Academic journal article Journal of Counseling and Development : JCD

Putting It on the Line: Telephone Counseling for Adolescent Smokers

Academic journal article Journal of Counseling and Development : JCD

Putting It on the Line: Telephone Counseling for Adolescent Smokers

Article excerpt

Shortly after adolescents start smoking regularly, they express a desire to quit. Studies indicate that more than half of adolescent smokers make quit attempts each year (Centers for Disease Control and Prevention, 1998). Yet only 2% to 4% of adolescents annually succeed on their own (Paavola, Vartiainen, & Puska, 2001; Stanton, McClelland, Elwood, Ferry, & Silva, 1996; Zhu, Sun, Billings, Choi, & Malarcher, 1999). Clearly, adolescents need help with quitting. However, when they enter counseling for smoking cessation, it is still unclear how best to intervene (Curry, 2003; Mermelstein, 2003). Published literature on adolescent cessation seldom provides sufficient detail on the content of counseling to allow clinicians to learn from one another or to allow researchers to assess reasons for the success or failure of interventions (McDonald, Colwell, Backinger, Husten, & Maule, 2003). The present article is one attempt to address this need. We document in detail an intervention protocol used in a large, statewide telephone program for teen smokers (Zhu, 2003).

Since 1992, when California established the first statewide telephone "quitline," this form of cessation assistance has become increasingly popular (Bailey, 2003; Stead, Lancaster, & Perera, 2003; Zhu et al., 2002). Statewide quitlines for adult smokers are currently operating in 40 states. Adolescent smokers, too, find telephone counseling attractive, as evidenced by their call rate. For example, the number of teens calling California's statewide quitline (the California Smokers' Helpline) increased from 200 in 1996 to 1,033 in 2002, even though program advertising targeted adults (Zhu, Cummins, Mills, Muesse, & Roeseler, 2005).

Five characteristics of telephone counseling for smoking cessation (Zhu, Tedeschi, Anderson, & Pierce, 1996) ensure broad appeal and suitability for adolescents. Telephone counseling is easy to access, requiring no transportation and reducing scheduling difficulties associated with traditional group programs. Telephone counseling is also semi-anonymous. Teen clients often share concerns more readily during a telephone session than in a face-to-face interview. Telephone counseling is delivered on an individual basis: Counselors can adjust to each client's readiness to take action, capitalizing on client motivation and skill level. The telephone format facilitates proactive counseling. After a teen makes the first call for service, a counselor can initiate all subsequent contact, thus creating a therapeutic level of social support and keeping the teen accountable during the quitting process. Finally, the telephone format permits use of a structured protocol. This gives counselors a written framework that ensures coverage of important topics while tailoring each session to the individual, resulting in an intervention that is brief, focused, and personalized.

In the present article we discuss an adolescent counseling intervention used by the California Smokers' Helpline and tested in one of the largest randomized trials to date. In this study, more than 1,400 teen clients were randomly assigned to an intervention group or a control group. Participants in the intervention group received telephone counseling in addition to written cessation materials, whereas participants in the control group received written cessation materials only. Preliminary analysis revealed that significantly more clients in the telephone counseling group than in the control group quit and remained abstinent for 6 months (Zhu, 2003). The results of this study show that the counseling protocol increased the 6-month prolonged abstinence rate for teens. This is a notable result given the challenging task of helping teens quit smoking and the shortage of rigorously tested interventions that have yielded statistically significant effects (McDonald et al., 2003; Mermelstein, 2003). The present article addresses our approach to adolescent cessation counseling, providing an overview of the theoretical constructs that underlie the protocol; a detailed description of the protocol itself, with special attention to developmental issues that shape the counseling intervention; and a discussion of counselor training for protocol implementation. …

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