In West Virginia, almost 28% of teenagers aged 14–18 years smoke, but the Not-On-Tobacco (NOT) smoking cessation program has helped more than 1,000 teenagers in the state quit smoking. In West Virginia, 750 people have been trained as NOT facilitators. Many of the facilitators report that NOT training is helpful and that the program is compatible with their schools’ policies and is highly worthwhile. But less than 5% of facilitators have implemented the program.
Researchers formed a partnership with the West Virginia state health and education departments, the Coalition for a Tobacco-Free West Virginia, and the American Lung Association (ALA) to develop NOT and deliver it in schools. NOT training is implemented by a state-level master trainer, who teaches regional coordinators and local facilitators how to introduce and maintain the program in middle and high schools, but less than 1% of teen smokers have enrolled in the program in the past 5 years. Factors that contribute to low enrollment in the NOT program include insufficient time and resources for facilitators and schools to implement the program, and lack of administrative support. A centralized, statewide approach to implementation will ensure consistent, high standards for facilitator recruitment, training, communication, and program management and that NOT will reach many more teen smokers.
Researchers are testing the effectiveness of a new, nine-phase dissemination strategy to provide NOT programs in four administrative regions of West Virginia. Health and process outcomes for these regions will be compared with outcomes from four similar regions that maintain existing practices. Researchers are working with the ALA master trainer, regional NOT program coordinators, and an external evaluator to establish supporting infrastructures and appropriate staffing levels to ensure access to all teen smokers who want to enroll. This team is providing a revised NOT training to both new and currently certified NOT facilitators. The training focuses on promoting NOT to teens and negotiating with school administrators to get consistent support for NOT activities. The revised-training recipients will commit to a memorandum of understanding that outlines their scope of duties.
The dissemination strategy aims to have facilitators implement at least one program after 3 months and 2 or more by 6 months. Regional coordinators check in with local facilitators at these milestones to monitor recruitment of teen smokers and provide mentoring. Researchers will use surveys, interviews, and observation of coordinators and facilitators to gather data on the progress of the dissemination strategy. Program reach will be measured by the number of sites offering NOT and the number of teenagers completing NOT. If this new dissemination strategy proves to be feasible and effective, it may inform the dissemination of other health behavior interventions.