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.
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
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).
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.
Note. CI = confidence interval; CPD = cigarettes per day for daily smokers; CTS = California Tobacco Survey. CTS percentages were weighted to estimate population values. CSH used 3-year intervals. aCurrent smokers included occasional and daily smokers. bUsed current smokers for CTS 1993. cUsed data starting August 1, 1992. dUsed data through November 30, 2006. Note. n = sample size (based on number of daily smokers, except for CTS 1993, which included current smokers); CI = confidence interval. CTS percentages were weighted to estimate population values. CSH used 3-year intervals. Income was based on Census 2000, median annual household income by zip code. aUsed data starting August 1, 1992. bUsed data through November 30, 2006.
Current Smokersa Daily Smokers No. % (95% CIs) No. % (95% CIs) CPD (95% CIs) 1993 CTS 5 698 15.0 (13.4, 16.6) 5 698 NA 11.7 (10.8, 12.6)a 1992–1994 CSH 20 715 14.0 (13.5, 14.5) 20 681 14.0 (13.5, 14.5) 16.6 (16.3, 16.9) 1996 CTS 8 904 17.5 (16.4, 18.6) 6 856 12.5 (11.7, 13.3) 12.8 (12.1, 13.5) 1995–1997 CSH 33 274 13.7 (13.3, 14.1) 32 997 13.7 (13.3, 14.1) 15.9 (15.6, 16.2) 1999 CTS 5 677 16.6 (15.6, 17.6) 4 172 13.9 (13.1, 14.7) 13.2 (12.3, 14.1) 1998–2000 CSH 68 651 12.6 (12.4, 12.8) 67 540 12.5 (12.3, 12.7) 16.3 (16.1, 16.5) 2002 CTS 5 504 17.1 (16.5, 17.7) 4 056 14.5 (13.6, 15.4) 12.5 (11.8, 13.2) 2001–2003 CSH 120 021 14.4 (14.2, 14.6) 119 171 14.3 (14.1, 14.5) 15.3 (15.1, 15.5) 2005 CTS 3 949 13.8 (12.4, 15.2) 3 017 11.4 (9.7, 13.1) 13.0 (11.3, 14.7) 2004–2006 CSHd 93 436 11.9 (11.7, 12.1) 92 088 11.9 (11.7, 12.1) 15.4 (15.2, 15.6) 1993 CTS (n = 683), % (95% CIs) 1992–1994 CSHa (n = 2903), % (95% CIs) 1996 CTS (n = 887), % (95% CIs) 1995–1997 CSH (n = 4506), % (95% CIs) 1999 CTS (n = 587), % (95% CIs) 1998–2000 CSH (n = 8416), % (95% CIs) 2002 CTS (n = 660), % (95% CIs) 2001–2003 CSH (n = 17 093), % (95% CIs) 2005 CTS (n = 327), % (95% CIs) 2004–2006 CSHb (n = 10 974) % (95% CIs) Gender Men 63.1 (57.8, 68.4) 55.7 (53.9, 57.5) 61.1 (56.7, 65.5) 54.3 (52.8, 55.8) 64.9 (61.2, 68.6) 48.0 (46.9, 49.1) 67.8 (63.9, 71.7) 47.6 (46.9, 48.3) 67.0 (60.0, 74.0) 49.3 (48.4, 50.2) Women 36.9 (31.6, 42.2) 44.1 (42.3, 45.9) 38.9 (34.5, 43.3) 45.7 (44.2, 47.2) 35.1 (31.4, 38.8) 52.0 (50.9, 53.1) 32.2 (28.3, 36.1) 52.4 (51.7, 53.1) 33.0 (26.0, 40.0) 50.7 (49.8, 51.6) Race/Ethnicity White 62.1 (56.5, 67.7) 49.0 (47.2, 50.8) 57.1 (52.3, 61.9) 57.6 (56.2, 59.0) 60.2 (54.6, 65.8) 57.2 (56.1, 58.3) 55.6 (50.8, 60.4) 55.7 (55.0, 56.4) 60.4 (51.7, 69.1) 50.1 (49.1, 51.1) Hispanic 28.2 (23.2, 33.2) 27.4 (25.8, 29.0) 23.1 (19.1, 27.1) 22.8 (21.6, 24.0) 27.0 (21.9, 32.1) 20.9 (20.0, 21.8) 25.1 (21.0, 29.2) 22.3 (21.7, 22.9) 14.1 (7.9, 20.3) 25.2 (24.3, 26.1) African American 2.6 (1.1, 4.1) 11.5 (10.3, 12.7) 7.0 (3.2, 10.8) 6.4 (5.7, 7.1) 3.9 (1.9, 5.9) 9.2 (8.6, 9.8) 5.1 (3.1, 7.1) 9.7 (9.3, 10.1) 6.1 (2.4, 9.8) 12.3 (11.6, 13.0) Asian 5.0 (2.6, 7.4) 6.7 (5.8, 7.6) 9.9 (7.0, 12.8) 5.5 (4.8, 6.2) 7.0 (4.4, 9.6) 6.9 (6.4, 7.4) 9.8 (7.4, 12.2) 7.0 (6.6, 7.4) 16.4 (9.2, 23.6) 6.4 (5.9, 6.9) Other 2.0 (1.1, 2.9) 4.8 (4.0, 5.6) 3.0 (1.9, 4.1) 7.1 (6.4, 7.8) 1.9 (0.4, 3.4) 5.3 (4.8, 5.8) 4.3 (2.3, 6.3) 4.6 (4.3, 4.9) 3.1 (0.5, 5.7) 5.8 (5.3, 6.3) Education, y ≤ 12 75.6 (71.7, 79.5) 59.5 (57.7, 61.3) 66.3 (61.3, 71.3) 60.9 (59.5, 62.3) 61.7 (57.3, 66.1) 61.6 (60.6, 62.6) 61.3 (57.5, 65.1) 64.6 (63.9, 65.3) 52.1 (43.8, 60.4) 67.1 (66.2, 68.0) > 12 24.4 (20.5, 28.3) 39.7 (37.9, 41.5) 33.8 (28.8, 38.8) 38.6 (37.2, 40.0) 38.3 (33.9, 42.7) 38.2 (37.2, 39.2) 38.8 (35.0, 42.6) 33.5 (32.8, 34.2) 47.9 (39.6, 56.2) 32.9 (32.0, 33.8) Income, $ < 40 000 . . . 49.7 (47.9, 51.5) 36.4 (32.6, 40.2) 46.3 (44.8, 47.8) 36.9 (30.9, 42.9) 49.9 (48.8, 51.0) 34.6 (30.0, 39.2) 46.1 (45.4, 46.8) 28.0 (21.4, 34.6) 48.3 (47.4, 49.2) ≥ 40 000 . . . 50.3 (48.5, 52.1) 63.6 (59.8, 67.4) 53.7 (52.2, 55.2) 63.1 (57.1, 69.1) 50.1 (49.0, 51.2) 65.4 (60.8, 70.0) 53.9 (53.2, 54.6) 72.0 (65.4, 78.6) 51.7 (50.8, 52.6)
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.
