CommunityBased Participatory Research: An AcademicCommunity Partnership to Promote Adolescent Health

1
Community-Based Participatory Research An
Academic-Community Partnership to Promote
Adolescent Health

• Geri Dino, PhD
• Principal Investigator Director
• WV Prevention Research Center
• Associate Professor
• Department of Community Medicine
• Robert C. Byrd Health Sciences Center
• Faculty Development Seminar
• September 20, 2007

2
Purpose

• Describe the underlying principles and processes
  of community-based participatory research (CBPR).
• Discuss how CBPR methods were utilized to
  develop, evaluate, and disseminate an
  international teen smoking cessation program.
• Illustrate how CBPR-principles can go from local
  solutions to national impact.

3
The Lay of the Land

• West Virginia (WV) is the second most rural state
  in the US. Its has a history of geographic
  isolation, economic exploitation, lower than
  average standards of living and educational
  attainment, economic underdevelopment, and
  restricted social and economic opportunities.
• WV also has one of the worst health profiles in
  the nation. WV consistently ranks near the bottom
  in total mortality, and has a higher than average
  prevalence of associated chronic disease risk
  factors, especially those related to sedentary
  lifestyle, obesity, and smoking.

4
The Lay of the Land

• Yet, WV clings to a sense of pride, tradition,
  culture, and customs. In many ways, West Virginia
  is a large community.
• West Virginians see themselves as one big
  community. If youre traveling out of the country
  and you meet someone from WV, you feel like you
  already know them because you will understand
  their culture, values, and spirit. Nancy Walker,
  WV PRC CPB Member

5
A Context of Collaboration

• Imagine, it was 1995 and WV lead the nation in
  teen smoking. Almost half of WVs teens smoked
  cigarettes. There was a public cry for help. That
  same year, the CDC-funded WV Prevention Research
  Center became operational.
• The newly-formed PRC and its state partners
  agreed that the WV PRC serve as the central
  enterprise to improve population health by
  conducting research to improve public health
  policy and practice.
• Partners identified youth tobacco control as a
  primary research focus for the PRC. Teen smoking
  cessation was identified as the top priority in
  tobacco control.
• PRC resources were committed to this effort.

6
The Central Approach

• Community-based Participatory Research
• Community-based participatory research is a
  collaborative approach to research that equitably
  involves all partners in the research process and
  recognizes the unique strengths that each brings.
  CBPR begins with a research topic of importance
  to the community with the aim of combining
  knowledge and action for social change to
  improve community (health)
• W.K. Kellogg Foundation, Community Health
  Scholars Program

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Community-based Participatory Research Blending
Perspectives

• Researchers bring knowledge of theory, research,
  methods, and evidence-basis for policy and
  practice-research to practice.
• Practitioners have first hand knowledge of the
  issues, limits, and demands of the field. This
  knowledge helps shape the research process to be
  meaningful to the user audience and recipients-
  practice to research.

8
If we want more evidence-based practice, we need
more practice-based evidence.

• Dr. Larry W. Green

Adjunct Professor, Department of Epidemiology and
Biostatistics, UCSF Co-Director, Program on
Society, Diversity, and Disparities, UCSF
Comprehensive Cancer Center.
9
Working Together to Strengthening School-based
Tobacco Policy

• Where It Began
• Tompkins, N.O., Dino, G.A., Zedosky, L.K.,
  Harman, M., Schaler, G. (1999). A collaborative
  partnership to enhance school-based tobacco
  control policies in West Virginia. American
  Journal of Preventive Medicine, 1, 29-34.

10
Partners

• WV Prevention Research Center
• WV Department of Education Office of Healthy
  Schools
• WV Bureau for Public Health
• Coalition for a Tobacco Free WV

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Study Objectives

• Examine the correspondence between WVs K-12
  school tobacco control policies and programs, and
  the CDC's (1994) Guidelines for School Health
  Programs to Prevent Tobacco Use and Addiction
  (referred to as CDC Guidelines).
• Provide recommendations to the DoE regarding
  policy modifications and policy implementation.
• Identify additional action steps to strengthen
  school-based tobacco practice state-wide.
• Disseminate findings and recommendations
  state-wide.

