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Kim and Choi: Effects of a Strength Based I-Change Smoking Cessation Program for Smoking Middle School Boys
Original Article

Journal of Korean Academy of Nursing 2017; 47(2): 164-177.

Published online: 28 April 2017

DOI: https://doi.org/10.4040/jkan.2017.47.2.164

Effects of a Strength Based I-Change Smoking Cessation Program for Smoking Middle School Boys

Jung Hee Kim1, Yeon Hee Choi2

1Department of Nursing, Hosan University, Gyeongsan, Korea.

2College of Nursing, Kyungpook National University, Daegu, Korea.

Address reprint requests to: Choi, Yeon Hee. College of Nursing, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. Tel: +82-53-420-4926, Fax: +82-53-421-2758, yeonhee@knu.ac.kr

Received 21 January 2016       Revised 26 September 2016       Accepted 10 October 2016

© 2017 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study was done to develop a strength based I-change smoking cessation program for middle school boys and identified its effects.

Methods

The study design was a nonequivalent control group pre-post test design. The participants were 97 middle school students from D city, who were in school from April 6 to September 25, 2015. The experimental group participated in the strength based I-change smoking cessation program, while the comparative group participated in a general smoking cessation program. The control group did not participate in any program. Data analyses involved χ2-test, Fishers' exact test, Bonferroni test, and Repeated measures ANOVA, with the IBM SPSS for Windows (version 20.0) program.

Results

Compared to the comparison and control groups, the experimental group showed significant improvement in knowledge, attitude, self-efficacy, behavior change. Also cotinine in urine and modeling of social influence in the experimental group significantly decreased after the strength based I-change smoking cessation program.

Conclusion

These findings indicate that the strength based I-change smoking cessation program is an effective intervention for middle school boys who smoke. The findings suggest that such programs can be used at public health centers or through school health education to decrease smoking in adolescents.

Keywords: Smoking cessation, Self efficacy, Adolescent

Figures and Tables

Table 1

Comparison of Applied to Cessation Program among Groups

jkan-47-164-i001
S Experimental group (S-ICSCP program) Comparative group (ICSCP program)
1 Forming relationships: · Introducing the program
· Program orientation & Informed S-ICSCP · Introducing participants, rules and settings
· Pulmonary function test (table tennis blowing game) · Test cotinine in urine & Pre-test
· Test cotinine in urine & Pre-test
2 My strengths style: · Talking about worries
· Talking about my story & reality check · Problems caused by smoking and announce worries
· Smoking tobacco knowledge and risk perception
· Find five strengths (strengths card)
3 Mind change: · Creating a smoke-free written pledge
· Smoking attitudes recognition · Explaining about smoking report method
· Exploring the benefits & damage of own smoking
· Describing change in motivation
· Sharing feedback on strengths & strengths auction
4 Step by step: · Knowing the components of tobacco
· Finding and utilizing social support · Knowing the influence on the human body caused by smoking
· Establishing short-term and long-term goals (creating a self-monitoring table)
· Improving self-efficacy (manitto & compliment relay game)
5 Out of stress: · Knowing the effects of secondhand smoke
· Analyzing stress (stress disposal game) · Finding one's own advantages and features
· Recognizing situations that lead to smoking temptation & recognizing withdrawal symptoms
· Checking self-monitoring table
· Role-playing
6 I-change: · Sharing cessation experience
· Enhanced self-efficacy · Coping with smoking situations
· Establishing the vision (I-change map)
· Creating a smoking cession planner
7 Dream building: · Smoking assessment of loss and benefits
· Talking about experience of success and failure · Checking the meaning of no smoking
· Exploring coping strategies for smoking temptation and withdrawal
· Checking smoking cession planner
· Dream board & hope capsule
8 New start: · Understanding the symptoms of withdrawal
· Can reduce amount of daily smoking · Observing changes in the body
· Announces smoking cession decision (praise and encouragement messages from health leaders)
· Checking smoking cession planner
9 New life : · Analyzing and understand the stress
· Talking about experience of success and recurrence · Maintenance of the cessation
· Renew plans after a failure and smoking cession maintenance
· Checking smoking cession planner
10 Only one : · Maintenance of the cessation
· Test cotinine in urine & success ceremony · Test cotinine in urine & Post-test
· Writing a letter of social support
· Post-test

S=Session.

