|
 |
|
|||||||
|
|||||||||
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.101741
RESEARCH AND PRACTICE |
The authors are with the University of California, San Diego.
Correspondence: Requests for reprints should be sent to Sharon E. Cummins, PhD, Cancer Center, 9500 Gilman Dr, Mail Code 0905, University of California, San Diego, La Jolla, CA 92093-0905 (e-mail: scummins{at}ucsd.edu).
 |
INTRODUCTION |
|---|
 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
|---|
This study compared state quitline data (1992–2006) with population survey data to assess use by young adults aged 18 to 24 years. Young adult daily smokers used the service in proportion to their numbers in the state. Young adults responded to mass media quitline promotion, even promotion that did not target them. Women, ethnic minorities, and persons with low income and lower education levels were well represented among young adult quitline callers. Quitlines are a viable means of intervening with this priority population.
Young adults (aged 18–24 years) are generally much less likely to seek help to quit smoking than are older adults.1,2 However, there are indications that telephone-based services may appeal to this age group.3,4 When California started a statewide smokers’ quitline in the early 1990s, for example, it was soon reported that young smokers were actively using the new service.3 Researchers questioned, however, whether this was a stable phenomenon. The California Smokers’ Helpline has been in operation since 1992 and has served more than 400 000 tobacco users. It provides services in English, Spanish, Chinese (Mandarin and Cantonese), Korean, and Vietnamese free of charge to California residents. The program is promoted by the California Department of Health Services through television, radio, and print advertisements as part of its antismoking campaign. These advertisements are aired in the languages mentioned in this paragraph, but they do not specifically target young adults.5 The California Smokers’ Helpline is also promoted by county health departments, physician groups, volunteer organizations, and word of mouth.
We examined the trend of young adult use of this quitline over a 14-year span and compared the characteristics of quitline users with those of smokers in the same age group in the general population.
|
METHODS |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
We examined data related to young adults by comparing California Smokers’ Helpline intake interview records and California Tobacco Survey (CTS) data. The CTS is a random-digit-dialed household survey conducted every 3 years. Procedural details of these data sources have been reported elsewhere.3,6
We aggregated California Smokers’ Helpline data into 5 intervals from 1992 to 2006 (3-year intervals except for August 1992–December 1994 and January 2004–November 2006) to compare with the 5 CTSs conducted over the same period. For example, the California Smokers’ Helpline data from 1992 to 1994 (approximately a 3-year period) were compared with CTS data from 1993. We examined both current smokers (i.e., occasional and daily) and daily smokers, except for 1993 when CTS did not ask about smoking frequency. Demographic information came from daily smokers. Median household income data from the 2000 census were used to recode zip codes into lower- and higher-income communities (except for the 1993 CTS, which did not include zip codes). All CTS percentages were weighted to reflect the general smoking population.6
|
RESULTS |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
Table 1
shows the data from the 14-year study span (1992–2006). Among the current smokers, young adult quitline callers were slightly underrepresented compared with young adult smokers in California in general. Among the daily smokers, however, no significant difference was seen for any period in the proportion of young adults who called the California Smokers’ Helpline and the estimates of their proportion in the population on the basis of the CTS. The young adults who called the help line were almost all daily smokers. Moreover, the young adults who called the help line were heavier smokers than were the young adult daily smokers in general. The former smoked 3.4 more cigarettes per day on average.
|
Table 2
shows that the young adult California Smokers’ Helpline callers were significantly more likely to be women (except in 1993). Ethnic minorities were well represented or overrepresented by proportion. Young adults with lower education levels were initially underrepresented, but their use of the quitline increased over the years, and they are now overrepresented. Callers from zip codes with lower median incomes have been overrepresented since the data became available for comparison.
|
During the 14-year period of Helpline operation, young adult callers were consistently more likely than older adults to report that they had heard about the California Smokers’ Helpline from media sources. On average, 58.1% of the young adults reported hearing about the help line from media compared with 44.3% of the older callers (P < .001).
|
DISCUSSION |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
The 14-year span of this study solidly confirmed the earlier finding that young adults actively use telephone quitlines.3 The results also are consistent with those of quitline studies of shorter time periods.4,7 Thus, we can conclude with reasonable confidence that quitlines are a good way to reach young adult smokers. Given that quitlines are effective interventions for adults in general,8 have been shown effective in young adults specifically,7 and are almost universally available in the United States, programs that have young adults as their priority population should consider using existing quit-lines to serve these young smokers.
Note that young adults were well represented at the help line only if daily smokers were the target. When occasional smokers were included in the comparison of Helpline callers to the general population of smokers, young adult callers were underrepresented. The reason is simple. Use of cessation service is associated with smoking level.1,2,9 Generally, nondaily smokers do not seek help, and many young adults are nondaily smokers.10,11 This study has shown that if daily smokers are considered the proper target for cessation services, then the help line has successfully reached young adult smokers.
