

week.

Behavioral Objective B Evaluation

Journal entries will be discussed during the discussions sessions. The content during the time can

be evaluated by the external evaluator during the first discussion in order to determine if sharing
Quit the Stick Program Plan
34

of the journal entries should be continued. Quit the Stick will take into consideration the

evaluators input after consideration of the participants vulnerability to share their entries.

● The external program evaluator will determine if journal entries are appropriate to

implement in Quit the Stick. This will take into consideration the emotions and

willingness to share during the program’s discussions.

Behavioral Objective C

● By October 2020, 80% of participants will report reducing their monthly costs spent on

nicotine products by at least 50%.

Behavioral Objective C Evaluation

The external evaluator will use the pre and post survey to acknowledge the comfort among

program participants. The evaluator will see any additional comments within the comments box.

● The external program evaluator will acknowledge the comfort among program

participants when conversing about financial matters in a group environment.

Environmental Objective A

● By September 30, 2020, 90% of the students attending Sabino High School and Tucson

Magnet High School will have access to recreational activities as stress outlets.

Environmental Objective A Evaluation

The external program evaluator will attend Pima County public meetings where they will assess

the willingness of them to contribute. Pima County officials will be given materials to vote on

creating recreational activities.

● The external program evaluator will assess Pima County committees willingness to offer

and expand the adolescent’s ideas of recreational activities as stress outlets.

Environmental Objective B
Quit the Stick Program Plan
35

● By October 2020, 70% of the participants can identify a support system within their

social environment.

Environmental Objective B Evaluation

The team building exercises implemented in the program are designed to build a support system

within the program. The health education specialists will hold discussions as well as offer

counseling services to the participants in the program. Through these discussion the education

specialists will be able to identify how many students feel they have a support system to help

them through the cessation process.

● The external program evaluator will confirm that Quit the Stick gives adolescents a

support system if the student does not present one.

Outcome Objective A

● By January 1, 2020, the rate of nicotine use among adolescents participating in Quit the

Stick will decline by 65%.

Outcome Objective A Evaluation

The external program evaluator will measure how many of the adolescents have reduced nicotine

use by giving a community survey. They will also pull data from Pima County’s database to

compare the number of adolescent who have stopped this behavior.

a. The external program evaluator will report the percentage of adolescents ages 14-18 in

the Tucson Unified School District and Tanque Verde District that have reduced nicotine

use.

Methods

The methods used for the process evaluation include focusing on sample sizes,

credentials, and scheduling conflicts. Sample size will be regulated through the enrollment of the
Quit the Stick Program Plan
36

class within their school schedule. Credentials will be cross referenced with state laws. Lastly,

scheduling conflicts will be comparing Quit the Stick’s schedule to the guest lectures personal

schedule.

The methods used for the impact evaluation was divided into: learning, behavioral, and

environmental. As for learning, there was an overall focus on: timeframe and the information

presented. In regards to time frame, the method was based off of the external evaluators

judgment. The method for evaluating the information presented was comparing the information

to accurate health manuals and books published. Furthermore, behavioral aspects were focused

on the information’s appropriateness and attainability. The method for judging the

appropriateness and attainability was based off of the external evaluators judgments as well as

feedback from the adolescents in the pilot test. Lastly, the environmental aspect had a focus on

the cooperation from Pima County and establishment of support systems. The method for the

Pima County co-operation was to attend the facilities and discuss their willingness to participate

in Quit the Stick. The method for evaluating the support system was to base off the pilot testing

experiences.

The methods used for evaluating the outcome of Quit the Stick was to look at all

feedback and results provided by the program participants.

Timeline

The timeline is ordered respectively to the objectives listed above.

Quit the Stick Program Plan
37

Figure 2. Timeline for Program Evaluation

Evaluation Tools

The evaluation tools will be given to the external program evaluator during each session

and discussion to evaluate the content presented. The external program evaluator will then use

the program evaluation form to assess the material presented during each session and discussion.

Depending on the comments and feedback given on this form, the program creators will make

any needed adjustments.

Quit the Stick Program Plan
38

Figure 3. Program Evaluation Form

Reports

The audience receiving the external program evaluators report will be Quit the Stick

program creators. This report ranges from very satisfied to unsatisfied. Depending on the

severity of the evaluators comments/remarks, Quit the Stick creators will adjust accordingly. The

external program evaluator will deliver the report to the appropriate audience. This report will be
Quit the Stick Program Plan
39

delivered by March 1, 2022. This gives the program creators enough time to make adjustments

before the next start date in August 2022.