Table 2

Homogeneity Test of Smoking related Characteristics and Outcome Variables in Pre-Test (N=97)

jkan-47-164-i002
Characteristics Categories Exp. (n=32) Comp. (n=34) Cont. (n=31) χ2/F p
n (%) or M±SD
Father smokes Yes 13 (40.6) 20 (58.8) 14 (45.2) 2.38 .304
No 19 (59.4) 14 (41.2) 17 (54.8)
Mother smokes Yes 6 (18.8) 5 (14.7) 7 (22.6) 0.67 .717
No 26 (81.2) 29 (85.3) 24 (77.4)
Silblings smoke Yes 5 (15.6) 9 (26.5) 5 (16.1) 1.57 .455
No 27 (84.4) 25 (73.5) 26 (83.9)
Number of friends who smoke <5 7 (21.9) 10 (29.4) 9 (29.0) 0.59 .744
≥5 25 (78.1) 24 (70.6) 22 (71.0)
Number of cigarettes smoked per day* 1~5 3 (9.4) 3 (8.8) 1 (3.2) 1.29 .257
6~10 6 (18.8) 6 (17.7) 4 (12.9)
11~20 18 (56.2) 22 (64.7) 20 (64.5)
21 5 (15.6) 3 ( 8.8) 6 (19.4)
Grade when started to smoke* Elementary school grade 4 3 (9.4) 3 (8.8) 7 (22.6) 11.27 .001
Elementary school grade 5 1 (3.1) 1 (3.0) 4 (12.9)
Elementary school grade 6 5 (15.6) 9 (26.5) 5 (16.1)
Middle school grade 1 15 (46.9) 15 (44.1) 10 (32.3)
Middle school grade 2 8 (25.0) 6 (17.6) 5 (16.1)
Awareness factors† Knowledge 7.97±3.88 6.21±4.08 7.32±4.32 1.57 .207
Motivation factors† Attitude 43.00±7.12 40.47±8.04 41.00±6.16 1.07 .348
Norms 23.28±2.99 22.65±4.40 23.13±2.51 3.13 .732
Modelling 6.16±2.50 7.41±2.43 7.03±2.99 1.71 .187
Pressure 13.38±6.69 11.41±6.73 11.32±6.81 0.83 .433
Self-efficacy 33.88±9.85 34.09±9.89 33.45±9.53 0.12 .889
Behavior factors Behavioural change
 Precontemplation 15 (46.9) 18 (52.9) 15 (48.4) 3.45 .486
 Contemplation 9 (28.1) 5 (14.7) 10 (32.3)
 Preparation 8 (25.0) 11 (32.4) 6 (19.3)
Cotinine in urine 32 (100) 34 (100) 31 (100) 0.00 >.999

Exp.=Experimental group; Comp.=Comparative group; Cont.=Control group.

*Fisher's exact test.

†ANOVA.

Table 3

Comparison of Outcome Variables among Groups (N=97)

