Youth Smoking Cessation

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Efforts to help adolescents quit smoking have received relatively little attention. Studies suggest that teenagers who smoke on a daily basis; who were unable to quit in the past for an extended period of time; who have parents who smoke, particularly mothers, and a number of friends who smoke; who do poorly in school and score high on a depression scale are least likely to quit smoking (Burt & Peterson, 1998; Zhu, Sun, Billings, Choi, & Malarcher, 1999). The more risk factors, the less likely adolescents are to quit (Zhu et al., 1999).

Reviews of quit-smoking programs for adolescents painted a bleak picture (Burton, 1994; Digiusto, 1994; Sussman, et al., 1999). Retention and recruitment of students were problematic, and end-of-group quit rates were modest. Many studies failed to use appropriate control groups, objective measures of smoking status, and long-term follow-up of graduates (Sussman et al., 1999). Teenage focus groups have provided insight into the nature of smoking cessation programs that appeal to youth (Balch, 1998). Some suggestions were to (1) highlight the seriousness of quitting smoking before becoming an adult; (2) include mood control and stress management; (3) help teen smokers deal with smoking peers; (4) avoid lecturing, preaching, or nagging; and (5) ensure confidentiality from parents.

Sussman, Dent, and Lichtman (2000) designed an innovative school quit-smoking program that featured interactive activities, such as "games" and "talk shows," alternative medicine techniques (i.e., yoga, relaxation, and meditation), and behavioral strategies for smoking cessation. Two hundred and fifty-nine students enrolled in the program at 12 schools and another 76 students served as "standard care" controls (smoking status surveyed at baseline and at 3 months). Objective measures of cigarette smoking were used. Elective class credit and class release time were offered for participation in the program.

Only 54% of the students (n = 141) completed the program, and only 14% of them were abstinent for 30 days at the end of group. Comparable outcome data for controls were not obtained, nor was the end-of-group quit rate based on an intent-to-treat analysis (students who did not complete the group were not included in the immediate outcome data).

A total of 128 (49%) of the clinic enrollees were contacted at 3 months, including 40 (42%) of the clinic dropouts (those who did not complete four sessions). Forty-four (58%) standard care controls were successfully contacted. The 30-day quit rate (no smoking in the past 30 days) for students who completed the program was 30%, compared to 16% for students assigned to the standard care condition. This difference was statistically significant. An intent-to-treat analysis, which assumed that students who were not contacted at follow-up still were smoking, yielded more modest, although still significantly different, quit rates of 17% and 8% for the program and control conditions, respectively.

Hurt and colleagues (2000) studied the effects of nicotine replacement patch therapy plus minimal behavioral intervention on smoking cessation in adolescents who expressed a desire to stop smoking. Out of 101 adolescents, 71 completed the entire 6 weeks of patch therapy. Biochemical tests confirmed that 7-day point-prevalence smoking abstinence rates were 10.9% at 6 weeks (end of patch therapy), 5% at 12-week follow-up, and 5% at 6-month follow-up. These outcomes are much poorer than those obtained for adults in similar studies.

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