12
CDC Recommendations

• Develop implement a school tobacco use policy
• (7 identified elements)
• Provide instruction about short long term
  negative physiologic social consequences,
  social influences, peer norms refusal skills
• Provide prevention education in K-12 grades
  especially intensive in middle school
  reinforced in high school
• Provide program specific training for teachers
• Involve parents or families
• Support cessation efforts among students school
  staff
• Assess program at regular intervals

13
Study Methods

• Partners collaboratively developed a 40- item
  telephone survey to assess the elements of school
  tobacco policies related to the CDC Guidelines.
• All middle/junior high (n131), high (n 128),
  and combined (n31) schools and a random
  sample of elementary schools (n179) were
  selected for inclusion, for a total of 472
  schools.
• The State Superintendent of Schools provides a
  letter of support for the study. All county
  Superintendents received a study information
  packet.
• Principals from selected schools were sent copies
  of the study materials prior The WVU Survey
  Research Center conducted the 15 and 20 minutes
  survey.

14
Study Results

• 418 schools participated for an overall response
  rate of 89.
• Few schools complied with all recommended policy
  components 10 - elementary, 21.9 -
  middle/junior, and 32.7 - high schools, (p
  .0003).
• 94 of elementary 86.2 of middle/junior, and
  81.5 of high schools provided tobacco prevention
  education.
• Few schools provided cessation services - only
  15 offered cessation services.

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Study Impact Changing School Policy

• This lead to four critical outcomes
• Partners revised the WV school tobacco control
  policy to be consistent with the Guidelines the
  policy is approved in 1998.
• All 55 counties adopt compliant policies
• Research-based implementation guidelines are
  collaboratively developed and dissemination via
  internet and at state-wide principal training.
• The partners decide to develop a new teen smoking
  cessation program for WV youth.

16
Study Impact Service to the State Becomes
Service to the Nation

• The WV PRC chooses teen smoking cessation as the
  focus for its core research project develop and
  evaluate a state-of the-art program for WV teens.
  
• The CDC puts the American Lung Association in
  contact with the WVU PRC. WV, the WVU PRC, and
  ALA share common goals and a common agenda.
• State partners agree that partnering with the ALA
  would increase the programs impact
  exponentially.
• The program was called Not On Tobacco or N-O-T.

17
Working Together to Develop Effective,
Adoptable Interventions

• The American Lung Associations International
  Teen Smoking Cessation Program
• Dino, G., Horn, K., Zedosky, L.,
  Monaco, K. (1998). A positive response to teen
  smoking Why O-T? NASSP Bulletin, (82), 46-58.
• Dino, G.A., Horn, K., Goldcamp, J.,
  Kemp-Rye, L., Westrate, S., Monaco, K. (2001).
  Teen smoking cessation Making it work through
  school and community partnerships. Journal of
  Public Health Management and Practice, 7(2),
  71-80.

18
N-O-T Development ProcessA
Collaborative, Participatory Approach
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Features of the Collaborative Spirit

• N-O-T development based on the 6 Cs of
  collaboration
• Commitment to a common goal
• Shared contribution of unique and complimentary
  skill sets
• Open, regular communication
• Compatibility of values and guiding principles
• Consensus that involves sharing concerns and
  issues honestly
• Acknowledging credit appropriately
• J. Lancaster, 1985

20
Beginning the CBPR Process-Developing Trust and
Respect

• Getting acquainted
• Identifying common agendas
• Identifying shared values
• Identifying community-based needs
• Selecting the research questions
• Identifying collaborators and stakeholders