jkan-47-164-i003
Variables Groups Pre-test Post-test Follow-up test (3m) Sources F p
M±SD
Awareness factors Knowledge Exp. 7.97±3.88 12.19±3.11 12.44±3.22 Group 8.91 <.001
Comp. 7.32±4.32 8.59±4.18 8.82±4.21 Time 42.58 <.001
Cont. 6.21±4.08 11.16±3.08 10.19±3.46 Group×Time 1.51 .031
a>c>b a>b,c
Motivation factors Attitude Exp. 43.00±7.12 51.16±5.63 48.72±5.97 Group 21.30 <.001
Comp. 40.47±8.04 39.88±5.72 40.68±5.83 Time 9.44 <.001
Cont. 41.00±6.16 44.19±7.15 41.29±7.67 Group×Time 5.45 <.001
a>c>b a>b,c
Norms Exp. 23.28±2.99 24.28±3.14 24.22±3.43 Group 1.18 .313
Comp. 22.65±4.40 22.97±3.77 24.38±3.39 Time 1.28 .281
Cont. 23.13±2.51 22.94±4.01 22.52±4.97 Group×Time 1.64 .166
Modelling Exp. 6.16±2.50 5.09±2.86 3.31±2.90 Group 8.13 .001
Comp. 7.41±2.43 7.76±2.69 7.21±2.82 Time 18.11 <.001
Cont. 7.03±2.99 5.77±3.47 5.26±3.70 Group×Time 2.36 .060
a,c<b a<b,c
Pressure Exp. 13.38±6.69 13.06±7.65 12.09±5.25 Group 1.42 .247
Comp. 11.41±6.73 10.26±5.67 10.82±7.92 Time 0.95 .389
Cont. 11.32±6.81 13.42±5.61 10.81±5.80 Group×Time 1.03 .392
Self-Efficacy Exp. 33.88±9.85 50.91±8.33 50.31±8.87 Group 47.96 <.001
Comp. 34.09±9.89 35.76±9.21 34.88±9.34 Time 8.11 <.001
Cont. 33.45±9.53 27.39±9.15 27.97±8.40 Group×Time 21.28 <.001
a>b>c a>b>c

Exp.=Experimental group(n=32); Comp.=Comparative group(n=34); Cont.=Control group(n=31).

a=Experimental group; b=Comparative group; c=Control group.

3m=after 3 months of intervention.

Table 4

Comparison of Behavior Stage and Cotinine in Urine among Groups

jkan-47-164-i004
Variables Categories Exp. (n=32) Comp. (n=34) Cont. (n=31) χ2 p
n (%)
Behavior stage* Pre-test Precontemplation 15 (46.9) 18 (52.9) 15 (48.4) 3.45 .486
Contemplation 9 (28.1) 5 (14.7) 10 (32.3)
Preparation 8 (25.0) 11 (32.4) 6 (19.3)
Trial 0 (0.0) 0 (0.0) 0 (0.0)
Maintenance 0 (0.0) 0 (0.0) 0 (0.0)
Post-test Precontemplation 0 (0.0) 8 (23.5) 11 (35.5) 46.88 <.001
Contemplation 0 (0.0) 8 (23.5) 10 (32.3)
Preparation 5 (15.6) 5 (14.7) 9 (29.0)
Trial 27 (84.4) 13 (38.3) 1 (3.2)
Maintenance 0 (0.0) 0 (0.0) 0 (0.0)
Follow-up test (3m) Precontemplation 0 (0.0) 11 (32.4) 12 (38.7) 64.88 <.001
Contemplation 0 (0.0) 9 (26.5) 10 (32.3)
Preparation 2 (6.2) 6 (17.6) 9 (29.0)
Trial 15 (46.9) 5 (14.7) 0 (0.0)
Maintenance 15 (46.9) 3 (8.8) 0 (0.0)
Cotinine in urine* Pre-test Positive 32 (100.0) 34 (100.0) 31 (100.0) 0.00 >.999
Negative 0 (0.0) 0 (0.0) 0 (0.0)
Post-test Positive 12 (37.5) 20 (58.8) 27 (87.1) 16.34 <.001
Negative 20 (62.5) 14 (41.2) 4 (12.9)
Follow-up test (3m) Positive 18 (56.2) 30 (88.2) 31 (100.0) 21.54 <.001
Negative 14 (43.8) 4 (11.8) 0 (0.0)

Exp.=Experimental group; Comp.=Comparative group; Cont.=Control group.

3m=after 3 months of intervention.

*Fisher's exact test.

Notes

This manuscript is based on a part of the first author's doctoral dissertation from Kyungpook National University.

CONFLICTS OF INTEREST The authors declared no conflicts of interest.

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