Michelle Kuhn sings in the choir and belongs to the Spanish Club at Abraham Lincoln High School. She also holds a job at Old Navy in the Mall of the Bluffs.

While those are all rewarding activities, Michelle said her work as a peer counselor helping fellow students to give up smoking is what really pleases her. "I just think it's very rewarding that I am there to help out," she said. Michelle saw some recruiters from the University of Nebraska Medical Center in the halls of A.L. looking for students to join the program. After visiting with them she was hooked ... on helping. "I thought it would be neat to be able to help somebody that has a problem of being addicted to smoking," Kuhn said. Students at Abraham Lincoln are part of a $2.2 million federally-funded study to determine how peer counseling can be used to help teenagers quit smoking. The four-year UNMC study will eventually involve 900 teen smokers from 24 high schools in Council Bluffs, Omaha and Lincoln. It's estimated that about 22 percent of the students in those schools are smokers. Each school will be part of the study for one year. Abraham Lin- coln has been part of the first year's rotation with Omaha's Bryan, Central and Northwest high schools. Because of the study's statistical design, it hasn't been determined when other schools in Council Bluffs may be involved. UNMC's lead researcher on the project, Dr. Kristine McVea, said it's long been known that peer pressure can increase teen smoking. "My idea was to see if we could turn that very powerful influence around into something positive," she said. That matches what Kuhn has learned from asking some of her fellow students about their smoking habits. "They thought it was cool. Peer pressure and stuff," she said. There are more reasons for teens to stop smoking than the well-established health concerns about cancer and heart disease. McVea said. Smoking has social consequences for teenagers because it's illegal, she said. That can lead to school suspensions and parental conflict. Smoking in teenagers also has been associated with depression, she said. "There's some evidence that smoking comes first and the depression later," McVea said. One consequence of depression can be suicide. The program recruits teenagers to serve as counselors. The peer counselors are then asked to find two smokers to give them some brief smoking cessation messages during the day. The goal is for each counselor to help two people. "It's really a friend talking to a friend," McVea said. She said it's a myth that teen smokers aren't interested in quitting. Teens make more frequent attempts to stop smoking than adults but are less successful. Studies show that more than 50 percent of teen smokers wish they'd never started and more than half also try to quit, she said. "They tend to try to do it on their own without a lot of planning," McVea said. Teens also continue to face negative peer pressure when they try to quit, so McVea developed the idea of finding a couple of friends who could provide support for the student. The peer counselors prepare for their role during a pair of two-hour training sessions in which they learn about positive counseling and how to be supportive and not just nag. They also learn how to determine if the smoker they're counseling is ready to quit, just thinking about quitting or not thinking about quitting at all. The peer counselors are then taught specific techniques for each of the three types, McVea said, The preparation also includes role playing and practice counseling, she said. "The goal is to, maybe, just make them give it some thought," McVea said. "You don't have to get the smoker to quit smoking in order to be successful in terms of your counseling." Researches plan to become more aggressive in their recruiting of counselors next year, McVea said. It often can be difficult to involve busy teenagers in research projects, so recruiters will spend more time in the schools and do more one-on-one work to recruit students. The study, which began in August, enrolled 48 peer counselors its first year, including 12 at Abraham Lincoln, McVea said. The counselors are not evenly divided among the schools. Kuhn said it can be difficult to get other teens to listen, but one student she has been working with, Jaime Defore, is in the final stages of giving up smoking. After two years of smoking and several attempts to quit, Defore said it's helpful to have a peer counselor. "You don't want to say anything like you smoke to an adult," she said. The juniors-to-be said they plan to continue working together during the summer. So far, six people from the four high schools have quit smoking, McVea said. "When you think about it, that's six people whose lives were saved by their friends."

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