The most encouraging finding of this study was that smokers who resided in lower-income zip code areas were well represented in the Helpline service. Previous studies of young adults focused mostly on college students. By contrast, we found that young adult smokers living in poorer communities and those of ethnic minority backgrounds were well represented in the California Smokers’ Helpline. This outcome was chiefly the result of the strong media campaign orchestrated by the California Department of Health Services.5 Even without targeted promotion, young adult callers were significantly more likely than were older callers to report having heard about the California Smokers’ Helpline from media sources. Given that a media campaign is an effective population-based cessation approach,12 embedding the quitline message into the anti-smoking campaign is one of the best ways to intervene with young adult smokers.
|
Acknowledgments |
|---|
Research was funded by National Cancer Institute (grant 5 P30 CA 23100-22S4). The California Smokers’ Helpline has been funded by the California Department of Health Services, Tobacco Control Section (contracts 92-15416, 96-27049, 00-90605, and 05-45834) and by the California Children and Families Commission (grant CCFC-6810).
Human Participant Protection
This study was approved by the University of California, San Diego, institutional review board.
|
Footnotes |
|---|
Peer Reviewed
Contributors
S. E. Cummins led the analysis and writing. K. K. Hebert contributed to the writing and obtained background information and references. C. M. Anderson directed the operation of the California Smokers’ Helpline. J. A. Mills coordinated outreach efforts for the help line. S.-H. Zhu originated the study and supervised all aspects of implementation. All authors contributed ideas and reviewed drafts of the article.
Accepted for publication January 3, 2007.
|
References |
|---|
|
TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
|---|
1. Fiore MC, Novotny TE, Pierce JP, et al. Methods used to quit smoking in the United States: do cessation programs help? JAMA. 1990;263:2760–2765.
2. Zhu S-H, Melcer T, Sun J, Rosbrook B, Pierce JP. Smoking cessation with and without assistance: a population-based analysis. Am J Prev Med. 2000;18:305–311.[CrossRef][Web of Science][Medline]
3. Zhu S-H, Rosbrook B, Anderson C, Gilpin E, Sadler G, Pierce JP. The demographics of help-seeking for smoking cessation in California and the role of the California Smokers’ Helpline. Tob Control. 1995;9(suppl 1):S9–S15.
4. Gilbert H, Sutton S, Sutherland G. Who calls QUIT? The characteristics of smokers seeking advice via a telephone helpline compared with smokers attending a clinic and those in the general population. Public Health. 2005;119:933–939.[CrossRef][Web of Science][Medline]
5. California Department of Health Services, Tobacco Control Section. A model for change: the California experience in tobacco control. Available at: http://www.dhs.ca.gov/tobacco/documents/pubs/modelforchange.pdf. Accessed September 1, 2006.
6. Gilpin EA, White MM, White VM, et al. Tobacco Control Successes in California: A Focus on Young People, Results From the California Tobacco Surveys, 1990–2002. La Jolla, Calif: University of California, San Diego; 2003.
7. Rabius V, McAlister AL, Geiger A, Huang P, Todd R. Telephone counseling increases cessation rates among young adult smokers. Health Psychol. 2004;23:539–541.[CrossRef][Web of Science][Medline]
8. Zhu S-H, Anderson CM, Tedeschi GJ, et al. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med. 2002;347:1087–1093.
9. Cokkinides VE, Ward E, Jemal A, et al. Under-use of smoking-cessation treatments: results from the National Health Interview Survey, 2000. Am J Prev Med. 2005;28:119–122.[CrossRef][Web of Science][Medline]
10. Wortley PM, Husten CG, Trosclair A, Chrismon J, Pederson LL. Nondaily smokers: a descriptive analysis. Nicotine Tob Res. 2003;5:755–759.
11. Hassmiller KM, Warner KE, Mendez D, Levy DT, Romano E. Nondaily smokers: who are they? Am J Public Health. 2003;93:1321–1327.
12. Biener L, Reimer RL, Wakefield M, Szczypka G, Rigotti NA, Connolly G. Impact of smoking cessation aids and mass media among recent quitters Am J Prev Med. 2006;30:217–224.[CrossRef][Web of Science][Medline]
This article has been cited by other articles:
|
|
 |
|
  B. A. Toll, S. Martino, A. Latimer, P. Salovey, S. O'Malley, S. Carlin-Menter, J. Hopkins, R. Wu, P. Celestino, and K. M. Cummings Randomized Trial: Quitline Specialist Training in Gain-Framed vs Standard-Care Messages for Smoking Cessation J Natl Cancer Inst, January 20, 2010; 102(2): 96 - 106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. G. Husten Smoking Cessation in Young Adults Am J Public Health, August 1, 2007; 97(8): 1354 - 1356. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |