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CORK Bibliography: Adolescents and Smoking Cesssation

68 citations. January 2006 to present

Prepared: December 2008

Abdullah ASM; Ho WWN. What Chinese adolescents think about quitting smoking: A qualitative study. Substance Use & Misuse 41(13): 1735-1743, 2006. (18 refs.)

The aim of this study was to investigate the attitudes of Chinese adolescents toward smoking, giving up smoking, and smoking cessation programs presently available. The study was a qualitative study carried out in 2002 by focus groups of 32 male secondary school students in Hong Kong who were either current smokers or had recently given up smoking. Subjects were students (grades 8-10) attending two full-day secondary schools in Hong Kong. Participants did not feel the need to make any serious psychological preparation for quitting. They underestimated the addictive nature of cigarette smoking and felt that they could choose to quit smoking at any time with little difficulty. Several barriers to quitting were reported, including boredom, peer influence, the urge to smoke, school work pressure, the wish to do something with their hands, difficulty in concentrating, and the ready availability of free cigarettes from peers. Those who had attempted to quit smoking (26/32) reported that peer influence and boredom were the main reasons why they started smoking and insisted that willpower and determination could have helped them in their quitting attempt. Participants were unanimous that pressure or encouragement from teachers, parents, or girlfriends did not help them to stay off cigarettes. Most (24/32) of the current smokers knew that smoking cessation services were available in Hong Kong, only 50% (12/24) of those who knew had made use of such services. None of the participants were able to identify any effective way of quitting smoking, though some suggested that the best practical measure was to avoid friends who smoked. The study suggests that attempts to persuade young people to quit smoking might benefit if they were framed to address issues such as the strong influence of their peers, the ease with which tobacco products can be obtained, the casual attitudes of young people toward smoking cessation, the perceived pros and cons of quitting, and (given that underage smoking is frowned upon by many parents and teachers) the need to respect confidentiality when offering support.

Albert DA; Severson HH; Andrews JA. Tobacco use by adolescents: The role of the oral health professional in evidence-based cessation programs. Pediatric Dentistry 28(2): 177-187, 2006. (94 refs.)

The use of tobacco products, especially cigarette smoking, represents the leading cause of preventable illness and death in the developed world. In the United States, major gains have been made to reduce smoking among adults. Similar gains, however, have not been realized with adolescents. In recent years, substantial interest has been directed to tobacco cessation studies with adolescents. The previously limited interest in adolescent cessation programs was attributable in large part to the mistaken assumptions that: (1) adolescent tobacco users were not dependent on nicotine and could stop at any time; (2) adolescents did not want to quit; and (3) adult tobacco cessation programs would be effective with adolescents. The need for programs to increase adolescent cessation attempts is underscored by the Healthy People 2010 goal that calls for an increase in tobacco use cessation attempts by adolescent smokers to 84%. Dental providers need to take steps to prevent tobacco use by adolescent patients. For those who are already addicted, they need to provide cessation Counseling services or referral for appropriate treatment. The purpose of this paper was to provide dental clinicians with information on: (1) tobacco and health; (2) the epidemiology of adolescent tobacco use; and (3) tobacco cessation programs for parents and adolescents that can be implemented in the dental office setting.

Albrecht SA; Caruthers D; Patrick T; Reynolds M; Salamie D; Higgins LW et al. A randomized controlled trial of a smoking cessation intervention for pregnant adolescents. Nursing Research 55(6): 402-410, 2006. (42 refs.)

Background: The smoking prevalence rate among pregnant adolescents has been estimated at 59-62%, and 60-80% of these adolescents continue to smoke throughout their pregnancies. Objectives: The aim of this study was to evaluate the short- and long-term effects. of smoking cessation strategies tailored to the pregnant adolescent to attain and maintain abstinence. The specific aim was to examine differences in short- and long-term smoking behaviors among three groups: Teen FreshStart (TFS), Teen FreshStart Plus Buddy TFS-B, and Usual Care (UC) control. Methods: In this randomized controlled intervention study, a 3-group (TFS, TFS-B, and UC) by 3-occasion (baseline, 8 weeks postrandomization, and 1-year following study entry) design was used. The study included 142 pregnant adolescents who were aged 14 to 19 years. Both self-reported smoking status collected on the Smoking History Questionnaire and saliva cotinine levels were used to identify smoking behaviors. Results: There were no significant differences among the three treatment groups at baseline in terms of the racial, distribution, age, gestational age, age of menses initiation, number in family household, number of family members who smoked, or tobacco use. A significant difference be tween the UC group and the TFS-B group (p = .010) was seen in smoking behaviors measured 8 weeks following treatment initiation. At 1 year following study entry, however, there were no differences between the groups in smoking behaviors. Discussion: The TFS-B intervention was more effective in attaining short-term smoking cessation in the pregnant adolescent than TFS or UC. Findings suggest that the peer-enhanced programming had a limited effect but could not sustain the participant beyond postpartum (1 year following study entry). Future studies should include relapse prevention to sustain smoking abstinence into the postpartum period.

Alouf B; Feinson JA; Chidekel AS. Preventing and treating nicotine addiction: A review with emphasis on adolescent health. Delaware Medical Journal 78(7): 249-256, 2006

This article is the fourth in a series of four providing current, state-of-the-art information about the tobacco problem and how physicians can effectively intervene. The articles review the health effects of second-hand smoke, current treatment strategies for nicotine addiction and the implementation of best practices, such as the "5 As," to effectively intervene with families with smokers. Three of the articles are accredited for free continuing medical education (CME) credit for physicians. To obtain AMA PRA Category 1 Credit(s)TM for this article, please go online to , your source for free continuing medical education from Nemours. Choose "Online Education" and the article, and complete the post-test as directed. CME accreditation for this educational presentation is provided at no cost as a service of Nemours, one of the nation's largest children's health systems. Nemours is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Nemours designates this educational activity for a maximum of .5 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. This article will focus on the prevention of adolescent smoking and discuss a global approach to the tobacco problem among youth. It also reviews the rationale for and pharmacology of treating nicotine addiction to empower physicians to assist smokers with quitting. By reading the article and completing the post-test, it is anticipated that the following learning objectives will be met: Physicians will become familiar with: 1) Options for treating nicotine addiction, 2) The unique aspects of the tobacco problem in adolescence, 3) The risk factors for teen smoking initiation.

Ames SC; Ames GE; Stevens SR; Patten CA; Werch CE; Schroeder DR. Effect of expressive writing as a treatment adjunct for reducing smoking cessation related weight gain in young adult smokers. Substance Use & Misuse 43(10): 1315-1325, 2008. (20 refs.)

This investigation evaluated the effect of expressive writing on weight gain in young adults being treated for smoking cessation. This study was conducted between July 2001 and June 2005. Participants (N = 196) ages 18-24 years (M = 20.8, SD = 2.0 years), who were recruited from a large city in the southeastern United States were randomized to brief office intervention or expressive writing plus brief office intervention. The sample was 56% female, 93% Caucasian, smoked a mean of 18.1 cigarettes per day (SD = 6.1), and had a mean body mass index of 24.9 (SD = 5.6). Participants who received the expressive writing plus brief office intervention gained significantly less weight than those receiving the brief office interventions from week 3 to 24, but did not significantly differ at week 52. A limitation of this investigation relates to the fact that the impact of expressive writing on weight was an unanticipated treatment effect that was evaluated in post-hoc analyses. Although the findings suggest that expressive writing holds promise as a treatment adjunct to decrease weight gain associated with smoking cessation, further research is warranted.

Ames SC; Patten CA; Werch CE; Schroeder DR; Stevens SR; Fredrickson PA et al. Expressive writing as a smoking cessation treatment adjunct for young adult smokers. Nicotine & Tobacco Research 9(2): 185-194, 2007. (35 refs.)

This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. Participants aged 18-24 years were randomized to a brief office intervention (n=99) or to an expressive writing plus brief office intervention (n=97). Both conditions received four individual visits plus 6 weeks of nicotine patch therapy, which began on the quit date following the week 2 visit. Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date. The brief office intervention group completed a control writing assignment. At end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition (33% vs. 20%, p=.043, OR=2.0, 95% CI=1.0-3.7, from a logistic regression adjusting for gender). At 24 and 52 weeks, abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention (12% vs. 11% at 24 weeks; 11% vs. 11% at 52 weeks). The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults. Lengthier interventions or the use of boosters should be tested to extend treatment effects. However, participants reported a low level of enthusiasm for the expressive writing, which may be a barrier to implementing it over a longer time frame. Therefore, other modes of delivering expressive writing to young adult cigarette smokers should be explored.

Amos A; Wiltshire S; Haw S; McNeill A. Ambivalence and uncertainty: Experiences of and attitudes towards addiction and smoking cessation in the mid-to-late teens. Health Education Research 21(2): 181-191, 2006. (42 refs.)

The late teens is an important transitional period as adolescents move into new social worlds which support or challenge their smoking. This paper draws on research with 99 Scottish 16- to 19-year olds which explored their understanding of their smoking and attitudes towards quitting and cessation support. The study involved qualitative interviews mostly with friendship pairs. Interviewees also completed a brief smoking questionnaire. Most regarded themselves as smokers but few thought they were addicted. Many were interested in quitting but this was not a priority. Perceived barriers to quitting related primarily to habitual and social aspects of dependence including friends' smoking, the smoking culture at work or college, stress and boredom. Few were interested in nicotine replacement therapy or cessation services, which they felt belonged to the world of older addicted smokers. The most effective quitting strategy was thought to be will-power. Traditional cessation services are therefore in their current form unlikely to appeal to older adolescents. Services aimed at this age group need to be grounded in their understandings of smoking and the social factors which support smoking. Young smokers should also be helped to understand how support may increase quitting success and how encourage quitting before smoking becomes entrenched in their daily routines.

