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Teen Reach: Outcomes From a Randomized, Controlled Trial of a Tobacco Reduction Program for Teens Seen in Primary Medical Care

Jack F. Hollis, PhD^*, Michael R. Polen, PhD^*, Evelyn P. Whitlock, MD, MPH^*, Edward Lichtenstein, PhD, John P. Mullooly, PhD^*, Wayne F. Velicer, PhD and Colleen A. Redding, PhD

^* Center for Health Research, Kaiser Permanente, Portland, Oregon
Oregon Research Institute, Eugene, Oregon
University of Rhode Island, Kingston, Rhode Island

Objective. To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care.

Methods. Both smoking and nonsmoking teens, 14 to 17 years of age, who were being seen for routine visits were eligible for this 2-arm controlled trial. Staff members approached teens in waiting rooms of 7 large pediatric and family practice departments within a group-practice health maintenance organization. Of 3747 teens invited at 1 visits, 2526 (67%) consented and were randomized to tobacco intervention or brief dietary advice. The tobacco intervention was individually tailored on the basis of smoking status and stage of change. It included a 30-second clinician advice message, a 10-minute interactive computer program, a 5-minute motivational interview, and up to two 10-minute telephone or in-person booster sessions. The control intervention was a 5-minute motivational intervention to promote increased consumption of fruits and vegetables. Follow-up smoking status was assessed after 1 and 2 years.

Results. Abstinence rates after 2 years were significantly higher for the tobacco intervention arm, relative to the control group, in the combined sample of baseline smokers and nonsmokers (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03–1.47). Treatment effects were particularly strong among baseline self-described smokers (OR: 2.42; 95% CI: 1.40–4.16) but were not significant for baseline nonsmokers (OR: 1.25; 95% CI: 0.97–1.61) or for those who had "experimented" in the past month at baseline (OR: 0.95; 95% CI: 0.45–1.98).

Conclusions. Brief, computer-assisted, tobacco intervention during routine medical care increased the smoking cessation rate among self-described smokers but was less effective in preventing smoking onset.

Key Words: tobacco • adolescents • intervention • cessation • primary care

Abbreviations: OR, odds ratio • CI, confidence interval • GEE, generalized estimating equations • PTC, Pathways to Change

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