M. D. Anderson Cancer Center
Cancer Newsline Audio Podcast Series
Date: October 6, 2008
Duration: 0 / 16:31
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Welcome to Cancer Newsline a weekly podcast series from The University of Texas M. D. Anderson Cancer Center in Houston TX. The aim of Cancer Newsline is to help you stay current with the news on cancer research, and the rapidly changing advances in cancer diagnosis, treatment and prevention. We will also provide you with the latest information on reducing your family’s risk of being diagnosed with cancer. My name is Dr. Leonard Zwelling I am a professor of medicine and pharmacology here at M. D. Anderson.
Today we will be talking with Dr. Alexander Prokhorov, professor in Behavior Sciences and head of the M. D. Anderson Tobacco Outreach Education Program designed to facilitate smoking prevention and cessations counseling by health professionals in Texas, and Joshua Hein, a research coordinator also in the department of Behavior Sciences. We will be talking about new approaches to smoking cessation efforts particularly for teenagers and the uses of new technology to get that message across in schools and at home. But before we go too far. I would like Dr. Prokhorov to remind us, ”What is the magnitude of the smoking problem in the United States, specifically for the teen population”?
Smoking remains the single most important preventable cause of death in this country and where dealing with major issue here because every fifth American today is still a smoker even though the social acceptance of smoking is not as it used to be ten, fifteen years ago. Still where dealing with about 45 million Americans who smoke. If you eliminate smoking from the face of the earth about one third of all cancers will be gone. But unfortunately people don’t realize that and still use tobacco. Unfortunately we still have kids who are interested in initiating smoking and one third of all smokers have their first cigarettes by the age of 14 years. 90 percent of all smokers begin smoking before the age of 21, and each day about 4,000 children under 18 years of age try there first cigarette.
Do you have any idea why, with all the work that has been done in all the public relations about not even starting smoking people that young still start to smoke?
Well the tobacco industry makes every effort to make those tobacco products look attractive to a kids. If you look at the variety of tobacco products today it’s amazing all these flavored tobacco products. Candy flavored, liquored flavored all kinds of different new smokeless tobacco products such as snoose which is a new form of tobacco products which is positioned as a virtually harmless product which is not true, we know that and leads to a curiosity among kids in trying tobacco then they can switch to conventional cigarettes if they want so. It’s also ah… the fact that kids are still interested in trying it is because it’s natural curiosity every kid is trying to try something new in there life. So cigarettes will be among them and a different form of tobacco is among them. Kids typically don’t have any kind of chronic diseases that would prompt adult smokers to think about quitting so therefore it’s a challenge to both prevent smoking and make them quit.
Is it harder for kids to quit then adults or is it equally hard for both groups?
What we have learned over the last few years is that kids develop nicotine dependence very high level of nicotine dependence, very soon. It’s no longer the fact that it takes years for a smoker to become hooked for life. There’s research out of Massachusetts that is convincingly showing sometimes it only takes fraction of a cigarette one cigarette to develop very high level of nicotine dependency and it depend on the genetic profile of the smoker.
One thing we talked about before on this newscast is that it not a habit it’s really an addiction. So that confirms what you are saying. Up until now and either one of you can chime in and answer this one. How have smoking cessation programs been structured and administer specifically to teenagers? What have we done up till now and I guess the next question is what’s new about your curbing program?
We've ah…been going this for 27 years and I remember times when I thought we can walk in the class room wearing white coat an looking very important and telling about health hazards related to tobacco use and as a result every single kid would quit smoking and not think about it. Well it turns out it’s not true and we have to be very creative in making this program both age relevant …interesting and educational. So we went though many, many generations of programs and including those delivered by the computers but the truth is the kids unfortunately have issues with written material, with so called one size fit all material. Therefore with computer technology we have now we have a generation of programs that can be tailored to the needs of every single user. Depending on there smoking status, wiliness to try or quit smoking and other characteristics.
Tell us a little about the program, its called “Curbing”? Is that the name of it?
I guess this is when I can chime in. Ah…Basically this program is very current in many areas. Ah…First of all these programs are web based and tailored to the individual user and it’s self administered. Um… you know we’re also include content that smokeless tobacco use prevention cessations that include chew, dip, snoose how Dr. Prokhorov previously mentioned. This is a very important issue especially in Texas. The program is also hybrid between standard curriculum and interactive game so there is going to be a didactic portion and there going to be elements to engage the user in interactive media.
Is this done in stages or are their separate different programs or is it done all in one sitting?
Basically the way that it’s going to work is that as part of like the research study there is going to be seven sessions the user is going to participate in. So it’s going to be five this fall 30 minute sessions spaced out one session per week and there going to be two follow up sessions this following spring. Um…but the program is very current in a lot of areas were incorporating a lot of things that are trends with teenager now days. Where including issues related to social media, social networking sites actually have a virtual active blog which is another feature to the program that users can access when they don’t have access the access to the program at school. We’re also including a social support component which is going to be a training for teacher and school personnel to equip them with the proper tools and skills to effectively deal with tobacco related issue that their students present to them. So this program is going to very relevant far as the technology that we use. It’s web based it’s going to be heavy on multimedia we’re actually utilizing green screen technology. In our previous program we used a lot of animation. With this one we going to use live professional actors who will are going to be super imposed on a illustrated background. It ads a different effect to the approach. It’s close to reality TV which we see a lot of.