Anatchkova MD; Redding CA; Rossi JS. Development and validation of decisional balance and temptations measures for Bulgarian adolescent smokers. (rapid communication). Addictive Behaviors 31(1): 155-161, 2006. (10 refs.)

The goal of this study was to develop measures for Decisional Balance and Situational Temptations for Bulgarian adolescent smokers and to test predicted theoretical relationships with Stages of Change in the same population. Consistent with previous findings for other populations, a 3-factor model for Decisional Balance (CFI = .95) and a hierarchical 4-factor model for Temptations (CFI = .90) best fit the data. The predicted crossover pattern for Decisional Balance and a decreasing trend for Temptations across the Stages of Change were verified. Both measures demonstrated good levels of factorial invariance across gender and across random split-half cross-validation samples. These results support the cross-cultural validity of the TTM constructs and indicate that they can be used as a basis for development of interventions for the population under study.

Backinger CL; Michaels CN; Jefferson AM; Fagan P; Hurd AL; Grana R. Factors associated with recruitment and retention of youth into smoking cessation intervention studies: A review of the literature. (reviw). Health Education Research 23(2): 359-368, 2008. (68 refs.)

This paper examines factors associated with high levels of recruitment and retention of youth into smoking cessation interventions. Fifty-five articles published from 1976 to June 2004 reported cessation outcomes were analyzed to examine the associations between selected variables and recruitment and retention rates. Studies with participants who smoked <= 5 cigarettes per day (cpd) were more likely to have recruitment rates >= 85%. Yet, studies with participants who smoked >= 6 cpd were more likely to have high retention rates. Studies that did not use incentives were more likely to have retention rates at end of intervention >= 85%. Findings indicate a lack of information reported about recruitment and retention procedures in adolescent tobacco cessation studies. Additional analyses and research need to be conducted to identify successful methods.

Bagot KS; Heishman SJ; Moolchan ET. Tobacco craving predicts lapse to smoking among adolescent smokers in cessation treatment. Nicotine & Tobacco Research 9(6): 647-652, 2007. (36 refs.)

Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean age=14.9 years [SD=1.3]; mean cigarettes/day=18.0 [SD=7.6]; mean Fagerstrom Test for Nicotine Dependence score = 6.8 [SD = 1.34]; 65% female), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p=.013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p <.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.

Bancej C; O'Loughlin J; Platt RW; Paradis G; Gervais A. Smoking cessation attempts among adolescent smokers: A systematic review of prevalence studies. (review). Tobacco Control 16(6): e-article 18, 2007. (91 refs.)

Objective: To synthesise estimates of the prevalence of cessation attempts among adolescent smokers generally, and according to age and level of cigarette consumption. Data sources: PubMed, ERIC, and PsychInfo databases and Internet searches of central data collection agencies. Study selection: National population-based studies published in English between 1990 and 2005 reporting the prevalence, frequency and/or duration of cessation attempts among smokers aged > 10 to,20 years. Data extraction: Five reviewers determined inclusion criteria for full-text reports. One reviewer extracted data on the design, population characteristics and results from the reports. Data synthesis: In total, 52 studies conformed to the inclusion criteria. The marked heterogeneity that characterised the study populations and survey questions precluded a meta-analysis. Among adolescent current smokers, the median 6-month, 12-month and lifetime cessation attempt prevalence was 58% ( range: 22-73%), 68% (range 43-92%) and 71% (range 28-84%), respectively. More than half had made multiple attempts. Among smokers who had attempted cessation, the median prevalence of relapse was 34, 56, 89 and 92% within 1 week, 1 month, 6 months, and 1 year, respectively, following the longest attempt. Younger (age, 16 years) and non-daily smokers experienced a similar or higher prevalence of cessation attempts compared with older (age > 16 years) or daily smokers. Moreover, the prevalence of relapse by 6 months following the longest cessation attempt was similar across age and smoking frequency. Conclusions: The high prevalence of cessation attempts and relapse among adolescent smokers extends to young adolescents and non-daily smokers. Cessation surveillance, research and program development should be more inclusive of these subgroups.

Blokland EAWDE; Hale WW; Meeus W; Engels RCME. Parental support and control and early adolescent smoking: A longitudinal study. Substance Use & Misuse 42(14): 2223-2232, 2007. (15 refs.)

The aim of this study is to examine the role of parental support and control on young adolescent smoking initiation, increase, continuation, and cessation. Longitudinal data gathered every 6 months over a one-year period were collected in Utrecht, The Netherlands,for 1,012 adolescents in 2000. Logistic regressions demonstrated that low parental control predicted adolescent smoking initiation but neither support nor control predicted adolescent smoking increase or continuation. Parental smoking status was important in adolescent smoking continuation and cessation. Suggestions based on these findings are made for prevention programs. A limitation is that the study only utilized adolescent reports.

Bloom PN; McBride CM; Pollak KI; Schwartz-Bloom RD; Lipkus IM. Recruiting teen smokers in shopping malls to a smoking-cessation program using the foot-in-the-door technique. Journal of Applied Social Psychology 36(5): 1129-1144, 2006. (27 refs.)

Persuading teen smokers to volunteer for smoking-cessation programs is a challenging yet understudied problem. As a method of dealing with this problem, we used and tested a foot-in-the-door (FITD) approach. Teen smokers were intercepted at malls and were assigned randomly to request compliance with a small behavior request of either (a) answering a few questions (light FITD) or (b) answering the same questions and a few additional ones, plus watching a short video about the effects of nicotine (heavy FITD). Participants were then called back by telephone several weeks later and asked to comply with a large behavior request of joining a cessation program that involved the use of self-help materials and telephone counseling. Although no differences were found in responses from the light and heavy groups, consent to enter the program was obtained from 12% of the pooled qualified intercepts and their parents (for those under 18 years). This recruitment rate was considered good, given that this is one of the only reported studies that recruited teen smokers from the general population to cessation programs.

Bright SJ; McKillop D; Ryder D. Cigarette smoking among young adults: Integrating adolescent cognitive egocentrism with the trans-theoretical model. Australian Journal of Psychology 60(1): 18-25, 2008. (65 refs.)

Personal fable aspects of adolescent cognitive egocentrism reflected in individuals' beliefs of omnipotence, invulnerability, and uniqueness, were examined in relation to cigarette smoking and stage of change status. A component of the Trans-Theoretical Model (TTM) of behaviour change, the stages of change maintain that current smokers consist of two groups-those who prefer to disregard the disincentives of smoking (pre-contemplators) and those who recognise these disincentives (contemplators). A Stages of Change Scale and the New Personal Fable Scale (NPFS) were administered to 249 university students aged 17 to 25 (M=19.09 years, SD=2.00). Pre-contemplative smokers had higher scores on the omnipotence subscale of the NPFS than contemplative smokers, suggesting that this personal fable could obstruct forward stage of change movement. Ex-smokers also had higher scores on the omnipotence and invulnerability subscales of the NPFS than individuals who have never smoked. Together, the findings suggest personal fable ideation is a salient smoking cessation variable and current conceptualisations of this construct need to be re-examined. Further, these results might explain the ineffectiveness of interventions underpinned by the TTM among adolescents. To extend the findings, prospective research is recommended.

Brook JS; Balka EB; Ning YM; Brook DW. Trajectories of cigarette smoking among African Americans and Puerto Ricans from adolescence to young adulthood: Associations with dependence on alcohol and illegal drugs. American Journal on Addictions 16(3): 195-201, 2007. (36 refs.)

This study predicts that heterogeneous smoking trajectories covering four time points pose differential risks for dependence on alcohol and illegal drugs in young adulthood in an African American and Puerto Rican community sample ( N = 475). The trajectory analysis yielded four smoking groups: nonsmokers, maturing out smokers, late-starting smokers, and early-starting continuous smokers. The early starting continuous group was more likely to become both alcohol- and drug-dependent in young adulthood than the other groups. Late-starting smokers were at higher risk than nonsmokers for drug dependence. Interventions are necessary from preadolescence through late adolescence to reduce the numbers of early and late smokers and their specific risks for substance dependence.

Cavallo DA; Cooney JL; Duhig AM; Smith AE; Liss TB; McFetridge AK et al. Combining cognitive behavioral therapy with contingency management for smoking cessation in adolescent smokers: A preliminary comparison of two different CBT formats. American Journal on Addictions 16(6): 468-474, 2007. (29 refs.)

This pilot study evaluated the optimal format of cognitive behavioral therapy (CBT) to combine with contingency management (CM) in a four-week, high school-based smoking cessation program. Thirty-four adolescent smokers received a standard weekly version of CBT or a frequent brief behavioral intervention. Results indicate a trend toward a higher seven-day point prevalence end-of-treatment abstinence rate and percent days abstinent during treatment in the CBT condition. In addition, significantly more participants in the CBT group completed treatment. These preliminary results suggest that when combined with CM, the standard weekly format of CBT is more acceptable to adolescent smokers.

Chen HH; Yeh ML. Developing and evaluating a smoking cessation program combined with an Internet-assisted instruction program for adolescents with smoking. Patient Education and Counseling 61(3): 411-418, 2006. (32 refs.)

Objective: The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction (IAI) program to help youth smokers quit smoking, and to evaluate the effectiveness of the program in changing youth's attitudes toward smoking, smoking behavior, and self-efficacy for smoking cessation. Methods: To achieve this goal, a comparative study of 77 senior high students divided into two groups was conducted. One group, designated as the experimental group, accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group. All participants completed questionnaires before and after the program. Results: The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth's attitude towards smoking, smoking behavior, and self-efficacy. There was a highly positive correlation between the participants' attitude toward smoking and self-efficacy. In contrast, cigarette consumption was in a strongly negative correlation with selfefficacy. Conclusion: Most of all participants in the experimental group recognized the effectiveness of the program, and thought the smoking cessation program with an IAI program was helpful and welcomed by youth. This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation.