Quit the Stick Program Plan
40

References

Adelman, W. P., Duggan, A. K., Hauptman, P., & Joffe, A. (2001, April 01). Effectiveness of
a High School Smoking Cessation Program. Retrieved from
http://pediatrics.aappublications.org/content/107/4/e50.full

Arizona Department of Health Services, 2012 Youth Smoking in Pima County [PDF file]
retrieved from https://azdhs.gov/documents/prevention/tobacco-chronic-disease/
tobacco-free-az/resources/btcd/youth-smoking-pima-county.pdf

AZDHS, (2013). Youth Smoking in Pima County. Retrieved from

https://azdhs.gov/documents/prevention/tobacco-chronic-disease/tobacco-free
az/resources/btcd/youth-smoking-pima-county.pdf

Balch, GI. (1998) Exploring Perceptions of Smoking Cessation among High School
Smokers: Input and Feedback from Focus Groups. Preventive Medicine. 27 (5): A55
A63. https://doi.org/10.1006/pmed.1998.0382

CDC. (2018). Not On Tobacco (NOT)—Smoking Cessation Program for 14–19 Year Olds
Selected as a Model Program. Retrieved from https://www.cdc.gov/prc/pdf/not
on tobacco-smoking-cessation.pdf

Center for Disease Control and Prevention. (2017). Health Effects of Cigarette Smoking.
Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/
health_effects/effects_cig_smoking/index.htm

City of Tucson. (2018) Community Resources. Retrieved from

https://www.tucsonaz.gov/welcome-tucson/community-resources

Data USA. (2018). Pima County, AZ. Retrieved 2018, from https://datausa.io/profile/geo/pima
county-az/

Difranza, J. R., Rigotti, N. A., McNeil, A. D., Ockene, J. K., Savageau, J. A., Cyr, D.,
& Rodgers, A. (2008).). Initial symptoms of nicotine dependence in adolescents.
Tobacco Control, 9(3), 313-319. doi:10.1136/tc.9.3.313

Mermelstein, R. (2003). Teen Smoking Cessation. Teen Smoking Cessation, 12(1), 25-24
Nichter, M., Nichter, M., Vuckovic, N., Quintero, G., & Ritenbaugh, C. (1997). Smoking
experimentation and initiation among adolescent girls: Qualitative and quantitative
findings. Tobacco Control, 6(4), 285-295. doi:10.1136/tc.6.4.285
Quit the Stick Program Plan
41

Parker, S. (2013). The Practice and Process of Health Education in Health Promotion.
Dubuque: Kendall Hunt Publishing Company.

Pima County. (2018). Retrieved from http://webcms.pima.gov/

Prokhorov, A. V., Pallonen, U. E., Fava, J. L., Ding, L., & Niaura, R. (1996). Measuring
nicotine dependence among high-risk adolescent smokers. Addictive Behaviors, 21(1),
117-127. doi:10.1016/0306-4603(96)00048

Siegel, J. T., & Alvaro, E. M. (2006). An Evaluation of Arizona’s Youth Tobacco Access
Prevention Media Campaign. American Journal of Preventive Medicine, 30(4), 284
291.doi:10.1016/j.amepre.2005.11.008

Smoking & Tobacco Use. (2018, June 25). Retrieved December 3, 2018, from
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index
htm

Tobacco Control State Highlights 2012. (2014, December 8). Retrieved December 3, 2018,
from https://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2012/
index.htm

Truth Initiative. (2018, June 29). 2018 Arizona tobacco use fact sheet. Retrieved from
https://truthinitiative.org/tobacco-use-arizona

U.S. Census Bureau. (2017). U.S. Census Bureau QuickFacts: Pima County, Arizona.
Retrieved from https://www.census.gov/quickfacts/pimacountyarizona

U.S Department of Health and Human Services. (2015). Arizona Adolescent Substance Abuse
Facts. Retrieved from https://www.hhs.gov/ash/oah/facts-and-stats/national-
and-state-data-sheets/adolescents-and-substance-abuse/arizona/index.html

U.S. News and World Report - Education. (2015). Sabino High School in Tucson, AZ.
Retrieved from https://www.usnews.com/education/best-high
schools/arizona/districts/tucson-unified-district/sabino-high-school-1120

U.S. News and World Report - Education. (2015). Tucson Magnet High School in Tucson, AZ.
Retrieved from
https://www.usnews.com/education/best-high-schools/arizona/districts/tucson-unified-
district/tucson-magnet-high-school-1123
Quit the Stick Program Plan
42

Whittaker, R., Maddison, R., McRobbie, H., Bullen, C., Denny, S., Dorey, E., Pegler, ME.,
Rooyen, JV., Rodgers, A. (2008). A Multimedia Mobile Phone-Based Youth Smoking
Cessation Intervention: Findings from Content Development and Piloting Studies. JMR
Publications. 10(5):e49. Doi: 10.2196/jmir.1007
Quit the Stick Program Plan
43

Appendix A
Quit the Stick Cessation Program 2020
Consent Form

The mission of Quit the Stick Cessation Program in Pima County is to help encourage
adolescents age 14-18 to seek healthy coping mechanisms through guided discussions,
counseling, along with advice from mentors in order to adopt a healthy lifestyle including
nicotine cessation. This program will be a 20 week program implemented in both Sabino High
School and Tucson Magnet High School. These 20 weeks will be divided into an introductory
presentation on the first week, followed by 8 sessions, and 11 discussions. The discussions
will cover the material presented in the previous session. Our goal is to reduce the rate of
nicotine use among adolescents 14-18 years old in Central and Northeast Tucson. To help the
research team reach this goal, there will be various methods and objectives implemented
throughout the program.

