Project EX

Project EX is a school-based smoking-cessation clinic program for adolescents that stresses motivation, coping skills, and personal commitment. Consisting of eight 40- to 45-minute sessions delivered over a 6-week period, the program curriculum includes strategies for coping with stress, dealing with nicotine withdrawal, and avoiding relapses. Project EX uses engaging and motivating activities such as games and yoga to reduce or stop smoking among adolescents and teach self-control, anger management, mood management, and goal-setting techniques. Adolescents are provided with accurate information about the social, emotional, environmental, and physiological consequences of tobacco use. The first three sessions are intended to prepare students for an attempt at quitting smoking, which should take place between sessions 4 and 6. The remaining sessions are designed to maintain quit status and enhance quit attempts. Project EX clinics operate during school hours. Each clinic group can accommodate 8 to 15 students.

The goal of this program is to reduce or stop smoking among adolescents.

At 3-month follow-up, 17% of youths in the treatment conditions reported having quit smoking for at least 30 days, compared with only 8% of those teens in the control condition. These positive effects were also demonstrated when moved from a clinic setting to the classroom, as students in the program condition experienced a greater reduction in weekly smoking and monthly smoking, at 6-and-12-month follow-ups.

The Project EX program has been evaluated on several occasions and with a variety of methods. The main trial of Project EX (EX-1) tested the original eight-session, school-based cessation clinic program using a three group experimental design: 1) clinic-only, 2) clinic plus a school-as-community (SAC) component, and 3) standard care control. Three other evaluations of the program have been conducted. Project EX-2 tested generalizability of the program in Wuhan, China; Project EX-3 was a randomized trial that used the addition of nicotine gum as a pharmacological adjunct; Project EX-4 adapted the program from a clinic setting to the classroom; and Project EX-Russia piloted a clinic based tobacco use cessation program in summer camps.

EX-1 results: At 3-month follow-up, 17% of youths in the two treatment conditions reported having quit smoking for at least 30 days, compared with only 8% of those teens in the control condition. This includes attrition rates that are adjusted based on readings that corrected 15% overreporting of quitting. No differences in quit rates between Project EX-only and Project EX plus SAC were seen. A subsequent secondary analysis study attempted to ascertain whether or not the program did, indeed, manipulate motivation, and whether motivation mediated program effects. 38% of the treatment effect was statistically mediated by motivation and 8% was due to reported motivation levels at pretest.

EX-2 results: Adjusting for biochemical validation, a 14% intent-to-treat quit rate was achieved at 4-month follow-up, compared to a repeated-baseline 3% control quit rate.

EX-3 results (regular and continuation high schools): At 2-month follow-up, the intent-to-treat 7-day quit rates were 11% in the Nicorette condition and 13% in the CigArrest condition. At 6-month follow-up, the intent-to-treat 7-day quit rates were 16% in the Nicorette condition and 15% in the CigArrest condition. There was no incremental effect of using NRT in this 2-condition trial.

EX-4 results: Students in the program condition experienced a greater reduction in weekly smoking and monthly smoking, at 6-and-12-month follow-ups. The net change varied between 5.8% and 12.6%, comparing the program condition to the control condition. Adjusted program and control quit rates differed by 6.3% at one-year follow-up (p<0.05, one-tailed).

EX-Russia results: The pilot was well received, significantly reducing future smoking expectation by 46%. At the 6 month follow-up, program subjects reported a higher intent-to-treat quit rate during the last 30 days (7.5% versus 0.1%).