Chinet L; Broers B; Humair JP; Narring F. Youth smoking cessation: An update for primary care physicians. Substance Use & Misuse 41(9): 1251-1261, 2006. (60 refs.)

Tobacco use is a major public health problem, and onset usually begins in youth. This article reviews current knowledge and evidence of specific aspects of smoking in youth, tobacco control strategies, and smoking cessation interventions that target young people. Finally, it provides recommendations for primary care physicians.

Chun J; Guydish J; Chan YF. Smoking among adolescents in substance abuse treatment: A study of programs, policy, and prevalence. Journal of Psychoactive Drugs 39(4): 443-449, 2007. (31 refs.)

The study was designed to: (1) identify smoking policies and interventions in adolescent residential treatment settings; (2) examine the prevalence of smoking among adolescents in these settings; and (3) assess relationships between program-level smoking policies and client-level smoking. The Center for Substance Abuse Treatment funded 17 sites to evaluate the effectiveness of Adolescent Residential Treatment (ART) programs for substance abuse. To describe program smoking policies and interventions, we conducted phone interviews with one key informant at each program (N = 12). To describe client smoking behaviors, we conducted a secondary data analysis of baseline data for adolescents (N = 912) entering ART programs. All sites had no smoking indoors and 75% of the site had tobacco-free grounds for adolescents. Forty-two percent provided their youth with nicotine replacement therapy, and 42% provided counseling for smoking cessation. Also, 33% did not allow staff smoking on and off campus. The prevalence of any smoking in the-past month was 66%, and 22% of current smokers were daily smokers at admission. Where smoking was allowed on grounds, adolescents more often reported recent smoking. Smoking behavior is prevalent among adolescents in residential drug treatment, and should be addressed in all such programs through policy implementation and client-level smoking cessation intervention.

Cummins SE; Hebert KK; Anderson CM; Mills JA; Zhu SH. Reaching young adult smokers through quitlines. American Journal of Public Health 97(8): 1402-1405, 2007. (12 refs.)

This study compared state quitline data (1992-2006) with population survey data to assess use by young adults aged 18 to 24 years. Young adult daily smokers used the service in proportion to their numbers in the state. Young adults responded to mass media quitline promotion, even promotion that did not target them. Women, ethnic minorities, and persons with low income and lower education levels were well represented among young adult quitline callers. Quitlines are a viable means of intervening with this priority population.

Curry SJ; Emery S; Sporer AK; Mermelstein R; Flay BR; Berbaum M et al. A national survey of tobacco cessation programs for youths. American Journal of Public Health 97(1): 171-177, 2007. (26 refs.)

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

Dalum P; Schaalma H; Nielsen GA; Kok G. "I did it my way" - An explorative study of the smoking cessation process among Danish youth. Patient Education and Counseling 73(2): 318-324, 2008. (25 refs.)

Objective: To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions. Method: Focus group discussions and individual interviews during April-May 2004 with 26 persons aged 15-21 years who all initiated a quit attempt on 1 January 2004. Results: The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart front 'commitment' or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. 'Smoking friends' and 'Social support' were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions. Conclusion: There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used. Practice Implications: Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies.

Dino G; Horn K; Abdulkadri A; Kalsekar I; Branstetter S. Cost-effectiveness analysis of the Not On Tobacco program for adolescent smoking cessation. Prevention Science 9(1): 38-46, 2008. (26 refs.)

Public health researchers and practitioners emphasize the need for effective, adoptable, and available youth smoking cessation interventions. Scarce resources demand that such interventions also be cost effective. This study describes a cost-effectiveness analysis (CEA) of the American Lung Association's Not On Tobacco (N-O-T) national and international teen smoking cessation program. N-O-T has been rigorously evaluated as an effective and adoptable program, and was recently found to be the most frequently-used teen smoking cessation program in the nation. N-O-T studies show intent-to-treat quit rates between 15% and 19%, among the highest reported in the literature. The current CEA resulted from a 2-year state-wide demonstration study in Florida, comparing the effectiveness of N-O-T with a 20-min brief intervention (BI). The CEA utilized a Markov transition model of decision analysis to explain stage progression of smoking cessation among participants from the age of 17 to 25 years. The Markov simulation predicted that out of a cohort of 100 N-O-T students, 10 will quit smoking and remain smoke-free at the age of 25 years and 14 will reduce smoking, resulting in 102.22 life years saved and a total of 20.11 years discounted life years (DLY) saved. Among BI youth, six will quit smoking and nine will reduce, indicating 64.31 life years saved and a total 12.65 DLY saved. The incremental DLY saved is 7.46 years. Results indicate that N-O-T is a very cost-effective option school-based smoking cessation, as cost effective as school-based primary tobacco prevention, and potentially more cost effective than adult tobacco use cessation.

Everson ES; Daley AJ; Ussher M. Does exercise have an acute effect on desire to smoke, mood and withdrawal symptoms in abstaining adolescent smokers? Addictive Behaviors 31(9): 1547-1558, 2006. (50 refs.)

Objective: Previous studies have shown that exercise acutely reduces desire to smoke and withdrawal symptoms among adult smokers; however, no study has examined these effects in younger smokers. This study investigated the impact of a short bout of moderate intensity exercise on desire to smoke, withdrawal symptoms and exercise-induced affect in temporarily abstinent adolescent smokers. Methods: Thirty-seven low-active male and female smokers aged 16-19 years, abstained from smoking overnight and were assigned to either (i) 10 min of moderate intensity cycle ergometry (n = 18) or (ii) a placebo control condition that involved very light intensity cycle ergometry (n = 19). Measures of desire to smoke, the Mood and Physical Symptoms Scale (MPSS) and Subjective Exercise Experience Scale (SEES) were administered at baseline, 5 min during, 5 min after and 30 min after both conditions. Results and conclusion: A significant interaction effect for group by time was recorded for psychological distress scores, when the baseline value was covaried. Follow-up tests indicated that the exercise group reported significantly higher PD scores than the placebo control during exercise, but not at any other time point. No other significant effects were found for any other variables. Unlike research involving adult populations, a short bout of moderate intensity exercise did not alter desire to smoke among abstaining adolescent smokers and may negatively impact affective responses during exercise.

Falkin GP; Fryer CS; Mahadeo M. Smoking cessation and stress among teenagers. Qualitative Health Research 17(6): 812-823, 2007. (26 refs.)

The authors describe the experience of quitting smoking, focusing on the obstacles youth struggle with, based on individual interviews and focus groups with 54 teenagers in New York City. A major obstacle was the belief that people should stop smoking forever. The youth had to cope with temptation, frequent and often intense urges or cravings for cigarettes, and lack of social support from their family and friends. The young participants not only had to cope with general life stresses without being able to use cigarettes to reduce tensions but also had to contend with new stressful situations, such as friends who put them down for not smoking. In addition, the teens had to give up things that were important to them, such as friendships, during their quit attempts. The study describes how quitting can be a much more stressful experience for youth than research typically acknowledges. The authors discuss public health implications.

Franken FH; Pickworth WB; Epstein DH; Moolchan ET. Smoking rates and topography predict adolescent smoking cessation following treatment with nicotine replacement therapy. Cancer Epidemiology, Biomarkers & Prevention 15(1): 154-157, 2006. (24 refs.)

Establishing measurement invariance of tobacco addiction among adolescents remains challenging. In adult smoking cessation trials, poor outcome is predicted by high cigarette consumption and large puff volume at baseline. We examined the predictive value of pretreatment smoking rates and topography variables for abstinence outcomes among 66 adolescents enrolled in a 3-month smoking cessation trial using nicotine replacement and cognitive behavioral therapy. Pretreatment variables included cigarettes per day (CPD), puff volume, puff duration, and several youth-adapted Fagerstrom-derived questionnaire scores. Outcome measures included prolonged abstinence at end of treatment and point-prevalent abstinence 3 months after the end of the trial. Logistic regression controlling for treatment group showed that increases in baseline CPD (odds ratio, 1.438; 95% confidence interval, 1.051-1.967) and average puff volume (odds ratio, 1.168; 95% confidence interval, 1.030-1.326) predicted continued smoking at the end of treatment. Puff volume (P = 0.013), but not CPD, predicted abstinence at the 3-month follow-up. None of the youth-adapted Fagerstrom questionnaires predicted outcome on either abstinence measure. If confirmed in a larger sample, our findings suggest that puff topography, and possibly CPD, might predict cessation outcome better than Fagerstrom scores in adolescent smokers.

Friedmann PD; Jiang L; Richter KP. Cigarette smoking cessation services in outpatient substance abuse treatment programs in the United States. Journal of Substance Abuse Treatment 34(2): 165-172, 2008. (46 refs.)

Objective: The objective of this study was to estimate the prevalence and determinants of cigarette smoking cessation treatment in U.S. outpatient substance abuse treatment (OSAT) units. Methods: Program directors and clinical supervisors from a national sample of 550 OSAT units in the United States were surveyed in 2004-2005. Supervisors reported the availability of cigarette smoking assessment, and individual or group counseling and pharmacotherapy for smoking cessation. This analysis examines whether institutional and resource factors influence the delivery of these services. Results: Of OSAT programs in the United States, 41% offer smoking cessation counseling or pharmacotherapy, 38% offer individual/group counseling, and 17% provide quit-smoking medication. In multivariate models, hospital affiliation, service breadth, the priority given to physical health, the availability of medication to treat addictive problems, assessment of cigarette smoking, and a greater perception of the proportion of patients who smoke were associated with the delivery of smoking cessation services. Program size and medical staffing also influenced the availability of quit-smoking medication. Conclusions: Of U.S. OSAT programs, two in five offer behavioral treatment for smoking cessation, but fewer than one in five provide access to pharmacotherapy. Substance abuse treatment programs that are medically oriented, provide more comprehensive services, and recognize the burden of tobacco smoking among their patients are more likely to deliver evidence-based smoking cessation services.

