Major Finding: At 12 months follow-up, 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.
Data Source: Sixty-five percent of 1,058 adolescents identified as smokers by a classroom survey in 25 schools in Washington completed at least one telephone conversation with trained smoking cessation counselors and were compared with 1,093 in a control group.
Disclosures: The work was supported by a grant from the National Cancer Institute. Ms. Kealey said she had no conflicts relevant to the study to disclose.
BALTIMORE – Proactively reaching out to adolescent smokers through their high schools is both an effective and cost-effective way of achieving smoking cessation, researchers in a Washington State study found.
The findings demonstrate that “modest investments in effective interventions can accelerate declines in smoking prevalence,” Kathleen Kealey said.
“The cost is much less than the cost to society of smoking,” said Ms. Kealey, who serves as administrative program manager at the Fred Hutchinson Cancer Research Center, Seattle.
“An investment of under $100 to get a teen to quit can save billions of dollars in health care costs and lost productivity.”
The randomized trial involved smokers in 25 high schools in Washington who were eligible for the intervention on the basis of parental consent or being at least age 18 years.
In the intervention group, 691 of 1,058 people (65%) identified as smokers by a classroom survey completed at least one telephone conversation with trained smoking cessation counselors; 47% (499) completed all planned telephone counseling calls.
No intervention was offered to the 1,093 students who identified themselves as smokers and served as a control group.
Surveys conducted at 12 months follow-up indicated that 22% of all smokers in the intervention group had abstained for the past 6 months, compared with 18% in the control group.
Among daily smokers, 10% of the intervention group had abstained for the past 6 months, compared with 6% in the control group.
Rather than recruit high school students with notices directed at smokers, the researchers removed what they considered the stigma of smoking, and a barrier to participation, by surveying all students–smokers and nonsmokers–for their views, according to Ms. Kealey. Without revealing whether the child smoked, researchers called students' parents to obtain consent. That approach was meant to preserve students' privacy, Ms. Kealey explained.
Letters then were sent to students to ask for their participation in the study.
Counselors were trained in motivational interviewing and cognitive-behavioral skills training. The sessions aimed to provide an opportunity for students to discuss their views of smoking in a nonjudgmental environment, Ms. Kealey said. If students wished to quit smoking, telephone counseling on smoking cessation was provided.
The study also focused on calculating the cost of the intervention per targeted smoker, including those adolescents who did not proceed to have any telephone counseling sessions.
Expenses included counselors' salary and benefits, data entry of students' telephone numbers, telephone calls and mailings, and the cost of quit kits.
Researchers calculated that $226 was spent per targeted smoker, and that disseminating the intervention to 10,000 smokers in a target population would cost an estimated $87 per targeted smoker.
The costs of intervention-attributable to smoking cessation at 1 year were $3,018, $3,329, or $5,659 per additional 7-day, 1-month, and 6-month prolonged quit, respectively.
Getting a teenager to quit smoking involves a small investment with a huge payoff, Ms. Kealey said.
Compared with the study's one-time cost of $5,659 per-person to achieve abstinence at 6 months, the Centers for Disease Control and Prevention estimates that smoking costs society $4,447 per smoker annually in medical bills and lost productivity, she said.
“If we reach out, we'll get agreement and participation,” Ms. Kealey emphasized.
“Teenagers don't seek out any formal [smoking cessation] help because they think it's not a serious enough problem to get help, and they're not aware that help is available.”