title: Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.
abstract: 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 > or =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.
authors.affiliation: Center for Health Research, Kaiser Permanente, Portland, Oregon 97227, USA. jack.hollis@kpchr.org
authors.forename: Jack F
authors.initials: JF
authors.lastname: Hollis
authors.forename: Michael R
authors.initials: MR
authors.lastname: Polen
authors.forename: Evelyn P
authors.initials: EP
authors.lastname: Whitlock
authors.forename: Edward
authors.initials: E
authors.lastname: Lichtenstein
authors.forename: John P
authors.initials: JP
authors.lastname: Mullooly
authors.forename: Wayne F
authors.initials: WF
authors.lastname: Velicer
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Redding
mesh_terms: D000293:Adolescent; D003194:Computer-Assisted Instruction; D006279:Health Maintenance Organizations; D006801:Humans; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods / Q000706:statistics & numerical data*; D000074606:Smoking Prevention