Gnich W; Sheehy C; Amos A; Bitel M; Platt S. A Scotland-wide pilot programme of smoking cessation services for young people: Process and outcome evaluation. Addiction 103(11): 1866-1874, 2008. (32 refs.)

Aim: To conduct an independent, external evaluation of a Scotland-wide youth cessation pilot programme, focusing upon service uptake and effectiveness. Intervention: National Health Service (NHS) Health Scotland and Action on Smoking and Health (ASH) Scotland funded a 3-year (2002-2005) national pilot programme comprising eight projects which aimed to engage with and support young smokers (aged 12-25 years) to quit. Design, participants and measurements Process evaluation was undertaken via detailed case studies comprising qualitative interviews, observation and documentary analysis. Outcomes were assessed by following project participants (n = 470 at baseline) at 3 and 12 months and measuring changes in smoking behaviour, including carbon monoxide (CO)-validated quit status. Findings: Recruitment proved difficult. Considerable time and effort were needed to attract young smokers. Advertising and recruitment had to be tailored to project settings and educational activities proved essential to raise the profile of smoking as an issue. Thirty-nine participants [8.6%, 95% confidence interval (CI) 5.0-11.2%] were CO-validated quitters at 3 months and 11 of these (2.4%, 95% CI 1.90-3.8%) were also validated quitters at 12 months. Older participants were more likely to be abstinent at 3 months. Conclusions: The overall quit rate was disappointing. As a result of low participant numbers, it was impossible to draw conclusions about the relative effectiveness of different project approaches. These findings give little support to the case for developing dedicated youth cessation services in Scotland. They also highlight the difficulties of undertaking 'real-world' evaluations of pilot youth cessation projects. More action is needed to develop environments which enhance young smokers' motivation to quit and their ability to sustain quit attempts.

Grimshaw GM; Stanton A. Tobacco cessation interventions for young people. (review). Cochrane Database of Systemic Reviews 4(article no. CD003289), 2006. (110 refs.)

Background: Teenage smoking prevalence is around 15% in developing countries (with wide variation from country to country), and around 26% in the UK and USA. Although most tobacco control programmes for adolescents are based around prevention of uptake, there are also a number of initiatives to help those who want to quit. Since those who do not smoke before the age of 20 are significantly less likely to start as adults, there is a strong case for programmes for young people that address both prevention and treatment. Objectives: To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Tobacco Addiction Group's Specialized Register, MEDLINE, EMBASE, PsyclNFO, ERIC, CINAHL, and the bibliographies of identified trials. We also searched the 'grey' literature (unpublished materials), and contacted authors and experts in the field where necessary. Selection criteria Types of studies: Randomized controlled trials, cluster-randomized controlled trials and controlled trials. Types of participants: Young people, aged less than 20, who are regular tobacco smokers. Types of interventions: The interventions ranged from simple ones such as pharmacotherapy, targeting individual young people, through complex programmes targeting people or organizations associated with young people (for example, their families or schools), or the community in which young people live. We included cessation programmes but excluded programmes primarily aimed at prevention of uptake. Types of outcome measures: The primary outcome was smoking status at six months follow up, among those who smoked at baseline. We report the definition of cessation used in each trial (e. g seven-or thirty-day point prevalence abstinence, or sustained or prolonged abstinence), and we preferred biochemically verified cessation when that measure was available. Data collection and analysis Both authors independently assessed the eligibility of candidate trials identified by the searches, and extracted data from them. We categorized included trials as being at low, medium or high risk of bias, based on concealment of allocation, blinding (where applicable) and the handling of attrition and losses to follow up. We conducted limited meta-analyses of some of the trials, provided that it was appropriate to group them and provided that there was minimal heterogeneity between them. We estimated pooled odds ratios using the Mantel-Haenszel method, based on the quit rates at longest follow up for trials with at least six months follow up from the start of the intervention. Main results We found 15 trials, covering 3605 young people, which met our inclusion criteria (seven cluster-randomized controlled trials, six randomized controlled trials and two controlled trials). Three trials used or tested the transtheoretical model (stages of change) approach, two tested pharmacological aids to quitting (nicotine replacement and bupropion), and the remaining trials used various psychosocial interventions, such as motivational enhancement or behavioural management. The trials evaluating TTM interventions achieved moderate long-term success, with a pooled odds ratio (OR) at one year of 1.70 (95% confidence interval (CI) 1.25 to 2.33) persisting at two-year follow up with an OR of 1.38 (95% CI 0.99 to 1.92). Neither of the pharmacological intervention trials achieved statistically significant results (data not pooled), but both were small-scale, with low power to detect an effect. The three interventions (5 trials) which used cognitive behavioural therapy interventions did not individually achieve statistically significant results, although when the three Not on Tobacco trials were pooled the OR 1.87; (95% CI 1.00 to 3.50) suggested some measure of effectiveness. Although the three trials that incorporated motivational interviewing as a component of the intervention achieved a pooled OR of 2.05 (95% CI 1.10 to 3.80), the impossibility of isolating the effect of the motivational interviewing in these trials meant that we could not draw meaningful inferences from that analysis. Authors' conclusions: Complex approaches show promise, with some persistence of abstinence (30 days point prevalence abstinence at six months), especially those incorporating elements sensitive to stage of change. There were few trials with evidence about pharmacological interventions (nicotine replacement and bupropion), and none demonstrated effectiveness for adolescent smokers. Psycho-social interventions have not so far demonstrated effectiveness, although pooled results for the Not on Tobacco trials suggest that that this approach may yet prove to be effective; however, their definition of cessation (one or more smoke-free days) may not adequately account for the episodic nature of much adolescent smoking. There is a need for well-designed adequately powered randomized controlled trials for this population of smokers, with a minimum of six months follow up and rigorous definitions of cessation (sustained and biochemically verified). Attrition and losses to follow up are particularly problematic in trials for young smokers, and need to be kept to a minimum, so that management and interpretation of missing data need not compromise the findings.

Ham OK. Stages and processes of smoking cessation among adolescents. Western Journal of Nursing Research 29(3): 301-315, 2007. (30 refs.)

The purpose of this study was to identify the stages and processes of change related to smoking cessation among vocational technical high school students to provide baseline data for smoking cessation programs. Cross-sectional data were collected in April and May, 2004, from 300 mate students at three vocational technical high schools in Korean metropolitan areas. The survey instruments included: decisional balance; self-efficacy; nicotine dependence; stages and processes of change; and knowledge related to smoking. The results indicated that 31.7%, 39.2%, and 29.1% of current smokers were in the precontemplation, contemplation, and preparation stages, respectively, and that 42.6% and 57.4% of former smokers were in the action and maintenance stages, respectively. Decisional balance, self-efficacy, and nicotine dependence were significantly associated with the stages of change. Regarding the processes of change, only behavioral processes were significantly associated with the stages of change, with experiential processes showing no significant relationship. The study results suggest that smoking cessation programs should emphasize behavioral strategies to help students progress through the stages.

Ham OK; Lee YJ. Use of the transtheoretical model to predict stages of smoking cessation in Korean adolescents. Journal of School Health 77(6): 319-326, 2007. (34 refs.)

Background: Smoking is popular among Korean male high school adolescents, with the prevalence of 20.7% differing markedly with the type of school, being 16.3% and 27.6% in academic and vocational technical high schools, respectively. The purpose of this study was to identify significant variables that predict stages of smoking cessation among Korean high school students using the transtheoretical model (TTM), in order to provide an empirical basis for developing smoking cessation programs. Methods: Cross-sectional data were collected in April and May 2004 from 300 male students at 3 vocational technical high schools in Korean metropolitan areas. The survey variables comprised decisional balance, self-efficacy, stages and processes of change, nicotine dependence, and use of smoking cessation aids. Results: Current and former smokers comprised 26.3% and 22.7% of the cohort, respectively, of which 71.4% had experienced smoking cessation at least once and 55.1% utilized smoking cessation aids to help stop smoking. Nicotine-free tobacco and nicotine gum were the most common smoking cessation aids. Decisional balance, use of behavioral processes, and higher self-efficacy were significant in explaining stages of smoking cessation after controlling for nicotine dependence. Conclusions: The study results suggest that smoking cessation programs developed based on the TTM may help adolescents to progress through stages, with it being important to include information regarding the use of smoking cessation aids.

Harris JB; Schwartz SM; Thompson B. Characteristics associated with self-identification as a regular smoker and desire to quit among college students who smoke cigarettes. Nicotine & Tobacco Research 10(1): 69-76, 2008. (23 refs.)

Tobacco use among college students increased substantially during the 1990s. Better understanding of college smokers is warranted to develop interventions specific to the needs of this population. We examined sociodemographic and tobacco-use characteristics associated with self-identification as a regular smoker and intentions to quit smoking among college students who smoke cigarettes. We conducted logistic regression analysis on baseline survey data from the Campus Health Action on Tobacco study, a 4-year group-randomized trial at 30 four-year colleges in Washington, Oregon, and Idaho. Students who self-identified as a regular smoker smoked more cigarettes before starting college, smoked a greater number of cigarettes the prior 30 days, smoked more cigarettes per day, and were more likely to smoke within 30min of waking up, compared with students who were current smokers but did not consider themselves regular smokers. Females, older students, and those who had decreased the amount they smoked since coming to college were more likely to want to quit "very much." Females and students in early college years were more likely to be planning to quit before graduation, as were students who had decreased the amount they smoked since coming to college. Interventions should target students who are in their early college years, given that habits prior to college, changes in smoking habits while in college, and year in college are associated with students' self-identification as a regular smoker, desire to quit smoking, or plan to quit smoking while in college.

