A comparative Review of the Effectiveness trial of n-o-t in Alabama - Guideposts for future Research

Oct 15, 2026

Uploaded by Grenda

The American Lung Association’s Not On Tobacco (N-O-T) program is a federally recognized option for teen smoking cessation, widely used in U.S. schools and communities. Over a decade of research supports its effectiveness in both cessation and reduction. A recent Alabama trial reported low impact and negative results, prompting the need to compare methods and analyze outcome differences. The manuscript contrasts Alabama procedures with prior studies, discusses analytical issues, and outlines guidance for future teen cessation research.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

About N-O-T

A brief review

Feature Article A comparative Review of the Effectiveness trial of n-o-t in Alabama: Guideposts for future Research Kimberly Horn and Geri Dino ABSTRACT The American Lung Association’s Not On Tobacco (N-O-T) program is federally recognized as an accessible and effective option for teen smoking cessation. The program is the most widely used teen smoking cessation program in schools and communities across the U.S. Over a decade of research demonstrates the program’s solid evidence base, with overwhelmingly positive findings for both smoking cessation and reduction. A recent publication detailing a Not On Tobacco trial in Alabama reported low impact and negative findings. Given the program’s widespread use across the country, it is important to understand differential outcomes between the Alabama study and past Not On Tobacco studies, and to explore what we can learn from these differences. The current manuscript: (1) details and compares the methodological differences between the Alabama study and previous Not On Tobacco efficacy and effectiveness studies in other states,(2) explores important issues surrounding the analysis of teen smoking cessation outcomes, and (3) provides guidance for future research for Not On Tobacco and other teen smoking cessation interventions. Horn K, Dino G. A comparative review of the effectiveness trial of N-O-T in Alabama: guideposts for future research. Am J Health Educ. 2009;40(1):47.55. This paper was submitted to the Journal on April 14, 2008, revised and accepted for publication on September 10, 2008. IntRoductIon Nearly one-fourth of U.S. high school teens currently smoke and most who smoke now will become adult smokers. Understandably, teen smoking cessation remains a public health priority. The American Lung Association’s (ALA) Not On Tobacco (N-OT) program is acknowledged as an accessible and effective option for teen smoking cessation. N-O-T is consistent with the current Youth Tobacco Cessation Collaborative guidance1 and recommendations in the teen smoking cessation literature.2-4 Its evidence base has been federally recognized by the Substance Abuse and Mental Health Services Administration, National Cancer Institute, and the Centers for Disease Control and Prevention, among other organizations.5,6 Over the past decade, the National Office of the ALA and the developers of N-O-T have welcomed, and will continue to welcome, independent replications of past N-O-T efficacy and effectiveness trials. Repeated independent investigations are the vehicle by which intervention programs reach their maximum potential and success. Although independent empirical investigations of N-O-T have been published,7 no true replications exist. The most recent of the independent investigations is presented in an article by Kohler and colleagues,8 in the American Journal of Health Behavior. Unlike other N-O-T studies, the study by Kohler et al. reported low impact and negative findings among Alabama teens. When studies of the same intervention program achieve discrepant results, methodological comparisons may help understand the discrepancies. Given that only a handful of empirically tested teen smoking interventions exist, the opportunity for this type of comparative review is rare. Relevant to the N-O-T investigations at hand, two questions arise,“What are the reasons for the differences in study outcomes?” and “What can we learn from them?”As one of only two published independent investigations of N-O-T, the Kohler Kimberly Horn is an associate professor of Community Medicine and associate director in the Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26505; E-mail: [khorn@hsc.wvu.edu. Geri Dino](khorn@hsc.wvu.edu. Geri Dino) is an associate professor of Community Medicine and director of the Prevention Research Center, West Virginia University, Morgantown, WV 26505; [E-mail: gdino@hsc.wvu.edu](E-mail: gdino@hsc.wvu.edu). American Journal of Health Educat

FAQs

What is the N-O-T program and why is it important for teen smoking cessation?

N-O-T is a federally recognized, widely used teen smoking cessation program. Research supports its evidence base for reducing smoking and helping teens quit in schools and communities.

How do the Alabama trial findings differ from earlier N-O-T studies?

A recent Alabama publication reported low impact and negative findings among teens. The paper highlights that discrepant outcomes between studies may be clarified through methodological comparisons.

What does the manuscript focus on to explain and learn from these differences?

The manuscript compares methodological differences between the Alabama study and prior N-O-T efficacy/effectiveness studies, examines key analysis issues for cessation outcomes, and provides guidance for future research and other teen cessation interventions.

Oct 15, 2026

Uploaded by Grenda