21
Developing Trust and Respect

• Clarifying roles and expectations
• Developing a communication plan
• Discussing strategies for managing conflict and
  consensus
• Engaging in regular self reflection
• Open and honest sharing of feelings and ideas

22
From Trust to Program Development

• Conducted literature reviews in prevention and
  adult cessation.
• Conducted pilot research.
• Discussed relevant literature with partners.
• Engaged in information exchange.
• Identified concerns and interests of potential
  users and consumers of N-O-T.
• Drafted, shared, drafted, shared

23
N-O-T Program Overview

• A voluntary smoking cessation program for 14-19
  year-old adolescents who are regular smokers
  (average gt 5 cigarettes a day) and who want to
  quit smoking.
• Grounded in Social Cognitive Theory.
• Includes 10 weekly sessions.
• Uses a prescribed facilitator curriculum and a
  standard training protocol.

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N-O-T Program Overview

• Gender-Sensitive
• Utilizes selected, trained facilitators.
• Promotes a total health approach. Goals include
• quit smoking
• reduce the number of cigarettes by non-quitters
• increase healthy behaviors in nutrition and
  physical activity
• improve life skills such as stress management,
  coping, decision-making, communication, and
  interpersonal skills

25
N-O-T Curriculum Topics

• Reasons for smoking and reasons for quitting
• Smoking history
• Nicotine addiction
• Physical, psychological, and social effects of
  smoking
• Preparing to quit
• Physical, psychological, and social aspects of
  quitting and withdrawal

• Managing the quitting process
• Stress management
• Dealing with family and peer pressure
• Volunteerism
• Recognizing social and media ploys
• Accessing and maintaining social support

26
Working Together to Evaluate Program Effectiveness

• Providing Practice-Based Evidence
• Horn, K., Dino, G., Goldcamp, J., Kalsekar,
  I., Mody, R. (2005). The impact of Not On
  Tobacco on teen smoking cessation End-of-program
  evaluation results, 1998-2003. Journal of
  Adolescent Research, 20 (6), 640-661.

27
Evaluation Overview

• The ALA and the PRC decide to conduct a two-part
  evaluation strategy for N-O-T. Between
  1998-2003, two types of school-based evaluations
  were conducted in NC, WV, FL .
• Empirical research studies (6)
• Follow rigorous scientific standards/
• Use a quasi experimental design (matched
  comparison group)
• Field-based real world evaluation (10)
• Pre/post program single group evaluation (without
  
• hands-on researcher involvement)
• Absence of a control/comparison group

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Measurement

• Standard surveys were administered to
  participants at baseline and at the end of the
  program (approximately three-months post
  baseline) to assess smoking status.
• Quit status was determined by the self-reported
  answer no to the question, Are you currently
  smoking? assuming at least 24- hour abstinence.
  Empirical studies collected days of continuous
  abstinence
• In the empirical studies, a Carbon Monoxide (CO)
  Record was used to document the results of a CO
  test to validate self-reported quit rates (CO lt
  9ppm). CO validation was not obtained in the
  field-based evaluations.

29
Participants

• Inclusion Participants were regular smokers/at
  least 1-5 cigarettes per day on weekdays and/or
  weekends.
• Participation was voluntary
• Approximately 6,130 youth from 5 states were
  enrolled
• 1,283 youth in the empirical studies
• 4,847 youth in the field-based evaluations.  

30
Participants

• There were slightly more female (56.2) than
  males (43.8).
• The overall daily mean smoking rate was 14.2
  cigarettes per day.
• Youth ranged in age from 12 to 19 years, with a
  mean age of 16.0 years.
• The grade levels ranged from 7th grade to 12th
  grader (98 were in 9th-12th grade).
• Nearly 76 of the participants were Caucasian,
  12.6 Hispanic, and 3.4 African American.