Henriksen L; Dauphinee AL; Wang Y; Fortmann SP. Industry sponsored anti-smoking ads and adolescent reactance: Test of a boomerang effect. (review). Tobacco Control 15(1): 13-18, 2006. (48 refs.)

Objective: To examine whether adolescents' exposure to youth smoking prevention ads sponsored by tobacco companies promotes intentions to smoke, curiosity about smoking, and positive attitudes toward the tobacco industry. Design: A randomised controlled experiment compared adolescents' responses to five smoking prevention ads sponsored by a tobacco company (Philip Morris or Lorillard), or to five smoking prevention ads sponsored by a non-profit organisation (the American Legacy Foundation), or to five ads about preventing drunk driving. Setting: A large public high school in California's central valley. Subjects: A convenience sample of 9th and 10th graders (n = 832) ages 14 - 17 years. Main outcome measures: Perceptions of ad effectiveness, intention to smoke, and attitudes toward tobacco companies measured immediately after exposure. Results: As predicted, adolescents rated Philip Morris and Lorillard ads less favourably than the other youth smoking prevention ads. Adolescents' intention to smoke did not differ as a function of ad exposure. However, exposure to Philip Morris and Lorillard ads engendered more favourable attitudes toward tobacco companies. Conclusions: This study demonstrates that industry sponsored anti-smoking ads do more to promote corporate image than to prevent youth smoking. By cultivating public opinion that is more sympathetic toward tobacco companies, the effect of such advertising is likely to be more harmful than helpful to youth.

Hoving C; Reubsaet A; de Vries H. Predictors of smoking stage transitions for adolescent boys and girls. Preventive Medicine 44(6): 485-489, 2007. (44 refs.)

Background. Aim of this study was to identify predictors of transition from never smoking to smoking monthly or more often in a European sample of adolescents. To show whether predictors differed between genders, analyses were run for boys and girls separately. Methods. From six European countries, 4055 never smokers participated at baseline (1998). One year later, respondents were asked to indicate their smoking status. Respondents were categorized as smoker (smoking monthly or more) or non-smoker (smoking less than monthly). The predictive qualities of predisposing, motivational and intentional concepts were assessed using logistic regression analyses. Results. Girls were more likely to be a smoker at follow-up. More spending money, modeling from parents and a higher intention to start smoking were predictive of smoking uptake in both genders. Boys were more likely to start smoking when perceiving less cons of smoking, drinking more alcohol and perceiving a social norm towards not smoking from parents. Girls experiencing higher social pressure to smoke from friends were more likely to start smoking. Conclusions. Separate uptake prevention interventions for boys and girls do not seem warranted. Boys may benefit from a program also addressing other deviant behaviors. Girls should continue to be supplied with specific skills to resist social pressure.

Husten CG. Smoking cessation in young adults. (editorial). American Journal of Public Health 97(8): 1354-1356, 2007. (21 refs.)

Jason LA; Pokorny SB; Adams M; Hunt Y; Gadiraju P; Schoeny M. Do fines for violating possession-use-purchase laws reduce youth tobacco use? Journal of Drug Education 37(4): 393-400, 2007. (15 refs.)

The present brief report followed children exposed to consequences for violating Purchase, Use, and Possession (PUP) laws over time to assess changes in their smoking status. Youth in 24 towns were surveyed once a year for 3 years, and rates of tobacco use for those fined for PUP law violations were assessed. Of those who were given a ticket for a PUP law violation, 35 (39%) reported not smoking during year 1. Students in grade 7 were more likely to have quit smoking (84%) than those in grade 8 (35%), grade 9 (32%), or grade 10 (21%). For the two follow-up years, 45% and 41% reported not smoking. Assuming those who attrited were smokers, it is possible that about 15% to 24% of the original sample of children cited actually quit smoking over the follow-up period. The implications of these findings are discussed.

Kealey KA; Ludman EJ; Mann SL; Marek PM; Phares MM; Riggs KR et al. Overcoming barriers to recruitment and retention in adolescent smoking cessation. Nicotine & Tobacco Research 9(2): 257-270, 2007. (51 refs.)

Participant recruitment and retention have been identified as challenging aspects of adolescent smoking cessation interventions. Problems associated with low recruitment and retention include identifying smokers, obtaining active parental consent, protecting participants' privacy, respecting participants' autonomy, and making participation relevant and accessible to adolescents. This paper describes nine strategies for minimizing these recruitment and retention problems via a proactive telephone counseling intervention, and reports on their simultaneous implementation among 1,058 smokers from 25 high schools in Washington state. Results are as follows: (a) 85.9% of parents of minor-age seniors provided active consent for their teen's participation, (b) 89.8% of eligible smokers were successfully contacted by counselors, (c) 86.5% of contacted smokers consented to participate in the cessation counseling, (d) 93.8% of consented smokers participated in smoking cessation counseling calls, and (e) 72.2% of participating smokers completed their full intervention. These results demonstrate that older teens who smoke, and their parents, are receptive to confidential cessation counseling that is personally tailored, supportive of their autonomy, and proactively delivered via the telephone.

Kleinjan M; Van den Eijnden RJJM; Van Leeuwe J; Brug J; De Ven MOMV; Engels RCME. Adolescents' movement towards cessation of smoking: Role and relative value of the processes of change and nicotine dependence. Psychology & Health 23(6): 729-743, 2008. (47 refs.)

The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents' readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14-18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents' readiness to quit.

Krishnan-Sarin S; Reynolds B; Duhig AM; Smith A; Liss T; McFetridge A et al. Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers. Drug and Alcohol Dependence 88(1): 79-82, 2007. (16 refs.)

Objective: To examine the relationship between impulsivity and smoking cessation treatment response among adolescents. Methods: Thirty adolescent smokers participated in a high school based smoking cessation program combining contingency management and cognitive behavioral therapy. Self-report (Barratt impulsiveness scale (BIS-II); Kirby delay discounting measure (DDM)) and behavioral (experiential discounting task (EDT); continuous performance task (CPT)) measures of impulsivity were assessed at treatment onset. Results: Sixteen participants (53%) were abstinent from smoking at completion of the four-week study. Compared to abstinent adolescents, those not achieving abstinence discounted monetary rewards more on the EDT and committed more commission errors on the CPT. Group differences were not observed on the BIS-II or DDM. Conclusions: These preliminary results suggest that specific behavioral measures of impulsivity may be associated with the ability to initiate and/or maintain abstinence from smoking among adolescent smokers.

Leatherdale ST. School-based smoking cessation programs: Do youth smokers want to participate in these programs? Addictive Behaviors 31(8): 1449-1453, 2006. (10 refs.)

The purpose of the present study was to examine characteristics that predict interest in school-based cessation programs among 3136 youth smokers with intentions to quit smoking. The majority of youth smokers report that they would not join a school-based smoking cessation program. However, improving awareness of these types of programs among students is important as sub-populations of youth smokers were more likely to be interested in school-based cessation initiatives when aware that such programs exist. Future school-based cessation intervention outcomes might be improved if programs are targeted to the youth that are most likely to use them, if more youth can be made aware of existing programs, and if the benefits of participating in such programs can be more adequately conveyed to youth smokers.

Liu JM; Peterson AV; Kealey KA; Mann SL; Bricker JB; Marek PM. Addressing challenges in adolescent smoking cessation: Design and baseline characteristics of the HS Group-Randomized trial. Preventive Medicine 45(2/3): 215-225, 2007. (75 refs.)

Objective. Well-documented challenges have hampered both intervention development and research in teen smoking cessation. Addressing these challenges, the Hutchinson Study of High School Smoking (HS Study), the largest group-randomized trial in adolescent smoking cessation to date, incorporates several design innovations to investigate the effect of a counselor-initiated, individually tailored telephone counseling smoking cessation intervention for older adolescents. This paper presents and discusses these innovative design features, and baseline findings on the resulting study population. Method. The trial used a population-based survey to proactively identify and recruit all high school juniors who had smoked in the past month - potentially expanding intervention reach to all smokers, even those who smoked less than daily and those not motivated to quit. For ethical and intervention reasons, some nonsmokers were enrolled in the intervention, also. Other important design features included the random allocation of schools into experimental conditions (intervention vs. no-intervention control) and a multi-wave design. Results and conclusion. The design innovations address problems and challenges identified in adolescent smoking cessation literature. The heterogeneous baseline characteristics of the study population, well-balanced between the two arms, have three significant implications: They (1) demonstrate the effectiveness of the trial's design features, (2) highlight several intervention-related issues, and (3) provide assurance that the trial's evaluation of intervention effectiveness will be unbiased.

Luther EJ; Bagot KS; Franken FH; Moolchan ET. Reasons for wanting to quit: Ethnic differences among cessation-seeking adolescent smokers. Ethnicity & Disease 16(3): 739-743, 2006. (23 refs.)

