Journal of the National Cancer Institute Advance Access originally published online on October 12, 2009
JNCI Journal of the National Cancer Institute 2009 101(20):1378-1392; doi:10.1093/jnci/djp317
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© The Author 2009. Published by Oxford University Press.
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Group-Randomized Trial of a Proactive, Personalized Telephone Counseling Intervention for Adolescent Smoking Cessation
Affiliations of authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA (AVP, KAK, SLM, PMM, JL, JBB); Group Health Center for Health Studies, Seattle WA (EJL); Department of Biostatistics (AVP) and Department of Psychology (JBB), University of Washington, Seattle WA
Correspondence to: Arthur V. Peterson Jr, PhD, Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M2-C826, PO Box 19024, Seattle, WA 98109-1024 (e-mail: avpeters{at}fhcrc.org).
Background: The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation.
Methods: Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided.
Results: The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = –0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers.
Conclusions: Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.
| CONTEXT AND CAVEATS Prior knowledge Approximately half of adolescent smokers have tried to quit, but only less than 5% succeed. Results from clinical trials of smoking cessation among adolescents have been variable due to methodological issues. Study design Randomized trial of smoking cessation intervention using multiple-component personalized counseling by telephone vs no intervention of more than 2000 high school senior smokers who were proactively identified as high school juniors in 50 schools. The primary outcome was 6-month abstinence from smoking. Contribution The intervention increased 6-month abstinence from smoking from 18% to 22%, and more than 88% of students who were followed-up were still participating 1 year after random assignment. Implications Smoking cessation intervention using personalized telephone counseling using proactive identification of participants can increase abstinence from smoking among adolescents. Limitations Because of the study design, the individual effects of each of the multiple types of intervention could not be determined. More than one-third of the proactively identified participants did not complete one intervention call. The number of minority participants was too small to perform analysis by racial and ethnic minority groups. From the Editors
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Manuscript received December 4, 2008; revised June 19, 2009; accepted August 12, 2009.
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  S. J. Leischow and E. Matthews Helping Adolescent Smokers Quit: Can Telephone Quitlines Lead the Way? J Natl Cancer Inst, October 21, 2009; 101(20): 1367 - 1368. [Full Text] [PDF]
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