31
Empirical Studies Typical Design

• N-O-T
• Small (lt 10) same-gender groups
• Led by same-gender facilitator
• Core program includes 10 hour-long sessions
• 4 booster sessions occurring at 2- to 4-week
  intervals post program

• BI
• 5-10 minutes scripted quit smoking advice
  self-help brochures
• Mixed-gender groups
• School personnel assisted with BI recruitment and
  setup
• BI facilitators were ALA staff or volunteers

32
Empirical Studies Typical Design

• Within each year, 10 N-O-T schools were matched
  with 10 BI schools based on
• community demographics of school locales
• student population size
• race and ethnic composition
• student-teacher ratio
• geographic location (urban, suburban, rural)
• economic status of community/county of school
  locales
• tobacco policy violation in previous year

33
Empirical Studies Data Analyses

• N-O-T BI Baseline comparisons on
• age
• grade level
• nicotine dependence
• number of cigarettes smoked per day on weekdays
  and weekends
• age of smoking onset
• motivation to quit smoking
• confidence in quitting smoking

34
Empirical Studies Data Analyses

• Separate analyses for (1) males and females
  combined, and (2) males and females separately
• Baseline comparisons within each year to check
  for biases due to attrition
• Baseline comparisons using individual and school
  as units of analysis
• Examination of quit and reduction rates

35
Empirical Studies Quit Rates (Intent-to-treat
sample)

• The aggregated intent-to-treat quit rate for
• N-O-T was found to be approximately 14
  compared to a BI quit rate of 7.9 (p lt 0.01)
• Results demonstrated that the adjusted odds of a
  N-O-T participant for quitting smoking were also
  nearly two times that of a BI participant
  (OR1.79p 0.006)

36
Empirical Studies Quit Rates (Compliant sub
sample)

• When the data for all six empirical studies were
  combined, the compliant quit rate for N-O-T was
  found to be approximately 19 compared to a BI
  quit rate of 9 (p lt 0.01).
• Results demonstrated that the adjusted odds of a
  N-O-T participant quitting smoking were nearly
  twice that of a BI participant (OR1.94 p
  0.002).

37
Field-based Evaluations

• Number of field-based evaluations - 10
• No rigorous comparison or control groups.
• The real-world evaluations followed a single
  group pre/post design, as recommended in the
  N-O-T curriculum.

38
Field-Based Studies Methods of Site Selection

• Based on convenience sampling per ALA general
  requirement.
• Across evaluations, 401 schools participated from
  3 states.

39
Field-Based Evaluations Quit Rates

• When the data for all the ten field-based studies
  were combined
• the overall N-O-T quit rate was 31 (compliant
  subsample)
• And 26 (intent to treat)

40
Other Independent Evaluations

• Between 2002-2004, three independent N-O-T
  evaluations were conducted in Illinois
  (University of Chicago), Virginia (Virginia
  Commonwealth University), and Wisconsin (Pacific
  Institute of Research and Evaluation).
• Virginia demonstrated the highest quit rates with
  43 of teens reporting quitting smoking.
• The bio chemically-validated quit rate for
  Wisconsin N-O-T youth was 23 compared to 7 of
  BI comparison youth.
• Using a GRT design, Illinois N-O-T youth had the
  lowest end-of-program quit rate (16), but when
  participants were contacted for 3-month
  follow-up, quit rates had risen to 26.
• All studies reported reduction rates (for
  participants who did not quit smoking) of between
  70-80.

41
Research Conclusion

• Research from the WVU PRC as well as others
  shows that teens who participate N-O-T positively
  change smoking behaviors.
• These results suggest that N-O-T is an effective
  teen smoking cessation option.

42
Our Impact in WV

• Since the widespread implementation of the school
  anti tobacco policy and N-O-T cessation
  programming in 1998, WV has seen a 20.1 drop in
  youth smoking.
• To illustrate, the teen smoking rate in WV has
  dropped from 43 to 27 in the past 7 years.
• N-O-T is available in almost every high school in
  WV and many community centers.
• Over 800 N-O-T facilitators have been trained in
  WV.