Objective: Enhancing adolescent cessation requires an understanding of approaches that will motivate youths to quit smoking. Methods: We compared reasons for wanting to quit expressed by European Americans to those of African American youths. Adolescent cessation-seeking smokers completed telephone interviews regarding their smoking behavior and reasons for wanting to quit in an open-ended format. Responses were then classified into nine categories. Results: Participants included 1,268 Baltimore-area adolescents (mean age 15.6 +/- 1.7 years, 60% female, 58% European American, mean Fagerstrom Test for Nicotine Dependence 5.8 +/- 2.2). While both groups broadly cited health as the predominant reason for wanting to quit, chi-square analyses of further stratification of health into general, future, and current health concerns showed that European Americans were more likely to endorse current health reasons (P <.001), while African Americans were more likely to state general health reasons (P=.004). European Americans were more likely to state cost (P=.002) or to not give a reason for wanting to quit (P=.008), while African Americans more frequently reported a lack of positive (pharmacologic or social) reinforcement (P <.001). Conclusions: The development of culturally tailored messages may help enhance smoking cessation efforts among adolescents.

MacDonald S; Rothwell H; Moore L. Getting it right: Designing adolescent-centred smoking cessation services. Addiction 102(7): 1147-1150, 2007. (25 refs.)

Aims: To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services. Design Structured qualitative interviews drawing on means-end theory. Setting Three youth-clubs and two secondary schools in south-east Wales. Participants: Twenty-five male and female 13-18-year-olds, mainly daily smokers. Findings Interviewees did not assume immediately that a smoking cessation service is something that will be available to them, and therefore they initially encountered difficulties in identifying attributes of such support. With further prompting interviewees were able to express a preference for support attributes, but these were not attributes that traditionally form part of cessation provision. Their main preference was for support from friends and family, access to nicotine replacement therapy and non-school-based, flexible support and guidance. Conclusion: The results re-emphasize the inadequacies of existing cessation provision for meeting adolescent preferences and suggest that developing more adolescent-appropriate support requires a reconceptualization of existing interventions, with service users situated at the core of intervention design. The study highlights a number of service development points for intervention planners including: rethinking the timing and location of provision; placing more emphasis on the selection of facilitators; harnessing support from friends and family; and rooting these developments in broader tobacco control strategies.

Maher JE; Rohde K; Pizacani B; Dent C; Stark MJ; Dilley JA et al. Does free nicotine replacement therapy for young adults prompt them to call a quitline? (letter). Tobacco Control 16(5): 357-358, 2007. (2 refs.)

McCuller WJ; Sussman S; Wapner M; Dent C; Weiss DJ. Motivation to quit as a mediator of tobacco cessation among at-risk youth. Addictive Behaviors 31(5): 880-888, 2006. (22 refs.)

The purpose of this study is twofold: 1) to evaluate the effects of a smoking cessation clinic (Project EX) on changing motivation to quit smoking, and 2) to assess differences in quit rates based on these changes in motivation. Student smokers in 18 continuation high schools in the Los Angeles county area were invited to participate in a tobacco cessation clinic designed to enhance motivation to quit tobacco use. The 18 schools were randomly assigned to one of three conditions. Compared to students in the control group, students who participated in the program conditions were more likely to express higher motivation to quit tobacco use. Higher motivation was also significantly related to higher quit rates. Motivation to quit as defined by constituents of the energy/direction model of motivation appears to be a plausible mediator of cessation program effects.

McVea KLSP. Evidence for clinical smoking cessation for adolescents. Health Psychology 25(5): 558-562, 2006. (40 refs.)

Objective: This report reviews the evidence that informs the role of health and mental health care providers in addressing youth smoking cessation. Design: Qualitative literature review. Results: Physicians do not consistently screen adolescents for tobacco use and fail to provide recommended cessation advice. Challenges to addressing smoking cessation include the need for procedures to ensure confidentiality and the existence of competing demands to provide other services. Few published studies have specifically addressed the effectiveness of clinical interventions. Interventions that require return visits or follow-up phone contacts are technically difficult to implement in this population. Successful interventions may require resources not available in nonresearch settings. Most studies have used brief clinical intervention as a control condition, making it impossible to evaluate its effectiveness. Conclusion: There is little evidence that supports current clinical smoking cessation guidelines for adolescents. More research is needed to develop inexpensive, efficient clinical interventions that can provide youths access to smoking cessation help. Future challenges include reorganizing clinical systems to offer greater counseling by support staff or in electronic formats and to provide effective booster messages and follow-up care in a population that is difficult to track.

Milne B; Towns S. Do paediatricians provide brief intervention for adolescents who smoke? Journal of Paediatrics and Child Health 43(6): 464-468, 2007. (24 refs.)

Aims: This study aimed to describe the self-reported practice of paediatricians in brief interventions for adolescents who smoke. We also aimed to compare practice with confidence, skills and knowledge of brief intervention and nicotine replacement therapy after a targeted training programme. Methods: Medical staff at The Children's Hospital at Westmead completed a questionnaire of clinical practice and confidence in brief intervention for smoking cessation. Data were analysed comparing self-reported practice with confidence, skill and knowledge of brief interventions, based on Fiore's 5A's approach (Ask about smoking at every opportunity, Assess willingness to quit, Advise patients to quit smoking, Assist quit attempts and Arrange follow up). Results: Fifty-seven clinicians completed questionnaires, 55 (96%) recognised the importance of asking adolescents about smoking. Thirty-one (54%) identified adolescent smokers all or most of the time, increasing to 50 (88%) if their presenting condition was associated with smoking. Twenty-five (44%) clinicians assessed the stage of change, 33 (58%) advised the adolescent to quit smoking, nine (16%) assisted quit attempts and 10 (17.5%) arranged follow up. Clinicians more confident in brief intervention skills, motivational interviewing and relapse prevention were more likely to use the 5A's (P < 0.05). Training increased clinician's confidence in brief intervention skills and knowledge of nicotine replacement therapy (P < 0.01); however, there was no statistically significant change in clinical practice 1 month post training. Conclusion: Training paediatricians in brief intervention skills, motivational interviewing and relapse prevention can increase the use of 5A's brief intervention in clinical practice, potentially increasing quit attempts in adolescents who smoke.

Molyneux A; Lewis S; Coleman T; McNeill A; Godfrey C; Madeley R et al. Designing smoking cessation services for school-age smokers: A survey and qualitative study. Nicotine & Tobacco Research 8(4): 539-546, 2006. (32 refs.)

To identify the preferred design characteristics of smoking cessation services for school-age smokers, we conducted focus groups with teenage smokers motivated to stop smoking. We surveyed all pupils in years 9-11 ( aged 13-16) in a random sample of 10 schools in Nottinghamshire, United Kingdom, to elicit details of smoking behavior, and conducted 25 focus groups in 6 schools with current smokers who wanted to stop smoking. Of 4,065 pupils surveyed, 888 (22%) were current smokers, and 438 (50% of smokers) wanted to quit smoking. We sampled 226 of these individuals for focus group studies, and 135 (60%) participated. These participants were motivated to quit, and almost all had tried to do so but had found it too difficult. Many were aware of smoking cessation methods but had low perceptions of their effectiveness based on their own or others' poor experiences of these interventions, and few were aware of the possibility of professional cessation support. Given clear, nondirective information about interventions, participants reported a preference for confidential, nonjudgmental services delivered during school time by a trained counselor, allowed the option to attend with friends, and offered nicotine replacement therapy (NRT). School-age smokers in Nottinghamshire, United Kingdom, who are motivated to stop smoking have low knowledge and opinions of smoking cessation interventions. Our findings indicate that young smokers would favor school-based services offering confidential professional counseling and NRT.

Moolchan ET; Frazier M; Franken FH; Ernst M. Adolescents in smoking cessation treatment: Relationship between externalizing symptoms, smoking history and outcome. Psychiatry Research 152(2/3): 281-285, 2007. (25 refs.)

Previous research has indicated a potential bi-directional link between youth substance use and externalizing psychiatric comorbidities. We hypothesized that the degree of externalizing symptoms predicts the likelihood of successful smoking cessation (prolonged abstinence) among adolescent smokers participating in a cessation trial. We also explored the association of extemalizing symptoms with age at smoking initiation. Ninety one adolescents (mean +/- S.D.; age 15.1 +/- 1.4 years, cigarettes per day 18.4 +/- 8.1, Fagerstrom Test for Nicotine Dependence 7.1 +/- 1.3) were included. The Child Behavior Checklist/4-18 and Youth Self-Report assessed the degree of externalizing symptoms. Regression analysis indicated that lower CBCL externalizing scores significantly predicted the likelihood of prolonged abstinence. Pearson's correlation analysis indicated a significant association of lower externalizing scores with later onset of smoking initiation. Our findings highlight the importance of addressing externalizing behaviors in adolescent smoking cessation programs.

Myers MG; Kelly JF. Cigarette smoking among adolescents with alcohol and other drug use problems. Alcohol Research & Health 29(3): 221-227, 2006. (23 refs.)

Cigarette and alcohol use often develop concurrently, and smoking is especially common among youth treated for alcohol and other drug (AOD) use disorders. Special considerations for adolescent smoking cessation treatment include peer influences, motivation, and nicotine dependence. Little research has addressed smoking cessation treatment for youth with AOD use disorders, but the few available studies suggest that tobacco cessation efforts are feasible and potentially effective for this population. Findings to date suggest that adolescents with AOD use disorders may benefit more from relatively intensive multicomponent programs rather than brief treatment for smoking cessation. Additional research is needed to further address the inclusion of tobacco-specific interventions for adolescents in AOD use disorder treatment programs.

Public Domain

Myers MG; MacPherson L; Jones LR; Aarons GA. Measuring adolescent smoking cessation strategies: Instrument development and initial validation. Nicotine & Tobacco Research 9(11): 1131-1138, 2007. (31 refs.)

