Students at a local high school were part of a landmark study showing it’s possible to recruit teens into a stop-smoking program and significantly improve their quit rates.
Heritage High, in the Evergreen School District, was one of 50 Washington high schools enlisted by the Fred Hutchinson Cancer Research Center in Seattle.
“We found results that had never been seen before,” said Art Peterson, lead author of the paper that was published recently in the online edition of the Journal of the National Cancer Institute.
Researchers surveyed more than 12,000 high school juniors, and almost 2,900 signed on for the project. Participants included 2,151 smokers and 743 nonsmokers.
Students in 25 schools received telephone-based counseling as seniors; students in the other 25 schools formed the control group and did not get counseling.
At the end of the study, about 22 percent of smokers in the counseling group had achieved continuous quitting for six months.
That’s a significant percentage, researchers say: Almost half of all current teen smokers say they tried to quit in the past year, but only about 4 percent succeeded on their own.
Heritage participated during the 2003-2004 and 2004-2005 school years. As part of the control group, the Heritage students didn’t receive the stop-smoking counseling.
Kelso and Castle Rock were the other Southwest Washington high schools in the study, funded by the National Institutes of Health.
It’s the largest randomized trial of teen smoking cessation ever conducted, and the first to significantly cut smoking rates.
Both accomplishments required new approaches to enlisting and then counseling teen smokers, Peterson said. The recruiting was done by contacting the junior class at each high school. Counseling was done by telephone, using a format that helped teens identify their feelings about smoking and then establish goals for quitting.
Thanks to earlier studies, the Hutchinson researchers knew what didn’t work.
“The prior studies were very helpful for identifying what the challenges were,” Peterson said. “Just reaching out and getting teens engaged was difficult. We studied what it is it about teens” that makes them tough to reach.
In previous studies that relied on teens to take the first step, 2 percent to 10 percent would participate, he said.
“Teens value their privacy, they value their emerging autonomy, and they don’t want others to be judgmental. They don’t take the initiative, and many teen smokers — especially (those who smoke) less than daily — don’t regard themselves as smokers,” he said.
“We decided to try a proactive strategy. We didn’t make any assumptions they wanted to quit. We sought to talk to both smokers and nonsmokers.”
Classroom surveys included a place for students’ contact information. Almost two-thirds of the smokers in the experimental group were eligible, which included parental approval for those younger than 18, and participated in the counseling.
“The fact that we included smokers and nonsmokers helped with that,” Peterson said. “We didn’t stigmatize anybody or inadvertently reveal their smoking status.”
With counseling done over the telephone, “There is a personalization and privacy you can’t get in a classroom,” Peterson said.
Nearly half completed all of their scheduled counseling calls.
Counseling was based on the idea that smokers need to believe it is important to quit. Then they need the confidence, the knowledge and skills it takes to quit.
The intervention used two types of counseling: Motivational interviewing emphasizes building motivation and confidence for quitting; cognitive behavioral skills training helps smokers cope with stress and events that can trigger smoking.
“In the end, it is the smoker’s own reasons and desire to quit that motivate the quit attempt,” Kathleen Kealey, project manager, said in a news release.
Nonsmokers were contacted to make sure they hadn’t started smoking and to help them support friends who were trying to kick the habit.
Researchers also looked at shorter time spans and found that almost half the smokers quit for at least a week.
Notably, the one-month and seven-day quit rates among the smokers with counseling were several times as high as those reported in nearly 50 previous teen smoking trials conducted over the past 20 years.
Researchers also found that 17.7 percent of the smokers in the control group quit without counseling.
Most of that success was among lighter smokers, Peterson said.
About 6 percent of daily smokers in the control group quit, while the quit rate was 10 percent among the daily smokers who got counseling.
Tom Vogt: 360-735-4558 or tom.vogt@columbian.com.
