09 Feb 2010

Smoking is the most preventable cause of death. In Hong Kong, tobacco was responsible for a quarter of all deaths between the age of 35 and 69 in 1998. Youth with current cigarette exposure would harm their cardiovascular risk profile by increasing systolic blood pressure as well as plasma homocysteine level. Studies have also shown that youth smokers had higher risks of common illnesses, including cough and phlegm, asthma, sore or irritating throat, back pain and neck pain, headache and dizziness, poor appetite, disorders of digestive system, skin problems, chronic anxiety and insomnia, depression, and menstrual pain (for girls). Moreover, cigarette smoking is also the gate-way to drugs consumption, leading to various kinds of substance abuse among youth. Youth smokers seem to have a higher chance to develop alcohol abuse when they grow up. Without effective tobacco control measures, there will be an estimated one billion pre-mature deaths due to tobacco-related diseases in the 21st century, including 250 million teenagers and children alive today. Quitting at an early age can largely reduce smoking-attributable mortality and morbidity. For example, it can reduce the risk of coronary heart disease and stroke, and largely reduce the risk of lung cancer, laryngeal cancer and oral cancer. Although the smoking prevalence of the Hong Kong population decreased in recent years, about 9.6% of secondary students smoked monthly. Previous school surveys conducted by HKU School of Public Health reported that half or more youth smokers intended to quit smoking. Most youth smokers overlooked their will power and failed to quit by themselves.

Establishment of the Hong Kong Youth Quitline (2855-9557)

A team of researchers led by HKU Department of Nursing Studies, and co-organized by the School of Public Health and Department of Social Work & Social Administration established a peer-led smoking cessation hotline (Youth Quitline) since August 2005. The quitline targeted on young smokers aged from 12 to 25, smoked at least 1 cigarette in the past 30 days, being capable to communicate in Cantonese, and willing to leave contact telephone numbers for follow up. Trained university nursing student volunteers received calls from the public as well as from youth smokers. They first assessed the smoking history of the smoker and provided tailored counselling over the phone. Booster calls were provided at 1-week and 1-month intervals to check progress and give encouragement to the youth smokers during the quitting process. Telephone follow up were provided at 3- and 6-month intervals to assess their smoking status.

Up to November 2009, the Youth Quitline (YQ) provided telephone counselling to 618 youth smokers, and 24% quit smoking successfully at 6-month follow up (did not smoke in the past 7 days).

General findings

General profile: Among the 618 youth smokers who received YQ service, 74% were males and 52% aged below 18 years. The majority were students (61%) and 32% were employed.

Smoking history: On average, youth callers smoked for 4.5 years (ranged from less than 1 year to 16.5 years); 73% smoked daily; 60% smoked half pack or less during the smoking day.

Motivation to quit: Most (73%) had ever attempted to quit smoking and 55% had the latest quit attempt within the past year. Over half (56%) intended to quit within the next 30 days and the most common reasons to quit included to improve health (76%) and being encouraged/ enforced by others (31%). They perceived quitting was important (Mean = 7.8, Scale from 0 [least important] to 10 [most important]) but they did not have high confidence to quit (Mean = 5.7, Scale 0 [least confident] to 10 [most confident]), since they perceived quitting was difficult (Mean = 6.9, Scale 0 [least difficult] to 10 [most difficult]) and they only had moderate self-efficacy to quit smoking (Mean = 2.6, Scale 1 [least self-efficacy] to 5 [highest self-efficacy]). Nearly 90% realized their significant others would like them to quit smoking, and would give them support when they planned to quit.

Tempting situations to smoke: The most tempting situations to relapse included observing other people smoke nearby (50%), craving (32%) and losing motivation to quit (26%). Over half of the smokers (55%) lived with smoking household members; 69% perceived over half of their friends smoked cigarettes.

Successful quitting: At 6-month follow up, 24% were able to quit smoking (no smoking in the past 7 days) and another 27% of youth callers reduced daily cigarette consumption as compared to baseline. Overall, 57% had quitted or had made a quit attempt.

Comparing youth smokers who are studying vs. working

In YQ, we recruited 367 student smokers (aged 12 – 25, mean age = 15.8 years) and 192 youth smokers who are employed (aged 15 – 25, mean age = 21.7 years). Youth smokers who are working had a longer smoking history (Mean = 6.9 vs. 2.8, P < .001) and more had moderate/ high nicotine dependency (57% vs. 30%, P < .001) compared to student smokers. The majority of the working youth smokers smoked at home (68%) while most student smokers smoked in public places (80%). More working youth smokers wanted to quit smoking to improve their health (66% vs. 54%, P = .03), while more student smokers wanted to quit because they were prohibited to smoke and encouraged to quit (44% vs. 23%, P < .001). Meanwhile, more working youth smokers reported alcohol drinking (69% vs. 57%, P < .001) and had depressive symptoms (Mean = 2.25 vs. 1.93, P < .001) compared with student smokers.

At 6 months, both groups had similar quit rate (working = 23% vs. studying = 27%, P = .23) or reduced smoking (working = 31% vs. studying l = 26%, P = .16) despite different nicotine dependency level and years of smoking. This shows that YQ is effective in helping quitters to quit.

Comparing student smokers who called the YQ proactively and those referred by school teachers

Student referrals were younger in age (Mean = 14.9 vs. 16.7, P < .001) and more studied in Form 1 to 3 (78% vs. 36%, P < .001) compared to those who called the YQ proactively. The referred students had a shorter smoking history (Mean = 2.3 year vs. 3.4 years, P < .001), lower daily cigarette consumption (Mean = 8.0 vs. 11.0, P < .001), more with low nicotine dependency (83% vs. 57%, P < .001), but fewer would like to quit in the next 7 days (32% vs. 50%, P = .003).

At 6 months, similar proportion of student referrals and called-in student smokers quit smoking (30.2% vs. 24.4%, P < .23) or reduced daily cigarette consumption as at baseline (27.4% vs. 23.9%, P = .45).

Conclusions

We have strived to promote quitting among youth smokers in collaboration with the youth organizations and schools. The findings shed light on the effectiveness of our Youth Quitline, a tailored smoking cessation counseling program, provided by student counselors, achieving a much higher quit rate of 24%, comparing with other local quitline, and effective for different levels of nicotine dependency and years of smoking. Youth smokers who are working are exposed to a more complex environment, and their smoking behavior are further influenced by other lifestyle factors such as alcohol drinking. Hence motivating smokers to quit while they are young and before they enter the workforce, is important. In addition, quitting early before the smoker gets too addicted, is easier, and more beneficial to health. Youth smokers should be encouraged to call the YQ and received counseling so as to increase their intention and decrease their perceived difficulty to quit. Those who were encouraged or enforced to quit were more likely to stop smoking, and those who were referred by school teachers also had a high chance to quit.

The HKU Youth Quitline is effective to help different groups to quit smoking and reduce their cigarette consumption. It is FREE of CHARGE and the operation hours are: 5 – 9pm during weekdays or 2 – 6pm on Saturday. We are open to collaborate with schools who want to assist young people quit smoking. For any query, please call Mr. Chik of the Department of Nursing Studies, HKU at 2855-9557 or visit our website on http://www.hku.hk/yquit for further information.

We thank the Health Care Promotion Fund, Food and Health Bureau, Hong Kong SAR Government and the Hong Kong Council on Smoking and Health which provided financial support to our project.

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