A majority of adolescent smokers attempt cessation and report intentions to quit, yet little is known regarding the teen cessation process. To advance inquiry into the adolescent smoking cessation process the present report describes the development and initial evaluation of the Ways of Quitting questionnaire (WOQ), a measure designed to assess adolescent smoking cessation strategies. All participants were recruited from four public high schools in metropolitan San Diego, California. Items and questionnaire wording and format were developed based on responses from 36 adolescent participants in six focus groups. The resulting questionnaire included 28 cessation strategies. Descriptive and psychometric analyses were conducted for 88 adolescents who had previously attempted smoking cessation. For each WOQ item, respondents indicated whether they had used a given strategy and, if used, how helpful it was. The most frequently reported cessation methods included avoidance, reduction, and distraction strategies. These, along with social support strategies, received the highest helpfulness ratings. Formal intervention approaches were the least frequently used strategies. Formal methods also were rated as least helpful. Initial validation analyses on a subsample of participants revealed that use of more social support and smoking reduction strategies was significantly associated with length of abstinence following a cessation attempt. The present findings thus provide initial support for the utility and criterion validity of this newly developed measure.

Price JH; Jordan TR; Dake JA. Pediatricians' use of the 5 A's and nicotine replacement therapy with adolescent smokers. Journal of Community Health 32(2): 85-101, 2007. (41 refs.)

The purpose of this study was to examine pediatricians' use of nicotine replacement therapy (NRT) and the 5 A's counseling method with adolescent smokers. Using a mail survey, 203 randomly selected pediatricians (52% response rate) responded to a valid and reliable 37-item questionnaire regarding: perceptions of prescribing NRT, confidence in using NRT, perceived barriers to prescribing NRT, sources of information regarding NRT, and use of the 5 A's counseling method. Forty-four percent of pediatricians did not feel competent in helping adolescents quit smoking cigarettes. Less than a fifth (17%) were currently prescribing NRT. A plurality (48%) perceived NRT to be safe for adolescent use but a majority (53%) rated themselves as not confident in their ability to use NRT. Those who prescribed NRT used transdermal patches (81%), nicotine gum (53%), or bupropion (44%). Pediatricians based their decisions on using NRT on whether: the adolescent showed an openness to quitting (78%), the adolescent requested NRT (72%), and if the adolescent had a health problem exacerbated by smoking (56%). The low level of perceived competence in helping adolescents quit smoking may be due to how few pediatricians identified medical school as a major source of information on helping adolescents stop smoking. Even though ample evidence suggests that NRT is safe to use with adolescents, less than half of the responding pediatricians perceived it to be safe, possibly indicating a desire for a more definitive conclusion on its safety before adopting the products or a lack of awareness of existing studies on this topic.

Price JH; Sidani JE; Price JA. Child and adolescent psychiatrists' practices in assisting their adolescent patients who smoke to quit smoking. Journal of the American Academy of Child and Adolescent Psychiatry 46(1): 60-67, 2007. (40 refs.)

Objective: This national study examined the practices and perceptions of smoking cessation activities among child and adolescent psychiatrists. Method: A random sample of child and adolescent psychiatrists was identified from the membership list of the American Academy of Child and Adolescent Psychiatry and was mailed a valid and reliable 34-item questionnaire. Results: A total of 184 responses (47%) were received. A plurality (48%) of psychiatrists reported being self-taught in smoking cessation techniques. A majority (67%) of psychiatrists were in the maintenance stage for asking about smoking status. However, only 19% consistently made attempts to assess willingness to quit, and 30% consistently gave messages urging the smoker to quit. The perceived number of barriers for addressing smoking was negatively correlated with psychiatrists' levels of confidence (r = -0.35, p < .001) and preparedness (r = -0.39, p < .001) in addressing smoking cessation. Estimations by the psychiatrists of youths who smoked were 61% of those with conduct disorders, 46% of those with schizophrenia, and 40% of those with attention-deficit/hyperactivity disorder. Conclusion: Considering the perceived high rate of patient smoking and the lack of formal training in smoking cessation, more postgraduate education is needed to adequately prepare child and adolescent psychiatrists for addressing tobacco cessation.

Robinson LA; Emmons KM; Moolchan ET; Ostroff JS. Developing smoking cessation programs for chronically ill teens: Lessons learned from research with healthy adolescent smokers. Journal of Pediatric Psychology 33(2): 133-144, 2008. (68 refs.)

Objective: Medically fragile teens who smoke need access to smoking cessation programs, because they are at even higher risk than their healthy peers for smoking-related complications. Methods To date, no studies on the outcome of smoking cessation programs for medically ill teens have been conducted. To suggest directions for future research, we turn to the literature on smoking cessation in the general population of teens and occasionally to the literature on adult smokers. Results Four areas are explored: (a) the prevalence of unaided cessation in healthy teens; (b) the outcomes of various treatments for smoking cessation in healthy adolescents; (c) special issues that should be considered when designing programs for medically ill teens; and (d) lessons learned from previous research. Conclusions: Medically ill teens face a number of medical, emotional, social, and developmental challenges that can affect the quitting process. Research is sorely needed to address the unique needs of this population.

Robinson ML; Schroeder JR; Moolchan ET. Adolescent smokers screened for a nicotine replacement treatment trial: Correlates of eligibility and enrollment. Nicotine & Tobacco Research 8(3): 447-454, 2006. (25 refs.)

The enrollment process determines the study sample and external validity of clinical trial results; however, few reports describe the process and outcome of screening efforts for smoking cessation studies among adolescents. We describe and evaluate a screening protocol to enroll adolescent smokers for a randomized clinical trial of nicotine replacement therapy. Adolescent smokers obtained the recruitment call-in number (1-800-NO-SMOKE) via media and other advertisements. Trained recruitment staff collected information using an internally developed, targeted telephone screening interview, which was used to determine pre-eligibility for the clinical trial. Correlates of qualification and of study enrollment were determined. Among 1,347 adolescents screened, 329 (24.4%) were eligible to participate in the trial. Light smoking (39.1%) and lack of parental support (14.8%) were the biggest contributors to ineligibility. Eligible adolescents were more likely to be female (66.9% vs. 58.2%, p=.0052) and more likely to be European American (63.5% vs. 52.2%, p=.0003). The higher rates of ineligibility for African Americans and boys were partly explained by lower scores on the Fagerstrom Test for Nicotine Dependence. Of those eligible to participate in the trial, 159 (48.3%) enrolled. Results underscore the need for screening instruments that are measurement-invariant across ethnicities and gender, and for enrollment strategies that maximize inclusion of eligible participants.

Roddy E; Romilly N; Challenger A; Lewis S; Britton J. Use of nicotine replacement therapy in socioeconomically deprived young smokers: A community-based pilot randomised controlled trial. Tobacco Control 15(5): 373-376, 2006. (19 refs.)

Background: Smoking is common in young people, particularly in disadvantaged groups, and continued smoking has a major impact on quality and quantity of life. Although many young smokers want to stop smoking, little is known about the design and effectiveness of cessation services for them. Objective: To determine whether nicotine replacement therapy (NRT) when combined with counselling is effective in young smokers in a deprived area of Nottingham, UK Methods and subjects: We surveyed smoking prevalence and attitudes to smoking and quitting in young people accessing an open access youth project in a deprived area of Nottingham, and used the information gained to design a community based smoking cessation service incorporating a randomised controlled trial of nicotine patches against placebo given in association with individual behavioural support. We resurveyed smoking prevalence among project attendees after completing the pilot study. Results: Of 264 young people surveyed (median age 14 years, range 11 - 21), 49% were regular smokers. A total of 98 young people were recruited and randomised to receive either active nicotine patches on a six week reducing dose regimen (49 participants), or placebo (49 participants). Adherence to therapy was low, the median duration being one week, and 63 participants did not attend any follow up. At four weeks, five subjects receiving active NRT and two receiving placebo were abstinent, and at 13 weeks none were. Adverse effects were more common in the active group but none were serious. Smoking prevalence among 246 youth project attendees surveyed after the trial was 44%. Conclusions: This study suggests that NRT in this context is unlikely to be effective in young smokers, not least because of low adherence to therapy. It also suggests that young smokers want help with smoking cessation, but that establishing the efficacy of smoking cessation services for young people who need them most will be very difficult.

Rose JS; Chassin L; Presson C; Sherman SJ; Stein MD; Col N. A latent class typology of young women smokers. Addiction 102(8): 1310-1319, 2007. (53 refs.)

Aims: Despite aggressive anti-smoking campaigns, smoking rates are increasing among young women, suggesting the need for new approaches to reach this population. Segmenting audiences can facilitate targeting interventions to specific populations, based on association of smoking behaviors with other health behaviors and psychological and social antecedents. Using latent class analysis, we sought to profile patterns of behavioral, attitudinal and cognitive variables related to tobacco use among young women. Design: This study is part of an ongoing Midwestern longitudinal self-report survey of the natural history of cigarette smoking. Participants: Participants were 18-25-year-old women smokers (n = 443). Measurements: Variables included a comprehensive range of demographic characteristics, smoking-related variables and general attitudinal variables. Findings Three distinct classes emerged with the following characteristics: (1) working women who tended to smoke daily but reported high levels of positive affect and life satisfaction (n = 212); (2) light-smoking college students who exercised regularly, began smoking after high school and quit successfully at follow-up 5 years later (n = 86); and (3) heavy smokers who were more likely to have children, report high levels of negative affect and smoke for addictive reasons, for stimulation and to control affect (n = 145). Differences in smoking cessation at a 5-year follow-up were significant across the classes (18.1%, 34.4% and 13.0% had quit for at least 6 months, respectively). Conclusions: The psychosocial and behavioral profiles of these classes can potentially be used to tailor smoking interventions more effectively within this population.