43
Historical reductions in smoking among WV youth
44
Our Impact Across the Nation

• Between 150,000 and 200,000 US teens received the
  N-O-T program between 1998-2005. Most commonly
  used program in the country.
• About 1 in 5 of these youths have quit.
• Even among participants who do not quit, the
  majority reduce smoking.
• Students consistently report that the curriculum
  also helps them improve other life skills (e.g.,
  increased physical activity, better nutrition,
  improved stress management).

45
National Recognition for N-O-T

• Several Federal organizations have recognized
  N-O-T
• SAMSHA Model Program
• ALA Best Practice
• CDC Award for Research Innovation (1st 20 years
  of the PRC Program)
• NCI Research Tested Intervention Program
• Office of Juvenile Justice and Delinquency
  Prevention Model Program
• Only teen smoking cessation program in the world
  identified as promising in a 2007 Cochrane Review
  (Grimshaw, G.M., Stanton, A. Tobacco cessation
  interventions for young people. Cochrane Database
  of Systematic Reviews, 2006, Issue 4. Art. No.
  CD003289. DOI 10.1002/14651858.CD003289.pub4.
• Most widely used program in the nation (Curry,
  S.J., Emery, S., Sporer, A.K., Mermelstein, R.,
  Flay, B.R., Berbaum, M. (2007). A national
  survey of teen smoking cessation programs.
  American Journal of Public Health, 207, 171-177).
  

46
National Dissemination of N-O-T

• Enhancing Evidence-based Practice

47
Working Together to Get the Word Out There

• Deciding when to move from research to practice
• Translating the intervention into a
  practitioner-friendly format
• Developing a strategy/Dissemination was never an
  after thought
• Evaluating dissemination effectiveness
• Creating favorable climates and infrastructures
  for adoption and institutionalization
• Assessing consequences and impact

48
Dissemination of N-O-T

• N-O-T has been designed for dissemination
• Dissemination has been theory driven
• Rogers Diffusion of Innovations
• RE-AIM Framework
• Stakeholder collaboration critical for
  dissemination
• ALA oversees training
• WVU oversees evaluation
• In WV, WVDE promotes program and WV DTP funds
  implementation and dissemination research

49
N-O-T Dissemination

• Between 150,000 and 200,000 US teens have already
  received N-O-T
• Used in Canada and US Army bases in Europe
• Most widely used program in the nation
• Spanish version available

50
The RE-AIM Framework and N-O-T

• Reach
• Effectiveness
• Implementation
• Adoption
• Maintenance
• Glasgow, R. E., Lichenstein, E., Marcus, A.
  C. (2003). Why dont we see more translation of
  health promotion research to practice? Rethinking
  the efficacy-effectiveness transition. American
  Journal of Public Health, 93(8), 1261-1267.

51
Reach

• Conducted formative research with potential
  adopters, implementers, and recipients inform
  program content, promotion, and recruitment
  strategies.
• Used evidence-based approaches to identify common
  intervention components needed for different
  sub-populations and multiple settings and
  incorporate them into the intervention
  development.
• Piloted the intervention in multiple states and
  in multiple settings.
• Included program promotion and participant
  recruitment in training. Considered diversity of
  sites and target populations.
• Conducted discussions with potential facilitators
  and teens to inform recruitment strategies,
  including identification of barriers and
  potential strategies to address them.
• Tracked the effectiveness of different
  recruitment strategies.
• Monitored participant characteristics across
  sites and states. Assessed reasons for dropout.
  Utilized this information to inform national and
  local training by the ALA.

