) Adolescent smokers are at high risk for future tobacco-related morbidity and mortality. Results of our trials in adolescent smokers using nicotine patch therapy indicate that pharmacologic intervention is not sufficient. Behavioral treatments tailored to adolescents offer the possibility of more effective intervention. An interactive, in home, computer-based system, CHESS (Comprehensive Health Enhancement Support System) has demonstrated positive health outcomes in a number of adult populations. In this proposal, an Internet-based CHESS module will be developed and evaluated for in home use for adolescent smoking cessation. We chose to study the efficacy of CHESS for adolescent smokers because it offers a number of advantages over traditional smoking cessation programs, including peer-based social support and other content which will be based on the needs identified by adolescents. It also has the potential for widespread dissemination through the Internet. The primary study aims are: 1) to assess the needs of adolescent cigarette smokers through a comprehensive needs assessment of adolescent current and former smokers ages 11 to 17; 2) to develop the content, design and subsequently construct a CHESS module for smoking cessation based on the needs identified by adolescents; and 3) to evaluate in a randomized trial the efficacy of providing in home computers with the CHESS module compared to brief office intervention on the week 24 smoking abstinence rates in 252 adolescent cigarette smokers ages 11 to 17. The primary hypothesis to be tested is that CHESS will increase the 6 month smoking abstinence rates in adolescent cigarette smokers compared to brief office-based intervention. The project will have three phases. The first phase will consist of a needs assessment using focus groups and surveys of 612 adolescent current and former smokers ages 11 to 17. The second phase will be to develop and construct an Internet-based CHESS module for adolescent smoking cessation. In the third phase, 252 adolescent smokers ages 11 to 17 years will be provided with brief office intervention for 4 weeks (n=126) or CHESS for 24 weeks (n=126) in a randomized, two-group design. The assessments will occur at weeks 0,4, 8,12, 16,20,24,36, and 52. The primary outcome will be the point-prevalence smoking abstinence rates at week 24 verified with expired air carbon monoxide. Adolescents will be recruited for participation in the study from four geographically and ethnically diverse locations. The study will be conducted by the Mayo Clinic, Rochester, MN and the University of Wisconsin, Madison, WI.
