The Effects of a Smoking Cessation Program for Thai Vocational College Students

Abstract

Aim/Purpose: This quasi-experimental research study aimed to determine the impact of a smoking cessation program on vocational college students.

Introduction/Background: Smoking remains one of the biggest public health threats in the world, especially in low- and middle-income countries. In Thailand, the typical age when a person first smokes is between 18 and 22, and smoking becomes habitual by the ages of 19 to 23 after approximately one year of continuous smoking. Many smokers are teenagers or young adults, including vocational college students. Many students in this demographic engage in smoking due to various social, psychological, and environmental factors, increasing their risk of developing long-term health complications. Addressing this issue requires targeted interventions, such as smoking cessation programs that focus on modifying behaviors and reinforcing positive attitudes toward quitting smoking.

Methodology: A purposive sampling method was utilized to select participants who met specific criteria relevant to the study's objectives. The sample consisted of 30 vocational college students who were over 18 years old with at least one year of smoking history, a Fagerström Test for Nicotine Dependence (FTND) score higher than 4.0, and a smoking cessation desire score greater than 3.0. The intervention employed in this study was a structured smoking cessation program developed by nine experts using a Delphi-technique. This 9-week structured program was based on Bandura’s self-efficacy theory and the 5A Model created by the Action on Smoking and Health Foundation Thailand. Each week incorporated behavioral and psychological strategies: Week 1: awareness, Week 2: commitment, Week 3: perseverance, Week 4: encouragement, Week 5: self-conquest, Weeks 6 and 8: self-regulation, and Weeks 7 and 9: liberation. The total program took nine weeks to support participants in their efforts to quit smoking.

The program emphasized education about the harmful effects of smoking, skill development for resisting smoking triggers, cognitive-behavioral techniques to modify smoking-related thoughts and behaviors, and peer support mechanisms to enhance motivation. Data collection was conducted over the 9-week period during which participants engaged in various components of the smoking cessation program. The effectiveness of the intervention was evaluated using questionnaires. The instrument was a smoking cessation behavior questionnaire that measured perceived harm of smoking, self-efficacy for smoking cessation, and a smoking behavior assessment. Its content validity was .97, and its reliability, assessed using Cronbach's alpha coefficient, was .88. Two standardized instruments assessed nicotine dependence as measured by FTND scores, along with smoking cessation intention scores. Descriptive statistics and a paired t-test were used to analyze the data.

Findings: The study included a total of 30 participants. Most of the sample were male (86.7%), with an average age of 19.17 (± .98 years). The average age to first start smoking was 14.57 years (SD 2.16), with 33.3% starting at age 15 years. The participants had been smoking for an average of 4.6 years (SD 2.16). In terms of the reasons for starting smoking, 60% stated it was due to curiosity; 36.7% smoked traditional cigarettes, 33.3% used e-cigarettes, and 26.7% smoked while drinking alcohol as well. In terms of nicotine dependence, 56.7% were at a moderately dependent level. In regards to participant cessation intentions, 23.3% had intention levels from 7 to 10 to cease smoking. There were statistically significant differences in scores for the perceived harm of smoking, self-efficacy for smoking cessation, FTND scores, smoking cessation intention scores, and smoking behavior assessment scores (p < .05).

Contribution/Impact on Society: The results indicated that the smoking cessation program was effective among vocational students, leading to an increased perception of the harm associated with smoking, enhanced self-efficacy, a stronger intention to quit, and greater leadership in encouraging peers to quit. These outcomes support reduced exposure to second-hand smoke and smoking-related diseases. The findings offer practical implications for nursing practice, youth-focused health education, and national tobacco control policies.

Recommendations: Based on the study’s outcomes, teachers can use this program in schools for students who want to quit smoking. They can also teach its concepts in health courses to reinforce knowledge about the harmful effects of smoking, and use them as strategies to stop smoking. In hospitals, nurses can use this program to help patients quit smoking, which leads to beneficial treatment and control of non-communicable diseases.

Research Limitations: First, this research was conducted with a small sample group, and the results from one vocational school may not be generalizable to other vocational students. Second, this program was implemented in only nine weeks, so the time may not have been long enough to assess long-term smoking cessation outcomes. As a result of this program, one student was able to quit smoking; if continued for a more extended duration, perhaps more students might have quit smoking. Lastly, external factors such as peer influences or stress levels related to their studies were not controlled, which could have impacted study variables.

Future Research: Conducting research with a larger sample or among other populations, along with long-term follow-up, would provide a clearer picture of the results among participants who quit smoking.