Effectiveness of LTPB
Lessons Learned
Age Tailoring
As young adulthood (emerging adulthood) comes to be recognized as a distinct stage in the lifespan, there is growing awareness that young adults have specific values, developmental issues, lifestyles and communication styles that differ from those of adolescents and adults in meaningful ways. With respect to tobacco control, the implication is that the effectiveness of smoking education, prevention, and cessation materials can be enhanced by adapting them to characteristics of the target audience. However, despite the existence of high-quality, age-tailored resources for adolescents and (mature) adults, there were virtually no such resources for the young adult audience prior to the introduction of LTPB. Therefore, it was important to develop resources specifically for young adults and to focus test these resources to ensure their appeal.
Central to the success of LTPB has been the ability to address the needs of post-secondary smokers and accommodate paradoxes in their smoking behaviours. It seems, for example, that students who smoke socially sometimes deny being 'smokers.' Inclusive messaging and outreach that positions LTPB as an initiative for non-smokers, smokers and ex-smokers helps us reach these students. Likewise, communication campaigns addressing the safety of so-called 'light' and 'mild' cigarettes, or uncovering the less savoury practices of tobacco companies, attract both smokers and non-smokers to LTPB displays. Finally, extensive reliance on interpersonal outreach over mass media clearly contributes to the success of LTPB. Although hundreds of posters and ads are displayed and multitudes of other promotions are disseminated, students who know about LTPB most often recall talking to someone at conveniently-located, interactive display tables. In the end, LTPB resources are highly appealing to the target audience because:
- 1. conceptualization, content and design originates with post-secondary students;
- 2. the types of interventions used and their design is based in empirical investigations of young adults' preferences; and
- 3. characteristics of the target audience are specifically addressed in all interventions developed by LTPB. Using students to assist us with our tailoring of communication and materials has made it possible to make inroads into smoking behaviours of this target population.
Peer Programming
Peer-delivered programs with health professionals providing guidance to peer-teams is one of the best way to guarantee that resources are properly used and program potential is achieved. Using students to deliver LTPB and gain the attention of other students is key to acceptance of tobacco control messaging.
Sustained Programming
In any population, producing and sustaining widespread changes in smoking behaviours demands continuous effort that incorporates one-on-one interventions for high-risk individuals, community-wide interventions that attempt to change social norms, and policy-level efforts that help modify the social and political environments. For the student population, campus setting and student lifestyle, the concept of sustained programming as opposed to event-based programming is vitally important. Students are a highly mobile and transient population, pursuing very busy, stressful lifestyles. Campus is one of the few constants in students' lives, and most students are very much campus-centric. Smokers in this age group fluctuate in and out of readiness to quit depending on their social life, their personal goal setting, and their peer group trends. To ensure that available services are not under-utilized by smokers it is important that these services be accessible whenever smokers are ready to deal with the issue. Thus, it is imperative to make it well-known throughout campus that cessation services are available from both peers and professionals. Furthermore, because continuous access to programs and services can lead to increased use of quitting supports, it is essential to keep peer programming in place all year long so that student smokers are recruited into services when their own personal circumstances make them most ready to quit. Finally, because of the mobility of the student population and the abundance of competing demands for their attention, sustained uninterrupted messaging and programming is needed to create awareness of and comfort with LTPB's role on campus.
Mobilizing Campus Clinics
Campus clinics are extremely busy with heavy patient loads. They generally operate with part-time physicians and part- or full-time nurses, and the professionals who work in the clinic very rarely meet as a whole 'team'. It is extremely difficult, therefore, to introduce changes into clinical routines. This difficulty extends to encouraging campus healthcare professionals to screen for cigarette use among all patients and to offer smokers brief intervention based on established clinical guidelines.
Because such interventions can have a marked impact on campus smoking prevalence, however, LTPB undertook the challenge of supporting clinic staff to integrate CTI procedures in the normal clinic routine. This challenge was undertaken because:
- Student Health Services clinics can play an important role in promoting smoking cessation, not just by providing Clinical Tobacco Intervention, but also by referring students to other programs and services on campus;
- health and medical professionals who are trained in CTI and who have the opportunity to effect changes in their patients, may become advocates of the approach and influence its uptake among their peers; and
- provided that there is a minimal level of continued support, resourcing, and training, CTI can be fully integrated into standard clinic services and sustained indefinitely.
In meeting the challenge of supporting campus health professionals to screen for cigarette use among all patients and to offer smokers brief interventions based on established clinical guidelines, these valuable lessons were learned.
Supporting campus health professionals to implement Clinical Tobacco Intervention needs to be done with careful planning and using a liaison person of influence. On post-secondary campuses, the Health Educator or Clinic Director is frequently the person to succeed in arranging a meeting for CTI training.
CTI training sessions need to be individualized to each campus. They need to be very well organized and presented in a way that clearly and specifically addresses the barriers to implementation in a campus clinic. LTPB has succeeded in training professional staff in most participating campus clinics and getting CTI brief interventions implemented as clinic routines.
To improve professional-delivered smoking cessation services to students, it is important to understand and address the interactions among all health professionals on campus, and with students. (A recent LTPB study surveying physicians, nurses and counselors working in campus student services revealed, for example, that on campuses without LTPB, doctors often refer smokers to counselors for assistance quitting, but counselors do not see smoking cessation counseling as part of their mandate).
Reciprocity in 'teaching' and 'learning' is essential. Campus health care professionals have guided LTPB staff in the process of adapting CTI to their settings. This has allowed LTPB to enhance its training protocols. Consequently, LTPB remains flexible when working with health professionals in campus clinics to ensure incorporation of CTI into clinical routines does not add to an already-stressful practice.
Centralization of Project Management
Timely, systematic knowledge translation underlies the success of an evidence-based tobacco control initiative like LTPB. Having LTPB facilitated and managed centrally has proven to be a highly serviceable and cost effective method of supporting immediate knowledge transfer to individual teams on geographically dispersed campuses. Resource-intensive tasks such as design and testing new program materials, professional development of student-staff and campus clinicians, and management of payroll and expenses are handled centrally, so that no individual campus is over-burdened by the personnel or financial demands of these tasks. Furthermore, because programming and training resources are developed centrally, there is no duplication of effort. Likewise, cost savings are realized because materials can be mass-produced at a more cost-effective price point.
Centralization of project management and the consequent efficiency of knowledge translation can also be used to speed progress toward policy objectives and organizational re-structuring at individual campuses. Specifically, news of change at one campus can be rapidly relayed to other campuses where such change can be held up as an example to follow. This phenomenon has been observed repeatedly over the course of LTPB and speaks to the value of coordinating tobacco control efforts.