52
Effectiveness

• Developed N-O-T content and implementation
  strategies to maximize relevance, feasibility,
  and cost-effectiveness for implementers and
  recipients.
• Developed training protocol designed to balance
  implementation fidelity with flexibility for use
  with diverse populations and in multiple
  settings. Used ancillary materials, such as
  modules for different sub-populations, and
  curriculum options.
• Incorporated social and environmental strategies
  and individual behavior change strategies, e.g.,
  integrating N-O-T with comprehensive school-based
  tobacco control policy encouraging participants
  to serve as role models for others and in
  volunteerism.
• Developed nationally standardized protocols for
  training, program delivery, and evaluation
• Considered intended and unintended consequences
  of the intervention when developing program
  materials training protocols.

53
Effectiveness

• Measured participant retention.
• Process data collected at each session.
• Utilized multiple outcome measures in research
  studies (e.g., smoking quit and reduction,
  attitude change, nicotine dependence, changes in
  physical activity, eating habits, academic
  performance, mental health variables).
• Utilized multiple evaluation strategies
  (matched-design, RCT, and field studies) to
  address multiple stakeholder concerns.

54
Adoption

• Provided training materials and a program format
  that is straightforward, low-cost, easy to use,
  and provides guidance in potential areas of
  uncertainty.
• Incorporated social marketing principles and
  techniques in program and training materials to
  promote dissemination and adoption.
• Conducted formative research to ensure that
  program addresses consumer needs at multiple
  levels of the adoption process.
• Technical assistance provided by the ALA and WVU
  PRC.
• Assessed facilitators and barriers to program
  option.
• Used evaluative feedback to enhance training and
  technical assistance.

55
Implementation

• Conducted formative research to ensure a program
  that can be easily implemented in a variety of
  settings.
• Identified stakeholders during the program
  development phase who have important roles in
  program diffusion, adoption, and maintenance.
• Training is standardized and provides clear
  guidance on implementation and evaluation. Plan
  for consider program and protocol revisions as
  needed to incorporated needed changes based on
  evaluation data and consumer feedback.
• Conducted cost effectiveness analysis.
• Collected process data.

56
Maintenance

• Developed booster sessions.
• Curriculum includes self-monitoring techniques
  and provides feedback to participants.
• Program incorporates techniques to help
  participants incorporate healthy behavior choices
  into daily lives, manage relapse, and obtain
  social support for continued cessation.
• Developed procedures for ongoing feedback from
  implementers and recipients so issues of
  sustainability can be incorporated into program
  promotion and training.
• Curriculum provides options so that facilitators
  can make choices based on their participants.
• Monitored program maintenance by state and site.

57
Related WV PRC Publications

• Dino, G. Horn, K., Abdulkadri, A., Kalsekar, I.,
  Branstetter, S. Cost effectiveness of the Not
  On Tobacco program for adolescent smoking
  cessation. Prevention Science (accepted).
• Horn, K., McCracken, L., Dino, G., Brayboy, M.
  (2006). Applying community-based participatory
  research principles to the development of a
  smoking cessation program for American Indian
  teens Telling Our Story. Health Education and
  Behavior, published online on May 31, 2006 as
  doi10.117/1090198105285372.
• Horn, K., Dino, G., Kalsekar, I., Mody, R.
  (2005). The impact of Not On Tobacco on teen
  smoking cessation End-of-program evaluation
  results, 1998-2003. Journal of Adolescent
  Research, 20(6), 640-661.
• Horn, K., McGloin, T., Dino, G., Manzo, K.,
  Lowry-Chavis, L., Shorty, L., McCracken, L.,
  Noerachmanto, N. (2005). Quit and Reduction Rates
  for a Pilot Study of the American Indian Not On
  Tobacco (N-O-T) Program. Preventing Chronic
  Disease 2(4).
• Dino, G., Kamal, K., Horn, K., Kalsekar, I.,
  Fernandes, A. (2004). Stage of change and smoking
  cessation outcomes among adolescents. Addictive
  Behaviors, 29(5), 935-940.
• Horn, K., Dino, G., Kalsekar, I., Massey, C.,
  Manzo-Tennant, K., McGloin, T. (2004).
  Exploring the relationship between mental health
  and smoking cessation A study of rural teens.
  Prevention Science, 5(2), 113-126.

