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What's New - Teen Smoking Intervention

Brief intervention in the medical office helps double teen smokers' quit rate

New study shows teens can stop smoking with help of computers during medical visit

(PORTLAND, Ore.) -  April 4, 2005 - A unique smoking-cessation program for teens, based on brief counseling and an interactive computer program, showed that 24 percent of teen smokers had stopped smoking after two years. This quit rate was more than double the quit rate (11 percent) of similar teen smokers who did not receive the intervention. Results of the study, called Teen REACH, appear in the April 4th issue of Pediatrics.

"Many teen smokers want to stop smoking, and they can stop," says lead author Jack Hollis, PhD, 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 says most teen smoking research has focused on school-based programs to prevent teens from starting to smoke. "Unfortunately, these prevention programs have had little long-term effect, and currently about one in four teens do start smoking. We took a different approach and tested a brief anti-smoking intervention provided by physicians and staff during a routine medical office visit," explains Hollis.

Teens, both smokers and nonsmokers, received brief advice from their doctor and then spent about 10 minutes using an interactive computer program designed to appeal to teens. The computer program asked a series of questions, and then provided different individually-tailored messages and information based on the teen's attitudes and whether they identified themselves as smokers, 'experimenters,' or non-smokers.

"What we found," says Hollis, "is that among teens who were already smoking, the intervention doubled the long-term quit rate. Unfortunately, the program was not effective in preventing nonsmoking teens from starting to smoke over the next two years."

More than 3,700 teens aged 14 to 17 were approached by study staff in seven Kaiser Permanente medical offices in Oregon and Southwest Washington and asked if they would be willing to stay after their medical visit to receive either a brief smoking or a brief nutrition program. More than 67 percent of the teens (2,526) consented and were randomized either to tobacco intervention (1,254 teens) or brief nutrition advice (1,272 teens). Teens in the two groups were very similar in age, sex, ethnicity, education plans, exercise, weight, and self-reported smoking status (non-smokers, "experimenters," and smokers).

Teens who were randomized to tobacco intervention received a 30-second advice message from their clinician, a 10-minute interactive computer program (tailored to each teen's smoking status, and attitudes about starting or stopping smoking), a 5-minute motivational interview with a health counselor, and two individual "booster" sessions with a health counselor over the next 11 months. Teens who were randomized to the nutrition intervention (the control group) received three to five minutes of motivational counseling to promote eating more fruits and vegetables. They were also given two nutritional information brochures and a small snack-pack of fruit leather. Teens in both groups were contacted after one and two years via questionnaires or telephone interviews to assess their current smoking status and other health measures.

Major findings of the study include the following:

• 24 percent of teen smokers who received the smoking intervention were not smoking after two years compared to 11 percent of teen smokers who did not receive the intervention,
• Non-smokers in the intervention group were less likely to start smoking after one year than teens in the control group, but both groups had nearly identical smoking rates after two years (14.2 percent versus 16.9 percent),
• "Experimenters" in both groups also had nearly identical rates of abstinence from smoking after two years (49.7 versus 48.7).
• There was no evidence that the nutrition intervention increased teens' consumption of fruits and vegetables.

"Our finding that the intervention had little long-term effect on preventing non-smokers from experimenting with tobacco or starting to smoke is consistent with other studies," Hollis says. "This is certainly discouraging, but the excellent quit rate for current smokers in this study suggests that physicians should focus greater efforts on helping teen smokers quit. Taking advantage of the powerful motivating force of physicians and making use of computer programs that teens find safe and engaging provides an effective and relatively inexpensive way to help teens stop smoking."

Funding for this five-year grant totaled $1,630,020 and was provided entirely by the National Cancer Institute.

Kaiser Permanente's Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health.

Kaiser Permanente Northwest is a group practice health care organization providing health care services to about 465,000 people in Oregon and Southwest Washington.

Fact Sheet

• Tobacco use is the number one cause of preventable illness and death in the United States, resulting each year in
  • more than 430,000 deaths,
  • more than 5 million years of potential life lost, and
  • $50 billion of direct medical expenditures related to smoking.
• Among adults who have ever smoked daily, 82 percent first tried cigarettes before age 18 and 53 percent smoked daily before that age.
• Almost one half of current adolescent smokers who continue to smoke regularly will die from a smoking-related disease.
• After several decades of decline, rates of smoking for grades 9 through 12 increased in the early 1990s and peaked at 37 percent for grade 12 in 1997. Smoking rates have since declined but remain unacceptably high at more than 25 percent for 12th-graders.
• Rates of smoking among 12th-graders in 2004 were higher among whites (28 percent) than among either Hispanics (18 percent) or African Americans (10 percent).
• For most teen subgroups, rates of tobacco use must be at least cut in half to meet Healthy People 2010 targets.