Providing quitline services to youth – 10/12/10

Q: West Virginia has been allowing for high school (age 15 – 18) enrollees to utilize their quitline, but there are plans to further expand this opportunity. West Virginia would like to know:

• Are other states allowing for youth under 18 to use their quitlines?
• If so, what specific services are offered, including NRT?
• Any “lessons learned” to share?

A:

1. Alabama: In 2008, we requested and received an opinion from our State Attorney General saying we “may legally provide telephone counseling services to a person under age 19 calling the Quitline without permission from his or her parent or legal guardian.” In the same opinion, we were given the okay to legally disseminate NRT patches to youth under 19 who have called the Quitline. However, we do require a physician’s written prescription for NRT for youth under 18. We do not have many Quitline users who are under 18, but we are hoping our new online service will get their attention.
    
   Regarding working with the youth and any lessons learned, our Quitline folks have said that the youth are sometimes hard to follow through with. They are harder to get back on the phone for the follow-up calls. They are less likely to call the Quitline back. We distributed information about our Quitline to all school nurses. We are asking them to talk about the Quitline to the kids at their schools and put our posters up in the schools as well.
    
2. California: The California Smokers' Helpline provides teen callers who smoke with two self-help booklets designed specifically for their age group. They're available from the Tobacco Education Clearinghouse of California: BUTTsOUT Issue #1 and BUTTsOUT Issue #2.
    
   Those who are 14-17 and want counseling receive one counseling session on-the-spot (i.e., when they first call the Helpline) without parental consent. The initial session is about 30 minutes and helps them prepare to quit. If they want follow-up counseling to help them avoid relapse, our IRB requires the consent of a parent or guardian. Verbal consent is acceptable. Teen callers do not receive NRT or other meds. A description of our protocol for teens can be found here.
   
   Lessons learned:
    
   • We tested the protocol in a randomized, controlled trial with teens aged 14-19 and found it to be modestly effective. There was a significant difference in outcomes at 6 months but not at 12 months. The effect was larger for older teens (18-19) than for minors (14-17). This finding is consistent with the general lack of evidence of efficacy for teen cessation services.
      
   • Before we provided counseling to teens, we assumed many parents might not know their teen was smoking. This turned out not to be true; for nearly all of our teen callers, the fact of their smoking was well known to their parents. In general, teen callers have been smoking for some time already. In many cases, parents and others in the household also smoke.
      
   • Obtaining parental consent can be very challenging, e.g., if the parents aren't around when the teen first calls or if the parents aren't supportive of the teen's desire to quit. In many cases, the need to obtain parental consent has delayed provision of follow-up counseling.
      
   Putting our study findings together with the fact that all of our other trials conducted with adult smokers were strongly effective, we decided to continue providing counseling to teens who called the Helpline but not to aggressively promote the service. Teens do call our quitline; however, over the last 5 years, they only accounted for 1.5% of callers.
    
3. Iowa: Quitline Iowa does allow minors to proactively contact the quitline without parental consent; however, Quitline Iowa will not provide follow-up phone calls to a minor without signed parent/guardian consent. Though NRT is currently not available through Quitline Iowa as of July 1, 2010, NRT was only provided to those ages 18 or older when it was available.
    
4. Tennessee: Tennessee allows callers aged 12 and up to enroll in the Tennessee Quitline Services. However, we no longer provide any medications.
    
5. Utah: In Utah youth have always been able to use the Quit Line. They cannot receive NRT until age 18. There are about 30 youth callers per month. The Quit Line is an approved remedial program for youth caught using or in possession of tobacco. Most youth who call are required by the courts to participate in the program, as it is illegal for anyone younger than 19 years of age to possess or use tobacco. They receive a certificate of completion when they have completed all five calls. The certificate of completion is provided to the courts as proof of participation. While we do not provide NRT to youth, we do provide incentives: a pen, a water bottle, and a carabineer after calls 1, 3 & 5 respectively. These incentives are quitting tools that give the youth other things to do rather than use tobacco. The Quit Line staff put together some lessons learned. Click here to view the document.
    
6. Wyoming: Wyoming allows ages 12-17 to access our online and telephone counseling services. These are age appropriate and geared towards the youth. No NRT is given to minors. Only reading materials (handouts/brochures, etc.) and counseling services (both telephone & online) are provided. Youth are recognized by a birth date. Online blogs and chat rooms are restricted to older users (recognized by birth date) to protect youth.

Back to Table of Contents