By Jocelyn Selim
Calling It Quits
Innovative telephone counseling helps teens stop smoking
By Jocelyn Selim
Getting teenagers to do something you want them to do can try just about anyone’s patience. Getting them to quit smoking can border on the impossible. Nevertheless, researchers at Fred Hutchinson Cancer Research Center in Seattle seem to have achieved just that.
How did the researchers do it? Via telephone.
Nearly every state already has telephone quit lines to help smokers kick the habit, but they rely on people being motivated enough to call. Although studies show quit lines help adults, they rarely reach teen smokers. But “teenagers and telephones have always gone well together,” says Kathleen Kealey, a cancer prevention researcher at Fred Hutchinson, whose study was published in the Oct. 21, 2009, Journal of the National Cancer Institute. What remained to be done was to tap the potential of this connection.
The problem that they had to overcome, says Kealey, was that “most teens don’t use quit lines because they either underestimate the addictiveness of nicotine and their ability to quit, they don’t think they smoke frequently enough to consider themselves smokers, or because they don’t believe counseling can help them.”
For the study, Kealey and her colleagues sought out seniors who smoked at 50 Washington state high schools. Half of the schools were randomly selected to participate in the intervention, while the other half served as controls. Overall, the researchers managed to recruit more than 60 percent of the 2,151 smokers at these schools, compared with less than 10 percent in previously reported adolescent smoking cessation trials. At the 25 schools selected to have students receive counseling calls, 736 agreed to take part, and 499 completed all planned calls.
“I think the major difference [between our study and those done previously] is that we could guarantee the teens complete privacy,” says Kealey. “Since we had already gotten permission from their parents and schools, they didn’t have to worry that their smoking status would be revealed.”
In an effort to increase the students’ desire to quit, telephone counselors used open-ended questions and nonjudgmental listening, and reflected back answers. “It’s a method that doesn’t tell them what to do,” says Kealey, “which we all know teenagers hate.”
If, after receiving three such motivational calls, teens were interested in making a quit attempt, program counselors continued to call and gave them tools—like self-talk, planning and anticipation of obstacles—that could help them be successful. “This is a technique that’s being used with adult smokers and alcoholics that’s really gaining momentum with its successes,” says Kealey.
Overall, 22 percent of the teens who received the telephone intervention remained smoke-free for at least six months, compared with 18 percent of those who quit on their own in the control group. A difference of 4 percent might not seem like a lot, Kealey acknowledges. But this is actually the first demonstration to show long-term effectiveness in a large group of adolescents.
“There’s been a misconception—both among the public and among researchers—that getting adolescents to quit smoking is nearly impossible, so most programs are aimed at prevention,” says Arthur Peterson, a biostatistician and cancer prevention researcher at Fred Hutchinson and lead author of the study. “We’ve shown that, with the right tools, it’s absolutely possible to get adolescents to quit and stay quit.”
Eva Matthews, an epidemiologist at the Arizona Cancer Center in Tucson, agrees. “We’re coming from a place where tobacco companies are very well-funded and have a history of targeting younger smokers,” says Matthews. “This is a benchmark study that gives us hope. Having an effective intervention strategy is an important first step.”
(photo credit: Bonnie Briant)