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Not-On-Tobacco Program (N-O-T)

Program Title Not-On-Tobacco Program (N-O-T)
Purpose Designed to promote cessation and reduce tobacco use among adolescent smokers. (2001)
Program Focus Smoking Cessation
Population Focus Current Smokers
Topic Tobacco Control
Age Adolescents (11-18 years)
Gender Female, Male
Race/Ethnicity American Indian, Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, Pacific Islander, White, not of Hispanic or Latino origin
Setting Community, Rural, School-based, Suburban
Origination United States
Funded by CDC: Prevention Research Center (Grant number(s): U48/CCU310821), West Virginia Department of Education (Grant number(s) not available.), National Office of the American Lung Association (Grant number(s) not available.), American Lung Association of Florida (Grant number(s) not available.)
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The Need

Despite progress made over the last decade in reducing teen smoking, helping teen smokers kick the habit remains a challenge. Teens, like adults, can face significant obstacles when trying to quit, including high levels of dependence and addiction. Research suggests effective teen smoking cessation efforts are needed in addition to traditional prevention approaches. Not-On-Tobacco (N-O-T) is a school based smoking cessation program designed specifically for teens that has been implemented and extensively evaluated since 1998 in many states across the country. Evaluations indicate that N-O-T is effective in increasing quit rates among teens who volunteer to participate, as well as encouraging other healthy behaviors that can support tobacco abstinence.

The Program

N-O-T was created by the American Lung Association (ALA) in collaboration with West Virginia University in response to both the growing number of teens addicted to tobacco and the lack of effective cessation interventions for teens. N-O-T is a group program designed for 14- to 19-year olds who are daily smokers (as opposed to experimenting smokers) and who demonstrate some motivation to quit. The protocol consists of 10 weekly 50 minute sessions plus 4 booster sessions, conducted in school or community settings, with 10 to 12 participants per group. N-O-T is gender tailored, delivered to males and females separately by same gender facilitators. The facilitators (usually teachers, school nurses, coaches, counselors, and other staff volunteers who are recruited based on specific criteria) undergo extensive training and follow a highly prescribed curriculum. Major program goals are to help teens (1) quit smoking, (2) reduce the number of cigarettes if unable to quit, (3) increase healthy lifestyle behaviors, and (4) improve life skills such as stress management, decision making, coping, and interpersonal skills.

Community Preventive Services Task Force Finding
Guide to Community Preventive Services This program uses the following intervention approach for which the Community Preventive Services Task Force finds insufficient evidence: provider education when used alone (Tobacco Control). Insufficient evidence means the available studies do not provide sufficient evidence to determine if the intervention is or is not effective. This does not mean that the intervention does not work. It means that additional research is needed to determine whether the intervention is effective.

Time Required

Implementation of the N-O-T program requires advance preparation for (1) coordination with the schools or community organizations that plan to sponsor the sessions, (2) recruitment of facilitators and participants, and (3) training of facilitators. The N-O-T program is conducted over 10 consecutive weeks, with the option of 4 additional weeks of booster or follow up sessions. Facilitators generally receive 8-10 hours of highly prescribed N-O-T instruction and training in research protocol.

Intended Audience

The program is suitable for all youth at the junior high and high school levels. N-O-T participants are generally between 14 and 19 years of age, with a mean age of 16 and a slightly higher representation of females (56 percent). 87.3% were White, 2.3% were Black, 1% were American Indian, 0.3% were Asian, 3.3% were Hispanic, 1% were Pacific Islander, and 4.7% were classified as "other". Students from all across the United States and parts of Europe and Canada have taken part in the program. The curriculum has been translated into Spanish, and development of culturally tailored versions for American Indian and rural youth is underway.

Suitable Settings

The intervention is suitable for implementation in school and community settings. It can be used as an educational, nonpunitive alternative to existing school tobacco enforcement policies (such as suspension) and a supplement to smoking prevention programs.

Required Resources

A facilitator instruction guide, surveys, and curriculum are available from the ALA.

Costs have been paid by state tobacco initiatives, state and local school systems, public and private research grants, and other sources of funding.

About the Study

The N-O-T program has been implemented and evaluated in several states including Florida, North Carolina, Virginia, West Virginia, and Wisconsin. Multiyear, multistate results suggest it is an effective teen smoking cessation program. Key findings include:

  • In the first published evaluation, both chemically validated and self-report measures found that at 8.5 months postbaseline, female N-O-T participants had significantly higher quit rates than females in the comparison group. There were no significant differences in quit rates for male participants.


  • In a five-year review of the program including five states, 489 schools, and over 6,000 youth significant results were also found. This review included experimental and quasi-experimental evaluations. The field-based quasi-experimental evaluations found an end-of-program quit rate of 32 percent (n=3761). The controlled or experimental evaluations found an end-of-program N-O-T quit rate of 19 percent, compared to 9 percent in the comparison group. This difference was statistically significant. Over all states, quit rates were similar for both males and females.

Graph of Study Results



Dino, G., Horn, K., & Meit, H. (1998). A pilot study of Not-On-Tobacco: A stop smoking program for adolescents. Journal of Health Education, 6 , 230-241.

Dino, G., Horn, K., Goldcamp, J, Kemp-Rye, L., Westrate, S., & Monaco, K. (2001). Teen smoking cessation: Making it work through school and community partnerships. Journal of Public Health Management and Practice, 7(2), 71-80.

Dino, G., Horn, K., Goldcamp, J., Fernandes, A., & Kalsekar, I. (2001). A two-year efficacy study of Not-On-Tobacco in Florida: An overview of program successes in changing teen smoking behavior. Preventive Medicine, 33, 600-605.

Dino, G., Horn, K., Zedosky, L., & Monaco, K. (1998). A positive response to teen smoking: Why N-O-T?. NASSP Bulletin, 82 (601), 46-58.

Dino, G., Kamal, K., Horn, K., Kalsekar, I., & Fernandes, A. (2004). Stage of change and smoking cessation outcomes among adolescents. Addictive Behaviors, 29(5), 935-940.

Doll, L., Dino, G., Duetsch, C., Holmes, A., Mills, D., & Horn, K. (2001). Linking science and practice: Two academic/public health collaborations that are working. Health Promotion Practice, 2 (4), 295-300.

Horn, K., Dino, G., Gao, X., & Momani, A. (1999). Feasibility evaluation of Not-On-Tobacco: ALA's new stop smoking program for adolescents. Journal of Health Education, 5 (September), 192-206.

Horn, K., Dino, G., Kalsekar, I., Massey, C., Manzo-Tennant, K., & McGloin, G. (2004). Exploring the relationship between mental health and smoking cessation: A study of rural teens. Prevention Science, 5 (2), 113-127.

Horn, K., Fernandes, A., Dino, G., Kalsekar, I., & Massey, C. (2003). Adolescent nicotine dependence and smoking cessation outcomes. Addictive Behaviors, 28(4), 769-776.

Horn, K., Dino, G., Kalsekar, I., & Mody, R. (2005). The impact of Not on Tobacco on teen smoking cessation: End-of-program evaluation results, 1998 to 2003. Journal of Communication, 20 (6), 640-661.

Massey, C., Dino, G., Horn, K., Lacey-McCracken, A., Goldcamp, J., & Kalsekar, I. (2003). Recruitment barriers and successes of the American Lung Association's Not-On-Tobacco Program. Journal of School Health, 73(2), 58-63.

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Updated: 06/25/2020