Program Lifts Quit Rate for Teen Smokers
By Tom Vogt, The Columbian Staff Writer
Monday, April 4, 2005
The teen's fingers tapped at the computer keys as he set off on an interactive quest to safeguard a precious treasure: his lungs.
This computer session was no game. It was part of a health study that examined a new way to help teens stop smoking through use of a computerized questionnaire, two brief clinic sessions and two follow- up sessions over the next 11 months.
According to investigators, the quit rate for teen smokers in the program was 24 percent; that was more than double the rate (11 percent) for teen smokers in a control group.
"Many teen smokers want to stop smoking, and they can stop," said Jack Hollis, senior investigator at Kaiser Permanente's Center for Health Research in Portland. "The job is to get teens the right kind of help at the right time."
Hollis is the lead author of the study, which was published in today's issue of Pediatrics magazine.
The results were drawn from 2,526 teens (14 to 17 years old) who visited seven Kaiser Permanente medical offices in Oregon and Southwest Washington.
The study included 277 Clark County teens who visited Kaiser's Mill Plain and Cascade Park medical offices. (Girls accounted for 59 percent of the overall study group, by the way; even among teens, going to the doctor doesn't seem to be a guy thing.)
Researchers asked teens if they were interested in sticking around for about 15 minutes to participate in a health study.
Two-thirds agreed, and the participants were split between a nutritional study and the stop-smoking study.
Most weren't smokers
At the start of the 1,254-person smoking study, 966 teens identified themselves as non-smokers.
The teens had a brief consultation with their doctors. Then they spent 10 minutes working with the interactive computer program, which asked a range of smoking-related questions: Do you smoke? If you don't, what are the chances you might try a cigarette over the next few months? If you are currently a smoker, are you interested in quitting?
Hollis said the program "examines confidence, barriers to quitting, and other factors known to have an effect in making an attempt to quit. It provided different feedback and information, depending on where the teen was."
Finally, the teen spoke with a health counselor for three or four minutes about making decisions.
"The most exciting thing we found was the 24 percent quit rate among those who were smokers at the beginning of the study," Hollis said. "That's a fairly large effect."
The study also found that teen smokers are interested in quitting.
"Most reported they had tried multiple times the previous year," said Hollis, who has a doctorate in social psychology. "Maybe two- thirds were seriously contemplating quitting before there was any intervention at all.
"They're having just as hard a time quitting as adults, but they want the right help," Hollis said. "They don't want to be lectured or nagged."
Two elements in the study were particularly teen-friendly, Hollis said.
"The fact that the intervention was provided in a medical-care context was significant. Teens tend to trust clinical care providers, and it is a teachable moment when you can relate smoking to asthma or their latest cold."
The interactive questionnaire also is a factor, he said.
"It's not an adult authority figure nagging them. It's a computer, which teens tend to be comfortable with," he said. "It's private and confidential, and it allows them to get information and facts and think about alternatives without an adult figure leaning over them. They like that."
Unfortunately, Hollis said, the study didn't have much success in stopping teens from becoming smokers over the next two years.
'Won't happen to me'
So why do they start, given the obvious health risks?
"Social influences are the biggest factors," he said. "Teens in homes where parents smoke are more than twice as likely to become smokers themselves. And certainly teens who have a majority of friends who smoke are more likely to smoke."
When they light up for the first time, "They say something like, 'I don't intend to smoke very much or very long, so I don't think those negative things will happen to me. I'll just smoke at parties, and I won't smoke as an adult.' It's some version of that," Hollis said.
"They fail to appreciate that a high percentage of people who become experimental smokers will become addicted and are still smoking at 25 or 30. It is more addictive than they realize," Hollis said. "All they need to do is talk to their friends who smoke regularly and ask them how hard it would be to just stop. Most would acknowledge that is it very hard, but it can be done."
Another piece of good news, Hollis said, is that most teens don't smoke.
"That's an important thing to stress. While it's a big problem for society, it's still a dwindling minority of teens and for all people."
While some beginning smokers take an everybody-does-it approach, they're wrong, Hollis said: "Actually, it's only a fourth."
It will be several years before the program is a standard part of clinical care, Hollis said: "If you were to ask to be part of the program, it doesn't exist."
Hollis called the initial findings "a very encouraging first step."
More study will be done in the fall, and other researchers will have to replicate the results.
"Then, within three or four years, we would hope this would be part of routine practice," he said.
Funding for the $1.6 million program came from the National Cancer Institute.
Did you know?
Among adults who have ever smoked daily, 82 percent first tried cigarettes before age 18, and 53 percent smoked daily before that age, says the U.S. Department of Health and Human Services.
Almost one-half of current adolescent smokers who continue to smoke regularly will die from a smoking-related disease.
Fruitless results: There was no proof from the other half of the research - the nutritional study that served as a control group for the smoking study - that a dietary counseling program could convince teens to eat more fruits and vegetables.