Sound very high tech. It might be high cost who is sponsoring all of this?
Ha…ha great question. Actually this is a five year grant being sponsored by National Cancer Institute which is a division of National Institute Health. Um… and this is being done at the University of Texas M. D. Anderson Cancer Center of course. Ah.. so where really grateful we have the ability to create this high quality cutting edge technology programs.
Tell us a little bit about the study design. This is not just a program this is actually research study. So what are you going to be studying and how is that set up?
Well we try to develop the state of art program but we also try to put it through the most rigorous test in terms of finding out whether or not it’s effective and whether or not it’s effective in the long run. Because many existing programs we know from published research are even though we know they may be effect is short lived. In our case we would like to ah… make sure the program not only is high impact but also that the impact is lasting. So therefore we have 16 schools involved rural and suburban half of which will be randomized into that new experimental program and the other half will receive standard pamphlet on tobacco use and how not to end up a smokers or how to quit smoking and we will conduct baseline survey to find out what’s going on in terms of smoking and there beliefs and attitude toward smoking and we will ah...ah…conduct ah…follow up surveys and our last follow up survey is in 18 months which is quite a long term follow up. So in fact the program lasts for 18 months we can be reasonably sure it’s a pretty strong impact.
What age kids you are targeting in this study?
It’s going to be 2,000 10th grade students 14 to 16 year olds.
So you will have plenty of time to follow up, follow them through and so 2,000 total?
2,000 total. Correct, correct.
Sixteen schools?
Yes.
Now tell me where the schools are located. Are they all in Texas?
Yes, there all going to be in Texas so ah… It’s gong to be 10 suburban schools those are high schools around the general Houston area. Then we are going to have 6 schools that are going to be located in rural areas of Texas. So you looking at areas ah.. kind of just around the LaGrange area through Giddings through some towns around there.
What do you tell the participants or the perspective participants the benefits are going to be?
That’s a really good question. We tell them that there having access through a cutting edge program that for people that don’t use tobacco there going to be equipped with the tools to be tobacco control advocates.
So that’s going to be half of the people though.
Yeah exactly, Um… and then you can have your current users of cigarettes and spit tobacco going to provide them with the tools and education to get them on the road towards quitting. So we are actively trying to get these individuals to quit .
Are you looking at these groups of people so that you have an equal distribution between those who have not smoked and those who are currently use tobacco, or is that random?
Well it’s a basically ah… who ever provides the parental consent, because we need to make sure that we abide by the human subject committee rules. But typically in studies like this we, have the majority of kids who are non-smokers but a pretty large percentage of these kids up to 40% are at risk for smoking initiation or susceptible to smoking as we say it.
What makes them at risk?
There uncertainty ahh… about for example trying cigarettes a year from now or accepting a cigarette if offered by a friend. So they can’t tell you definitely not… I’m not going to definitely not going to take this cigarette from my friend or I’m definately not going to try cigarettes a year from now or sooner. Then it will make them susceptible to smoking.
Are there any obligations on the part of the schools that are participating? How did you select them? What are their obligations?
Well basically we look at them for the classification are they suburban on rural and looking at demographics and size and as far as obligations as long as they can provide 125 students per school to participate and if they can you know make these kid available to participate at our timeline which is like I said five sessions in the fall and two sessions in the spring along with the surveys and if they have at least 20 computers at the school with the high speed internet access. Those are pretty much we used to…
Do you expect most of these participants to use the training at the school itself?
Correct. That’s correct.
Actually national statistics show that 99% of public schools are equipped with computers with high speed internet access. So we see a great potential for use of this program in the future should it show considerable effect.
So there is one real big final question we just got to ask and that is, how will you know if this works? What are the determinates of success because I assume that once you get to success your going to try to spread this to other schools assuming it works.
Absolutely, ah…we actually are now in the phase of dissemination of a different program as many as 16 states ah… as a pilot project and it’s our previous program that we designed for predominantly inner city kids predominately minority kids who are at high risk for smoking so where well familiar with the simulation of evidence based programs. So for this program we certainly look at there known initiation of smoking at there rate of cessation of smoking if they already smoke. We also look at there use of smokeless tobacco, because that’s another important issue that we address on this program. So if we achieve statistically significant reduction in smoking initiation and increase smoking cessation then we can safely assume that this is a high impact program that warrants dissemination.
Thank you both. Anybody have any final comments?
We believe that you know working at M. D. Anderson is a great privilege, because this institution is paying serious attention to cancer prevention, and tobacco control and provides unparallel resources to effectively conduct studies like this.
Very good. Listeners if you have questions about anything you heard today on Cancer Newsline please contact M. D. Anderson at 1-877-MDA-6789 or online www.mdanderson.org/ask. Thank you both for coming today. Thank you for listening this episode of Cancer Newsline, please tune in again next week for our next episode of this series.
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