| As tobacco use is the main cause of human death, smoking control has been recognized as one of the effective ways to improve peoples'heath status in the worldwide. Adolescence is a critical time period for human growth. Health-damaging effect of smoking to teens would be much more severe than to adults. School health educations and health campaigns titled "refusing the first cigarette" are mainly focused on preventing students from trying to start smoking, which may not quite meet the needs of those who have already started smoking. The rapid development of information and communication technologies(ICTs)provide an opportunity to improve the effectiveness of intervention in various health related behaviors.There were two main purposes of the present study. The 1st purpose was to design an ICT-based smoking cessation implementation model that could be used to provide tailored assistance to Chinese adolescent smokers.Designing of the intervention model was based on following works as a focus group discussion (FGD) among teenager smokers to understand their needs in smoking cessation, a cross-sectional survey to clarify the relationship between health-information-seeking practices via ICTs and health-related behaviors among teenagers in general, as well as reviewing of published papers.The 2nd purpose was to examine the effectiveness of this designed smoking cessation model implemented in the real field by using quasi-experiment trial.1.Findings of the focus group discussion among teenager smokers to understand their specific needs in smoking cessation. Among 15 smoking students enrolled in the FGD, every body owned a mobile phone, and mobile short message was the main service used by adolescents for daily communication. Most of them had habits of talking with other people by using instant message tools like QQ, MSN, fetion, etc. As for smoking, all participants smoked 1 to 40 cigarettes per day. Ten of them had ever considered about quitting because of cost burden, objection of their parents, constrain of the school regulations and the changing smoke-free social culture. But such of the quitting ideation and attempt had been terminated for some so-called reasons as of addiction and peer influences. Because adolescents are usually concerned that their smoking behavior would be punished by their school teacher, most of the FGD participants expressed their preference of school-based smoking cessation help from professional personnel.2 Findings of the cross-sectional survey to clarify relationship between adolescents' health-information-seeking practices and health-risk behaviors. A cluster-randomized sample of 2577 secondary school students were selected.,and a structured self-administered questionnaire was used to obtain their usage of ICTs and their practices of various health-related behaviors. It was found that the average time spent online was 18.7 h per week, while the current smoker spent 29.0 h per week. 63.0% of the participants had got an email account, with 2.2 emails being received or sent every week.88.5% of the participants owned mobile phones. They sent 30.1±48.8 and received 32.6±53.9 short messages per day on average.10.7% of the participants reported to smoke at least 1 cigarette per day. Among those current smokers,34% had searched via Internet for smoking related harmful effect,30.2% had searched for how to quit smoking. The results of present survey indicated that current adolescents in Shanghai spent quite a lot of time on Internet surfing, and usage of mobile phone and other online instant communication tools was common. Considered the characteristics of ICTs such as convenience, anonymous and interactiveness, more and more adolescents would prefer a health behavior promoting intervention that taking the advantages of ICTs, especially for dealing with some private health problems.3.Designing of ICT-based smoking cessation implementation model.On the basis of former works, an ICT-based smoking cessation implementation model was designed by integrating key constructs of health promotion theories such as the transtheoretical model and social support. The basic intervention steps were as followings:recruiting subjects with the help of school heath teachers; asking to sign an informed consent; asking to fill out a baseline questionnaire; organizing mobile short messages according to each participant's stages of their smoking cessation, i.e., "no intention", "intending to quit", "under preparing", "taking an action" and "maintaining stage". In general, each participant received at leastl message per day at their convenient time. The contents involved the harmful health effects of cigarette, the rational attitude towards smoking and its cessation, how to prepare for quitting, skills in dealing with quitting, communication skills in saying'no'in front of a cigarette invitation, and how to prevent relapse, etc. Research consultant asked each participant to report the number of cigarettes they smoked in past day on some randomly selected time-point during the whole intervention period. On the other hand, participants were encouraged to text/communicate to the consultant at anytime and anywhere with any questions if they wanted to inquire for. Besides the mobile short message services, other components of online instant communication tools, e.g. QQ and feiton, were also used to provide solutions of problems encountered in the process of quitting smoking. At the same time, a QQ space was set up to provide smoking cessation related articles, pictures and medias that can be accessed by all intervention group members.4. Evaluating the effectiveness of the ICT-based smoking cessation implementation model by a quasi-experiment trial.176 smoking students aged 16-20 yrs were recruited from 6 occupational high schools located in Hongkou, Changning and Xuhui district in Shanghai. Three schools were randomly decided as intervention group with its members receiving ICT based intervention. Whereas, the other 3 schools were decided as control group with its members being provided a self-help booklet of smoking cessation. The trial lasted for 12 weeks. Questionnaires of beseline and after-trial survey showed that 7-day and 30-day quitting rates in the intervention group(14.1% and 9.8%, respectively) were significantly higher than those in the control group (8.0% and 6.9%, respectively).66.3% participants in the intervention group reduced amounts of cigarette, while it was 34.5% in the control group was(P<0.001).On the average, subjects in the intervention group decreased 4.07 cigarettes per day, while there was only 1.87 decrease in the control group (P =0.011).Such kind of smoking reduction was especially reported in situations of staying with friends. Moreover, the Fagerstrom Test of Nicotine Dependence(FTND) and the Cigarette Dependent Scale (CDS) dropped as 0.46 and 3.76, respectively, in the intervention group, while these two indexes increased as 0.30 and 1.63, respectively, in the control group. Although there was found a slight difference of smoking related health knowledge, positive attitude towards smoking cessation became much more obvious for intervention group. In regard to satisfaction of the implementation itself,88.6% subjects in the intervention group agreed that ICT based smoking cessation program did help them in their quitting process, and the advantages of this unique intervention strategy included convenient and practical (37.5%),easy to remember (33.3%)and more fitted to their own conditions (26.7%). In comparison to the traditional ways used by the control group, the effectiveness of this ICT based intervention relied much more heavily upon its mechanisms of enhancing participants' confidence, grasping the needed skills, reducing their smoking amount and relieving their psychological pressure.In conclusion, as ICT is commonly used among adolescents, it can be confirmed that using SMS and other communication technologies familiar in adolescents to convey tailored interactive smoking cessation intervention is applicable and effective.
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