From OncoLog, June 2005, Vol. 50, No. 6
Teen-Savvy Smoking Prevention
by Karen Stuyck
When most people hear the words “smoking prevention,” they don’t think of computer games. But ASPIRE is just that—an interactive multi-media CD-ROM used as part of a curriculum to convince teenagers to stop smoking—or better yet, never start.
ASPIRE (“A Smoking Prevention Interactive Experience”) provides smoking cessation awareness for high school students using captivating graphics and a video game feel. The program was originally designed as a research project in Houston-area schools, but portions of the program are now available online (www.mdanderson.org/aspireonline) for kids to access any time, according to the project’s creator, Alexander Prokhorov, M.D., Ph.D., an associate professor in the Department of Behavioral Science at The University of Texas M. D. Anderson Cancer Center.
“Student response to the program was overwhelming,” he said. “Now that we’ve completed the study, we’re eager to let parents, teachers, and most of all, teens, know that help is available.”
ASPIRE’s interactive multi-media CD-ROM includes quizzes, a video game, animated scenarios, and videos of other teenagers confronting smoking dilemmas. ASPIRE shows students why smoking is harmful and offers specific help on how to stop. Each part of the curriculum is modified for individuals, depending on how they answer questions about their behavior and attitudes toward smoking. Once the student’s stage of readiness to change is identified, ASPIRE offers eight educational tracks to meet the students’ individual needs. Thus, someone who is only thinking about starting to smoke would see different scenarios and get different information than another student who is already smoking and not sure that he wants to quit.
While young people are a notoriously difficult audience for stop-smoking programs, they are an important group to reach since 90% of smokers start smoking before age 18. Part of the problem in interesting younger smokers in quitting is that young people tend to think of themselves as invincible. “Younger smokers usually don’t yet have smoking-related physical problems, and telling them that smoking increases their chances of dying of lung cancer at 40 or 50 just doesn’t work,” Dr. Prokhorov said. “In addition, adolescent smokers often don’t want their parents to know that they smoke.”
Different approaches are needed to reach younger smokers than those traditionally used with adults. Lung cancer statistics, for instance, may not be compelling to these students, but they are very interested in how smoking may affect their athletic performance or how it can lead to impotence, infertility, or complications during pregnancy—factors that might affect them now or in the near future.
Increasingly, M. D. Anderson researchers are designing tobacco cessation programs for specific populations. Realizing that different groups of people respond to stop-smoking programs in different ways, the scientists tailor clinical trials to determine the best approach for each audience. Recent stop-smoking research projects, for instance, have focused on pregnant women, teenagers, Spanish-speaking people, and college students. Several of Dr. Prokhorov’s smoking cessation projects are designed for young people; ASPIRE, for instance, is targeted specifically for high school students.
The video game component of ASPIRE has players making a journey up a steep mountain to find their place on Mount Aspire. Along the way, students reach Decision Point, Commitment Peak, Action Steppes, Perseverance Gorge, Balance Bluff, Temptation Quarry, and Independence Overlook. Each stopping place on the mountain gives students a variety of information and a chance to make decisions. At Temptation Quarry, for instance, they learn that the three main motivations for teen smoking are social reasons, addiction, and mood alterations such as calming down or help in coping with difficult situations.
Three animated monkeys show how to stop smoking using the three R’s: Recognize what kinds of things tempt you to smoke, such as a specific time of day or being around certain types of people; Remember why you want to quit, such as wanting to be a better athlete or deciding “I want to respect Number One”; and React to the situation without smoking.
Furthermore, students are able to interact with the program and find myriad ways to cope with their own specific temptations. For instance, if a teenager is having a hard time dealing with social pressures such as smoking at parties or not knowing what to say when friends offer a cigarette, he can click the icon with this temptation on the screen. In a variety of scenarios—videos of other teens discussing the issue, an animated ballpark stand where each character has a different phrase on how to say no if friends are pressuring him to smoke—he can pick up ideas.
The student learns that it’s smart to avoid situations where people are smoking. But if friends are smoking around him, it’s a good idea to have phrases ready. Maybe he’ll want to ask for support: “Dude, I’m trying to quit smoking. Do you mind?” Or perhaps she’ll opt for being direct (“It’s not my thing.”), changing the subject (“Want a carrot?”), or using humor (“No way, man. Cigarettes kill trees. Smoke veggies, not cigarettes.”) The coping devices, illustrated by other kids implementing the approaches, include having positive plans, using humor, being smart, ignoring the invitation to smoke or changing the subject, being direct, and asking for support.
About 1,600 students from Houston-area high schools completed the ASPIRE program. Eighteen months after completing the program only 2% of ASPIRE students had become new smokers, compared with 6% of a control group. “We showed that the program changes kids’ perceptions of tobacco,” Dr. Prokhorov said. “It increases their self-efficacy in quitting smoking or in not starting.”
Dr. Prokhorov’s passion to help young people give up or avoid smoking has not stopped with high school kids. Another study is designed to help college students quit smoking by having them look at their own health and by showing them how smoking has affected their lung and bronchial function.
“We tried to make ‘invulnerable’ students feel more vulnerable,” he said. Using spirometry, a lung function test, students can see the age of their lungs. “Quite a lot of the students who smoked exhibited decreased lung function, which frequently translated into a 19-year-old having the lungs of a 30-year-old,” Dr. Prokhorov said. A carbon monoxide meter showed students how smoking increases their carbon monoxide level, which adversely affects athletic performance. Students who later quit smoking were happy to see their individual respiratory symptoms improve, their carbon monoxide levels go down dramatically, and their lung age decrease.
“Students were intrigued by the program; it held their interest,” Dr. Prokhorov said. “Many student participants said they would recommend the program to friends and family members.”
Dr. Prokhorov’s group is now developing a Web-based smoking cessation program specifically for middle school students. The program will use some elements of ASPIRE such as quizzes, games, flash animation, and video clips. “We want this program to be edgy, full of animation and videos,” Dr. Prokhorov said. He hopes that an adolescent, for instance, who feels pressured to try smoking, can go to the ASPIRE program on the Internet and choose from menu options to see how to cope. Since the program can be accessed at any time, Dr. Prokhorov hopes this “cyber support” will help make a real difference in teens’ attitudes toward smoking.
For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.
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