58
Related WV PRC Publications

• Horn, K., Dino, G., Kalsekar, I., Fernandes, A.
  (2004). Appalachian teen smokers Not On Tobacco
  15 months later. American Journal of Public
  Health, 94(2), 181-184.
• Horn, K., Fernandes, A., Dino, G., Massey, C.,
  Kalsekar, I.(2003). Adolescent nicotine
  dependence and smoking cessation outcomes.
  Addictive Behaviors, 28, 769-776.
• Massey, C., Dino, G., Horn, K., Lacey-McCracken,
  A., Goldcamp, J., Kalsekar, I. (2003).
  School-based teen smoking cessation programs
  Recruitment issues in research. Journal of School
  Health, 73(2), 58-63.
• Dino, G.A., Horn, K.A., Goldcamp, J., Fernandes,
  A., Kalsekar, I., Massey, C.J. (2001). A
  two-year efficacy study of Not On Tobacco in FL
  An overview of program successes in changing teen
  smoking behavior. Preventive Medicine, 33,
  600-605.
• Doll, L., Dino, G., Deutsch, C., Holmes, A.,
  Mills, D., Horn, K. (2001). Linking science and
  practice Two academic/public health partnerships
  that are working. Health Promotion Practice,
  2(4), 296-300.
• Dino, G.A., Horn, K.A., Goldcamp, J., Massey,
  C.J., Maniar, S.D., Fernandes, A. (2001). A
  state-wide demonstration of Not On Tobacco A
  gender-sensitive teen smoking cessation program.
  Journal of School Nursing, 17(2), 90-97.

59
Related WV PRC Publications

• Dino, G.A., Horn, K.A., Goldcamp, J., Kemp-Rye,
  L., Westrate, S., Monaco, K. (2001). Teen
  smoking cessation Making it work through school
  and community partnerships. Journal of Public
  Health Management and Practice, 7(2), 71-80.
• Horn, K., Dino, G., Gao, X., Momani, A. (1999).
  Feasibility Evaluation of Not On Tobacco The
  American Lung Associations New Stop Smoking
  Program for Adolescents. Health Education, 99
  (5), 192-206.
• Tompkins, N.O., Dino, G.A., Zedosky, L.K.,
  Harman, M., Schaler, G. (1999). A collaborative
  partnership to enhance school-based tobacco
  control policies in West Virginia. American
  Journal of Preventive Medicine, 16,(3S), 29-34.
• Dino, G., Horn, K., Zedosky, L., Monaco, K.
  (1998). A positive response to teen smoking Why
  N-O-T? NASSP Bulletin, (82), 46-58.
• Dino, G.A. Horn, K., Meit, H. (1998). A pilot
  study of Not on Tobacco A stop smoking program
  for adolescents. Health Education, 6, 230-241.

60
Acknowledgments

• WV PRC Community Partnership Board
• NC Commission on Indian Affairs
• Thousands of N-O-T Facilitators across the US who
  make N-O-T happen
• Schools across the country that have welcomed
  N-O-T
• The teens who are the reason for N-O-T

• Prevention Research Center Program Office at CDC
• American Lung Association-National Office
• Local ALAs especially in FL, NC, NJ, VA, WV,
  WI, ME
• ALA N-O-T Master Trainers
• WV Division of Tobacco Prevention
• WV Office of Healthy Schools

61
WV Prevention Research CenterCOLLABORATION
INNOVATION IMPACT PO Box 9190Morgantown,
WV 26506-9190304-293-8612FAX
304-293-8624http//prc.hsc.wvu.edu/
62
Acknowledgements

• The Staff of the
• WV Prevention Research Center
• and the
• Translational Tobacco Research Reduction Program
• Mary Babb Randolph Cancer Center, in partnership
  with the WV PRC

63
Thank You andQuestions