There will be a pre-test and post-test conducted throughout the duration of the program. The
pre-test will consist of 10 questions. The pre-test will be given to the participants at the
beginning of the program and the post-test will be given at the completion of the program.
The survey is expected to take approximately 15 minutes each.

Participants information will remain confidential throughout the duration of the program.
Participants have the right to withdraw from the program at any time. Further questions about
Quit the Stick can be directed to the program director at (520) 345-6789.

I, _____________________, (legal guardian) agree to allow ______________ (participant) to

engage in Quit the Stick sessions and discussions. I _________ (participant) understand that I
can withdraw from the program at any time.

_______________(Guardian Name) _________________ (Participant Name)

________________ (Guardian Signature) __________________ (Participant Signature)

Quit the Stick Program Plan
44

Appendix B
Quit the Stick
Pre-Survey
2020

Thank you for participating in Quit the Stick and taking the pre-survey. This pre-survey will
allow Quit the Stick staff to obtain knowledge and information about the attitudes towards
nicotine use through smoking behaviors. This survey is expected to take 15 minutes and
encourage you to leave any comments or questions.

1. I am a
○ Female
○ Male
○ Do not wish to answer
2. How old are you?
○ 14
○ 15
○ 16
○ 17
○ 18
3. What grade are you in?
○ 9th grade
○ 10th grade
○ 11th grade
○ 12th grade
4. What is your race/ethnicity? (select all that apply)
○ White
○ Hispanic/Latino
○ American Indian/Alaska Native
○ Asian
○ Black or African American
○ Native Hawaiian/Other Pacific Islander
○ Do not wish to answer
5. Have you ever used nicotine through smoking behaviors (cigarettes, e-cigarettes,
Juuls, cigars, etc)?
○ Yes
○ No
6. If yes, how often do you engage in these behaviors?
○ Only tried once
○ Once a week
○ 2-5 times a week
Quit the Stick Program Plan
45

○ >5 times a week

7. What do you consider to be a smoker? Someone who smokes
○ Once a year
○ Once a month
○ Once a week
○ > once a week
8. How often in the past 30 days have you experienced some form of stress?
○ Never
○ 1 or 2 days
○ 2 - 5 days
○ >5 days
9. How many times did this stress lead you to use nicotine through smoking behaviors?
○ Once
○ Twice
○ 3-5
○ >5
10. List two stress coping mechanisms that does not involve nicotine use.
____________________________________________________________________________
____________________________________________________________________________
Quit the Stick Program Plan
46

Appendix C
Quit the Stick
Post-Survey
2020

Thank you for participating in Quit the Stick and taking the post-survey. This post-survey will
allow Quit the Stick staff to make necessary adjusts to the program for future participants.
This survey is expected to take 15 minutes and encourage you to leave any comments or
questions.

1. I am a
○ Female
○ Male
○ Do not wish to answer
2. How old are you?
○ 14
○ 15
○ 16
○ 17
○ 18
3. What grade are you in?
○ 9th grade
○ 10th grade
○ 11th grade
○ 12th grade
4. What is your race/ethnicity? (select all that apply)
○ White
○ Hispanic/Latino
○ American Indian/Alaska Native
○ Asian
○ Black or African American
○ Native Hawaiian/Other Pacific Islander
○ Do not wish to answer
5. Have you ever used nicotine through smoking behaviors (cigarettes, e-cigarettes, Juuls,
cigars, etc)?
○ Yes
○ No

6. How do you feel that your outlook on nicotine use through smoking behavior has changed?
____________________________________________________________________________
_________________________________________________________________________
Quit the Stick Program Plan
47

7. List four health outcomes of nicotine use through smoking behaviors?

____________________________________________________________________________
____________________________________________________________________________

8. List three stress coping mechanisms that Quit the Stick has taught you.
____________________________________________________________________________
____________________________________________________________________________

9. Would you recommend Quit the Stick to friends and family? Please circle one

Yes No

Why?
____________________________________________________________________________
____________________________________________________________________________

10. Do you have any recommendations to improve Quit the Stick?

____________________________________________________________________________
____________________________________________________________________________

11. Do you think this program has the ability to help adolescents across the country?
____________________________________________________________________________
____________________________________________________________________________
Quit the Stick Program Plan
48

Appendix D
Quit the Stick
Post-Pilot Survey
2020

Thank you for participating in Quit the Stick and taking the post-pilot survey. This post-pilot
survey will allow Quit the Stick staff to make necessary adjusts to the program for future
participants. This survey is expected to take 15 minutes and encourage you to leave any
comments or questions.
1. I am a
○ Female
○ Male
○ Do not wish to answer
2. How old are you?
○ 14
○ 15
○ 16
○ 17
○ 18
3. What grade are you in?
○ 9th grade
○ 10th grade
○ 11th grade
○ 12th grade
4. What is your race/ethnicity? (select all that apply)
○ White
○ Hispanic/Latino
○ American Indian/Alaska Native
○ Asian
○ Black or African American
○ Native Hawaiian/Other Pacific Islander
○ Do not wish to answer
5. Would you recommend Quit the Stick to be implemented in two different high school?
Why?
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6. Do you have any suggestions to make this program better?

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