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):1393-1405; doi:10.1093/jnci/djp318
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© The Author 2009. Published by Oxford University Press.
ARTICLES |
Design and Implementation of an Effective Telephone Counseling Intervention for Adolescent Smoking Cessation
Affiliations of authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (KAK, PMM, SLM, JBB, AVP); Center for Health Studies, Group Health Cooperative, Seattle, WA (EJL); Department of Biostatistics, University of Washington, Seattle, WA (AVP)
Correspondence to: Kathleen A. Kealey, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA 98109-1024 (e-mail: kkealey{at}fhcrc.org).
Background: Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST).
Methods: We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor’s calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code.
Results: Among identified smokers, 948 (89.6%) were eligible for intervention by age (
18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors’ calls demonstrated that more than 85% of counselors’ calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%).
Conclusion: An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers.
| CONTEXT AND CAVEATS Prior knowledge Recruitment of adolescent participants in clinical trials of smoking cessation has been difficult because of several effectiveness barriers, including lack of motivation, lack of skills to quit, using smoking to reduce stress, and life transitions. Study design A personalized counseling smoking cessation intervention of motivational interviewing and cognitive behavioral skills training by telephone was developed and used on more than 1000 high school senior smokers who were proactively identified as high school juniors in 25 schools. Quality of implementation was evaluated. Contributions Of the smokers identified, nearly half completed all intervention calls. The intervention was executed with more than 90% adherence to the intervention protocol and more than 85% of counselors met or exceeded behavioral benchmark scores. Implications A smoking cessation intervention of personalized telephone counseling using motivational interviewing and cognitive behavioral skills training can be used in a general population of adolescent smokers. Limitations In some cases, counselors failed to initially contact, to recontact and initiate telephone counseling, and to recontact participating smokers. From the Editors
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Manuscript received December 5, 2008; revised June 19, 2009; accepted August 12, 2009.
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J Natl Cancer Inst 2009 101: 1365.
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  A. V. Peterson Jr, K. A. Kealey, S. L. Mann, P. M. Marek, E. J. Ludman, J. Liu, and J. B. Bricker Group-Randomized Trial of a Proactive, Personalized Telephone Counseling Intervention for Adolescent Smoking Cessation J Natl Cancer Inst, October 21, 2009; 101(20): 1378 - 1392. [Abstract] [Full Text] [PDF]
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