摘要：Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths’ smoking prevalence. Cigarette smoking remains the leading cause of premature morbidity and mortality in the United States. 1 Recent data from Monitoring the Future, a national survey of secondary school students, show an overall smoking prevalence of 24% among 12th-grade students; among students who do not plan to attend a 4-year college, the prevalence is 36%. 2 Because students often initiate smoking between grades 6 and 7 (between ages 11–13), many high school-aged smokers have well-established addictions to tobacco. 2 Although young smokers are motivated to quit, quit rates among youths are low. 3 – 5 In the 2003 Youth Risk Behavior Surveillance Survey, 54% of current young smokers reported an unsuccessful quit attempt in the previous year. 6 Unfortunately, the vast majority of these quit attempts occurred without the support of evidence-based tobacco cessation treatments, such as group programs, telephone quit lines, or pharmacotherapy. 7 , 8 The number of published studies of tobacco cessation treatments in youths remains small. To date, the most comprehensive description of cessation programs for youths is Sussman’s review of 66 program evaluation studies. 9 All of the programs described were part of research studies, and the review concluded that data suggest a doubling of cessation rates with cessation interventions for adolescents; methodological limitations across studies precluded definitive estimates of program effectiveness. A recent evidence review panel identified only 20 studies from the Sussman review that were of sufficient rigor to inform recommendations. 10 The panel concluded that programs with cognitive-behavioral components show the most promise for increased quit rates. 10 Recent randomized trials report no significant differences among different types of treatment (e.g., self-help materials with and without telephone counseling 11 or behavioral treatment and nicotine replacement with and without bupropion 12 ); these studies generally do not include untreated control groups. There is evidence from controlled studies that young smokers receiving active treatment quit smoking or reduce their smoking at higher rates than untreated controls. 13 , 14 In 2000, the Youth Tobacco Cessation Collaborative, 15 a group of public and private organizations committed to increasing the availability of effective youth cessation programs, released its National Blueprint for Action: Youth and Young Adult Tobacco-Use Cessation, which outlines a series of strategic objectives to ensure that every tobacco user aged 12 to 24 years has access to effective cessation treatments by the year 2010. 16 Prompted by the work of the Youth Tobacco Cessation Collaborative, The Robert Wood Johnson Foundation, with additional support from the National Cancer Institute and the Centers for Disease Control and Prevention, recruited the Institute for Health Research Policy at the University of Illinois at Chicago to launch Helping Young Smokers Quit, a national 3-phase initiative to identify best practices in tobacco cessation for youths. 15 In phase 1 of Helping Young Smokers Quit, the purpose was to profile a national sample of existing tobacco cessation programs for youths to understand their prevalence and overall characteristics.
