Quitline language for callers under 18 – 12/5/05

Q: What language has been incorporated by your Quitline vendor for handling callers under the age of 18? (e.g. parental consent, disclaimers, etc.)

A:

1. Alabama: As a standard procedure, when a caller identifies themselves as under 18, we ask if there is a parent or guardian with whom we can speak to verify if it is ok that we continue the counseling with the caller. If they do not want the parent to know, we would have to say that to the caller that we could send information, but if we did not have it on file that parent/guardian had given consent, we would not be able to continue with counseling. We will then ask if there is an adult that they trust, like an older brother, sister, church member, teacher, counselor, etc. that would be willing to help us keep in touch.
    
2. Arizona: Our protocol is essentially no different than working with adults except for the content of the counseling process e.g. we try to identify the youth's motivators, most of which are not the long-term effects of smoking. We do not require consent for a person under 18 who voluntarily calls us. We maintain confidentiality with the young person, who may not want her/his parents to know about her/his smoking, as we do with all clients. We also have the Youth Diversion Program, which is for persons under 18 who get caught smoking. Because these are involuntary clients, we require parental consent to work with them.
    
3. California: Attached please find a compilation of the relevant scripts, divided into sections:
    
   • Teen screening questions. These are the questions in our 5-6 minute intake protocol that are specific to teen callers. The protocol is fully programmed, so skip patterns are automated.
      
   • Parental consent. Our IRB allows immediate, on-the-spot counseling without consent for all callers ages 14-17. But in order for us to call them back (either for follow-up counseling, or because they don't have time for on-the-spot counseling, or because a counselor is not immediately available), we need consent from a parent or guardian. Minors under the age of 14 can received written materials for themselves or a family member, but not counseling.
      
   • Parental intervention. This immediately follows the parental consent and is intended to help parents help their kids with the quitting process.
      
   • Teen assent. This is done at the beginning of the first counseling session.

   You didn't ask for info on our teen counseling protocol, but if you're interested, we recently published a paper describing it. Here's the citation: Tedeschi GJ, Zhu S-H, Anderson CM, Cummins S, Ribner NG (2005). Putting it on the line: telephone counseling for adolescent smokers. Journal of Counseling and Development, 83: 416-424.

4. Kentucky: Here is our basic protocol - it would depend a lot on the specific laws of the state, but the basics would be the same. Kentucky and Mississippi follow this protocol, we have the same vendor.
    
   As a standard procedure, if a caller tells us that they are under 18 years old, we let them know that we will need to talk with their parent or legal guardian. In Mississippi, the legal age is 18, but you cannot deny the telephone counseling if under 18 since it is not considered 'intensive' and there is no medication being discussed. We will ask if there is a parent or guardian available that we can speak with. If the caller says yes and gives the phone to someone who says they are the parent/guardian, we have to go on the 'good faith' premise that the person actually IS their parent or guardian. If they sound like they are another child, we will document that the person saying they are the parent/guardian sounded much younger but said who they were. This usually exonerates us from any liability since we have no way of knowing other than the verbal statement.
    
   We do ask about the parent/guardian and often have youth who do not want to talk with us because they don't want parents to know they smoke. If this happens, we will ask if they have an adult they trust, like an older brother, sister, teacher, counselor, church member, etc. who could be relied on to give them a message if we could not reach them. That has worked.
    
   My biggest concern from the start was when we have someone underage who says they don't want their parent to know they are calling and do not want us to identify ourselves when we call - I would not like it if someone called my child, was an adult and refused to identify themselves. It can get sticky.
    
5. North Dakota: Here are some questions we've used in North Dakota to gauge public support for smoke-free policy:
    
   1. Which one of the following two statements do you feel comes closer to your personal point of view...
      1. As long as smoking is a legal activity, people should be allowed to enjoy a cigarette in indoor public places without being sent outside
      2. Even though smoking is a legal activity, non-smokers have a right to breathe clean air in indoor public places, free from the smell and health effects of secondhand smoke.
          
   2. Which one of the next two statements do you feel comes closer to your personal point of view...
      1. business owners have a right to decide whether people smoke or not in their places of business, so we should not have laws that prohibit smoking in public places like restaurants.
      2. non-smokers have a right to breathe clean air in restaurants and other public places, so we should have laws that prohibit smoking in public places like restaurants.
          
   3. Some cities and towns are considering laws that would make most indoor places smoke-free, including workplaces, public buildings, restaurants and bars. What would be your reaction if a law was proposed in your community to eliminate all tobacco smoke from most indoor places - would you say you would...
      1. strongly support
      2. somewhat support
      3. somewhat oppose
      4. strongly oppose
      5. have no reaction
    
6. Utah: The Utah Tobacco Quit Line has a youth protocol in place, including an intensive "Youth Support Program" that includes up to 5 proactive follow-up calls. We are not required to obtain parental consent or state disclaimers to service, but some sensitive questions around insurance status and NRT services are not included in the youth protocols.

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