With the help of students of the class of 2004 at Lakes High School, the Fred Hutchinson Cancer Research Center has obtained landmark results from the Hutchinson Study of High School Smoking, the largest randomized trial of teen smoking cessation ever conducted. The study for the first time demonstrated that it is possible to:
- successfully recruit and retain a large number of adolescent smokers from the general population into a smoking intervention study; and
- significantly impact rates of six-month continuous quitting through personalized, proactive telephone counseling.
These findings, by Arthur V. Peterson Jr., Ph.D., Kathleen A. Kealey and colleagues in the Hutchinson Center’s Cancer Prevention Program, were reported in a pair of scientific articles in the Oct. 12 online edition of the Journal of the National Cancer Institute.
“This is the first youth smoking cessation trial to report statistically significant increases in six-month prolonged abstinence, as measured a full 12 months after the start of the intervention, among a large population of teen smokers in a non-medical setting,” said Peterson, a member of the Hutchinson Center’s Public Health Sciences Division and lead author of the paper that reported the results of the Hutchinson Study of High School Smoking.
The trial, funded by the National Institutes of Health, involved more than 2,000 teenage smokers from 50 high schools in Washington, including Lakes High School. Half of the schools were randomly assigned to the experimental intervention; teens in these schools were invited during their senior year to take part in confidential, personalized telephone counseling designed to help motivate them to quit. The remaining 25 schools served as control, or comparison, schools; teen smokers from these schools did not participate in the telephone intervention. Lakes High School was one of the 25 control schools. The study also included 745 nonsmokers to ensure that contacting students for participation in the trial would not reveal a participant’s smoking status.
Students in the class of 2004 – both nonsmokers and smokers, and with their parents’ permission – were invited to participate in the study. As juniors, they participated in an in-class baseline survey, and then were followed by mailed survey one year post-high-school graduation to learn about changes over time in their attitudes and practices with regard to smoking and nonsmoking.
“We applaud, and thank, the administrators and staff of Lakes High School and the class of 2004 and their parents, for their terrific interest and cooperation, which were so essential to the success of this pioneering study,” Peterson said. “Their strong support and cooperation made it possible to rigorously evaluate the effectiveness of the study’s innovative, proactive, personalized telephone-counseling approach to youth smoking cessation. We are delighted with this study and its results,” he said.
Study recruitment was robust: by proactively identifying and recruiting teen smokers (with parental consent for those under age 18), two-thirds of all identified smokers participated in the telephone counseling, and nearly half completed all of their scheduled counseling calls.
The study found that the proactive, personalized, confidential telephone counseling sessions were effective in helping teen smokers kick the habit. At the completion of the study, 21.8 percent of all smokers (daily and less than daily) in the counseling group had achieved continuous quitting for six months, as compared to 17.8 percent of those in the comparison group, a difference of four percent.
The intervention also impacted three-month, one-month and seven-day smoking abstinence, with differences between the counseling group and the comparison group of 3.3 percent, 6.8 percent and 7.5 percent, respectively.
The intervention integrated two types of counseling: motivational interviewing, which emphasizes building motivation and confidence for quitting, and cognitive behavioral skills training, which gives smokers the tools they need to learn how to quit.
“Motivational interviewing is very caring, nonjudgmental and respectful. It is non-confrontational. A counselor would never say, ‘I want you to quit smoking.’ Instead the counselor would ask what the behavior means to the participant. What do they like about it? What don’t they like about it?’” explained Kealey, first author of the companion paper, which describes in detail the design and implementation of the telephone counseling intervention.
“In the end, it is the smoker’s own reasons and desire to quit that motivate the quit attempt,” said Kealey, project manager for the study.
Cognitive behavioral skills training seeks to help people build skills for quitting and preventing relapse through counseling strategies that emphasize practical tools, such as self-talk strategies, ways to cope with stress and smoking triggers, and collaborating on a plan for quitting.
The National Cancer Institute funded the study, which also involved investigators at Group Health Research Institute in Seattle.