Stage transitions of smoking cessation among Chinese youth who called the Youth Quitline in Hong Kong

Abstract

Tobacco smoking among youth presents a significant and growing public health problem worldwide. In Hong Kong, over 60% of daily smokers started weekly smoking before the age of 20. Although quitting at an early age can largely reduce the health hazards, most smoking cessation services in Hong Kong are targeted at adults, and the utilization of youth smokers is low. A youth-oriented smoking cessation hotline (Youth Quitline) was implemented from August 2005 onwards to publicize quitting among youth smokers, and to encourage and support those who want to quit by providing tailor-made advice and counseling through the telephone. The Transtheorectical model (TTM), which has been widely used in the past two decades to explain behavioral changes in smoking cessation, was applied to motivate youths’ intention to quit smoking by moving up the stages of change (pre-contemplation, contemplation, preparation, action, and maintenance). Traditional outcome measurements such as point prevalence and prolonged abstinence have been found to be deficient when exploring the stage transitions in TTM, and the results is always under-powered by small sample size. This presentation aims to evaluate the effectiveness of Youth Quitline with the aid of Latent Transition Analysis (LTA) as an alternative outcome measurement. Up to August 2007, 385 youth smokers aged 12 - 25 were recruited through school referrals and mass media campaigns. Trained youth volunteers delivered telephone smoking cessation counseling at baseline, 1 week and 1 month after recruitment based on TTM. At baseline, the stage proportions were 33% (pre-contemplation), 30% (contemplation), 26% (preparation), and 11% (action). At 6 months, the probability for pre-contemplators to move up the stages was 0.47, whereas the probability for quitters to sustain in the action stage was 0.58. Interventions should be strengthened to motivate pre-contemplators towards quitting, and prevent quitters from being relapsed. The findings could serve as a building block for healthcare professionals to design and implement smoking cessation interventions for youth smokers in the future.