School-level disadvantage and failed cessation treatment among adolescent smokers

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dc.contributor.authorHorn, Kimberly A.en
dc.contributor.authorAli, Malihaen
dc.contributor.authorGray, Tiffanyen
dc.contributor.authorAnesetti-Rothermel, Andrewen
dc.contributor.authorBranstetter, Steveen
dc.date.accessioned2019-06-03T21:03:12Zen
dc.date.available2019-06-03T21:03:12Zen
dc.date.issued2018en
dc.description.abstractINTRODUCTION While understanding factors that lead to successful adolescent smoking cessation outcomes is necessary, it is also prudent to determine factors and conditions that contribute to failure to quit smoking. The present study posits that adolescents’ proximal environments, such as schools, may influence cessation treatment outcomes. METHODS Using aggregated and geographically-referenced data from multi-year school-based cessation trials with 14-19 year olds seeking cessation in 5 States of the USA, the present study developed and applied a tobacco-specific socio-spatial model inclusive of Hierarchical Linear Modeling. Specifically, this novel approach spatially joined individual data files (n=8855) with measures of school (n=807) and county socio-economic factors. Once linked multi-level analyses explored the extent to which cessation treatment failure was explained by the interplay of individual, school and county-level factors. Treatment was deemed as failing to meet its primary goals if participants continued to smoke cigarettes, measured 3-months post baseline. RESULTS Ten per cent of the variation in cessation treatment failure was attributable to school-level variables. Adolescent smokers were more likely to experience failure to quit in: a) school districts with large percentages of the population having less than high-school education, and b) schools with a higher ratio of students to teachers. The strength of the relationship between cessation self-efficacy and treatment success was further weakened among adolescents attending schools with higher percentages of students eligible for free or reduced lunch programs. CONCLUSIONS Findings implicate school-level socio-economic disadvantage as a significant factor inhibiting cessation, regardless of adolescent self-efficacy to quit smoking. Understanding the interplay of proximal school environments and individual-level factors may provide insights to educators, policy makers and practitioners into the complexities that inhibit or strengthen an adolescent’s smoking cessation treatment experience.en
dc.format.extent13 pagesen
dc.format.mimetypeapplication/pdfen
dc.identifier.doihttps://doi.org/10.18332/tpc/87074en
dc.identifier.urihttp://hdl.handle.net/10919/89730en
dc.identifier.volume4en
dc.language.isoenen
dc.publisherEU European Publishingen
dc.rightsCreative Commons Attribution-NonCommercial 4.0 Internationalen
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/en
dc.subjectadolescentsen
dc.subjecttobacco useen
dc.subjectcessation behavioren
dc.subjectschool-level determinantsen
dc.subjectsocio-spatial modelen
dc.titleSchool-level disadvantage and failed cessation treatment among adolescent smokersen
dc.title.serialTobacco Prevention & Cessationen
dc.typeArticle - Refereeden
dc.type.dcmitypeTexten

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