Can school nurses help teens quit smoking?

By Genevra Pittman

NEW YORK (Reuters Health) - Going to a few counseling sessions with a school nurse helped some high school students quit smoking in the short term -- but it didn't seem to influence whether they kicked the habit for good, according to a new study.

Out of about 1,000 teens who wanted to quit, less than one in five said they hadn't smoked recently a year down the line -- whether they had gotten counseling or educational pamphlets instead.

A few sessions with a nurse probably isn't "going to do it all," said Robin Mermelstein, who studies smoking cessation at the Institute for Health Research and Policy, University of Illinois at Chicago.

"Relapsing is really the biggest problem at any age. Teens can be more vulnerable to relapse," Mermelstein, who wasn't involved in the new study, told Reuters Health.

But, she added, "The more options kids have for where they can go for help, the better."

The new study, published in Pediatrics, included nurses at 35 Massachusetts high schools and about 1,000 teens who said they wanted to quit smoking.

Half of the nurses were trained to give their students one-on-one counseling sessions based around goal setting and problem solving, including making a plan to quit and then preventing relapses.

The other nurses gave students information pamphlets on quitting smoking and volunteered to answer any questions they had about the process.

Both groups of nurses saw their students at four weekly sessions, ranging from ten to 30 minutes.

Three months later, close to 11 percent of kids who got counseling had quit smoking, compared to six percent of those who only received educational materials.

NO HELP IN LONG TERM?

The counseling intervention seemed to especially help boys in the short run -- those who had made goals and tracked progress with their nurses were three times more likely to say they had stopped smoking than boys in the "control" group.

But a year after the sessions, there was no difference in smoking rates based on what kind of assistance teens had gotten from their nurses.

Between 13 and 17 percent of both boys and girls reported they had stopped lighting up by then, regardless of whether or not they had received counseling.

"It's nice that there was some effect at three months, (but) what we really care about is sustained cessation," said Dr. Michael Siegel, who studies tobacco control at the Boston University School of Public Health but wasn't involved in the research.

"The overwhelming majority of these kids are not quitting," he told Reuters Health.

COULD MORE SESSIONS HELP?

Lori Pbert of the University of Massachusetts Medical School in Worcester, one of the study's authors, was hopeful that expanding the counseling program with extra sessions may help more teens kick the habit once and for all.

"You have a pool of adolescents who are interested in quitting and want help in quitting," she told Reuters Health. "This is providing them a resource that's easily accessible."

Pbert pointed out that school nurses are "ideal" to lead one-on-one quit-smoking sessions, because they are already trained to do health counseling. And the extra counseling didn't cost schools anything, because nurses found they could fit it into their regular duties.

The findings tell her that teens that just see the nurse for educational pamphlets may also benefit from those brief encounters, but that more work needs to be done to help high schoolers quit for good.

"I think it makes sense for school nurses to be involved in smoking cessation," Siegel said. However, he added, "I don't see this type of intervention as having a population-level effect on smoking. We're not going to substantially put a dent in smoking rates by having nurses talk to students."

He said instead that these types of programs should be part of larger state-wide policy efforts to raise taxes on cigarettes and keep them out of indoor spaces, for example.

Mermelstein recommended that nurses could pair counseling sessions with follow-up through text messages or online materials to try to prevent relapses.

She highlighted the effectiveness of programs that focus on "helping teens understand what triggers them to smoke, what are their alternatives (and) how they manage to resist the urge to smoke."

SOURCE: bit.ly/o4z0xc Pediatrics, online October 17, 2011.