Rubinstein ML; Benowitz NL; Auerback GM; Moscicki AB. A randomized trial of nicotine nasal spray in adolescent smokers. Pediatrics 122(3): E595-E600, 2008. (26 refs.)

OBJECTIVES. Nicotine nasal spray has been 1 of the most successful forms of nicotine-replacement therapy in adult populations. The nasal sprayer has not been studied in adolescent smokers. The objective of this pilot study was to determine the feasibility and utility of using nicotine nasal spray for adolescent smokers who wanted to quit smoking. METHODS. Forty adolescent smokers who were between 15 and 18 years of age and smoked >= 5 cigarettes daily for at least 6 months were recruited from several San Francisco Bay area schools from 2005 to 2007. Using a randomized, open-label, 12-week trial, adolescent smokers were assigned to receive either weekly counseling alone (control) for 8 weeks or 8 weeks of counseling along with 6 weeks of nicotine nasal spray. Self-reported smoking abstinence was verified by both expired-air carbon monoxide and salivary cotinine. RESULTS. There was no difference in cessation rates, the numbers of cigarettes smoked per day, or cotinine levels at 12 weeks. Fifty-seven percent of participants stopped using their spray after only 1 week. The most commonly reported adverse effect was nasal irritation and burning (34.8%) followed by complaints about the taste and smell (13%). CONCLUSIONS. The unpleasant adverse effects, poor adherence, and consequent lack of efficacy observed in our pilot study do not support the use of nicotine nasal spray as an adjunct to counseling for adolescent smokers who wish to quit.

Smith AE; Cavallo DA; McFetridge A; Liss T; Krishnan-Sarin S. Preliminary examination of tobacco withdrawal in adolescent smokers during smoking cessation treatment. Nicotine & Tobacco Research 10(7): 1253-1259, 2008. (46 refs.)

Tobacco withdrawal symptoms have been shown to play a significant role in mediating relapse to smoking in adult smokers; however, few prospective studies have examined the course of tobacco withdrawal symptoms over time and their connection to lapse in adolescent smokers. Withdrawal symptoms were assessed weekly for 4 weeks in a sample of adolescent smokers participating in a pilot cessation intervention. Adolescent smokers experienced an exacerbation in overall withdrawal symptoms, particularly of cravings and restlessness, although symptoms were generally mild. The course of symptoms was different for boys and girls: Girls generally experienced a peak and subsequent decline in symptoms early in the establishment of abstinence, whereas boys experienced a constant level of symptoms that did not decline over the 4 weeks. Finally, withdrawal symptoms experienced on quit day were not related to lapse to smoking during the course of treatment for either boys or girls. These results suggest that although withdrawal symptoms may be uncomfortable, they may not be the most salient to a lapse to smoking for adolescent smokers attempting to quit. These findings have direct implications for the design and implementation of treatment of nicotine dependence in adolescent smokers.

Smith DW; Lee JT; Colwell B; Stevens-Manser S. Confirming the structure of the Why Do You Smoke? questionnaire: A community resource for adolescent tobacco cessation. Journal of Drug Education 38(1): 85-95, 2008. (21 refs.)

In response to the problem of adolescent smoking and limited appropriate cessation resources, this study examined the pattern and structure of the American Lung Association, Why Do You Smoke? (WDS) to determine its appropriateness for use in youth smoking cessation programs. The WDS is used to help smokers identify primary motivations for using tobacco and is comprised of eight subscales, each with three items representing primary smoking motivations ("Stimulation," "Handling," "Pleasure," "Crutch," "Psychological," "Habit," "Peer," and "Independence"). Study participants were all rainors enrolled in a tobacco cessation program (n = 251). The pattern and structure of this self-assessment was examined using a correlated multiple group component factor analysis as a confirmatory approach. Findings show that the level of endorsement (as evidenced by subscale means and standard deviations) was relatively large across the eight subscales. Alpha coefficients ranged from .54 to.85. Results also underlined that the pattern coefficient matrix provided support for the hypothesized subscales through an examination of simultaneously extracted confidence intervals. These subscales should be further examined as to their usefulness in cessation interventions, such as the validity of using this instrument by gender, ethnicity, and age. However, from a measurement perspective, the confirmatory analysis provides excellent credence for the continued use of the WDS in cognitive/behavioral intervention programs targeting adolescents.

Solomon LJ; Bunn JY; Pirie PL; Worden JK; Flynn BS. Self-efficacy and outcome expectations for quitting among adolescent smokers. Addictive Behaviors 31(7): 1122-1132, 2006. (15 refs.)

Relatively little is known about smoking cessation self-efficacy and outcome expectations for quitting smoking in adolescent smokers. In this study, we created measures of these two constructs and conducted factor analyses with data from a diverse sample of 1126 adolescent smokers. Results yielded a two-factor solution for the self-efficacy measure, and a four-factor solution for the outcome expectations scale. In a subset of the original sample (n = 515), we re-administered the measures one year later and also examined the longitudinal associations between the baseline sub-scale scores and cigarettes smoked per week at follow-up. Results revealed significant relationships between the negative affect sub-scales of the self-efficacy and outcome expectations measures and weekly smoking level. These associations remained when adjusting for baseline smoking level and other sub-scales. The findings lend support for the possible role of affect regulation in smoking reduction in adolescents.

Stanton W; Baade P; Moffatt J. Predictors of smoking cessation processes among secondary school students. Substance Use & Misuse 41(13): 1683-1694, 2006. (37 refs.)

Many adolescents want to quit and have specific ideas on how they want to go about it. This study extended the search for factors related to different aspects of quitting. Four cross-sectional surveys of Queensland (Australia) secondary schools every three years over the past decade (1993, 1996, 1999, and 2002). A total of 9993 school students in grades 8 to 12 completed the survey. The data for 2451 students who had smoked in the last week (51% female) were used for the analysis of smoking cessation outcomes. The outcome measures for the study represented various smoking cessation outcomes, such as a desire to quit, attempts to quit, quitting for a week or more, and an intention not to be smoking in the following year. More than 60% of adolescent smokers are involved in the process of smoking cessation. The strongest predictor of cessation was whether or not students had actively influenced other students not to smoke. This finding supports the concept of involving adolescents more actively in prompting their peers to try quitting and supporting their efforts to quit smoking.

Steinberg ML; Krejci JA; Collett K; Brandon TH; Ziedonis DM; Chen K. Relationship between self-reported task persistence and history of quitting smoking, plans for quitting smoking, and current smoking status in adolescents. Addictive Behaviors 32(7): 1451-1460, 2007. (31 refs.)

The task persistence construct has previously been measured primarily behaviorally (e.g., with a mirror-tracing task, or breath holding), and only in adults. It has been shown to differentiate between adult smokers and nonsmokers and to predict smoking cessation in adult smokers trying to quit. This theory-based analysis is the first to examine task persistence in adolescent smokers and to examine a two-item, internally consistent, self-report measure of task persistence. Results indicate that task persistence is greater among adolescent non-smokers as compared to adolescent current smokers, and those planning to quit smoking as compared to those with no plans to quit. Contrary to hypotheses, task persistence was not found to be related to prior successful attempts to quit smoking. Our results suggest that a brief, self-report measure of task persistence may be a methodologically sound, practical clinical tool for this population.

Sussman S; Dent CW. Five-year prospective prediction of self-initiated quitting of cigarette smoking of high-risk youth. Addictive Behaviors 32(5): 1094-1098, 2007. (7 refs.)

This paper provides a 5-year replication-extension of a previous 1-year follow-up study of the same sample of southern California alternative high school youth. Demographic, behavioral, psychosocial, and emerging adult function predictors of adolescent self-initiated smoking cessation were investigated. Based on the first (1-year) prospective study and this follow-up, one may speculate that smoking cessation programs for adolescents should include counteraction of problem-prone attitudes, assistance with job aspirations and information about drug-free workplaces, motivation to quit strategies, and assistance with overcoming withdrawal symptoms.

Thorner ED; Jaszyna-Gasior M; Epstein DH; Moolchan ET. Progression to daily smoking: Is there a gender difference among cessation treatment seekers? Substance Use & Misuse 42(5): 829-835, 2007. (17 refs.)

The goal of this study was to develop an understanding the developmental trajectory of smoking behaviors in adolescents who seek smoking cessation treatment to inform tailored prevention and treatment efforts; this includes identifying gender differences in smoking behaviors. Smoking trajectory was examined retrospectively in 639 treatment-seeking adolescents (59% female; 44% African American, 50% European American, mean +/- SD daily cigarettes per day [CPD] 19.16 +/- 7.2 for both girls and boys). Smoking trajectory variables examined included age at first cigarette, age at daily smoking (a proxy measure for onset of dependence), and age at treatment request. The time interval from first cigarette to daily smoking was shorter for girls than for boys (mean +/- SD 0.9 +/- 1.1 years for girls, 1.3 +/- 1.5 years for boys, p < 0.01). From this clinical sample of adolescent smokers, findings suggest only a brief window of opportunity for secondary preventive interventions before the development of tobacco dependence. Additional research is needed to explore the specific factors that differentially affect smoking trajectory in girls compared to boys.

Titus JC; Godley SH; White MK. A post-treatment examination of adolescents' reasons for starting, quitting, and continuing the use of drugs and alcohol. Journal of Child & Adolescent Substance Abuse 16(2): 31-49, 2006. (36 refs.)

Qualitative data from 923 adolescents treated in outpatient and residential settings were used to create taxonomies of their reasons for starting, continuing, and quitting use of drugs and alcohol. Three raters independently categorized reasons by dominant theme. The final sets of taxonomies were defined within several iterations and the raters' use of the categories showed strong inter-rater agreement. Frequencies of reasons were examined overall and by level of care. Adolescents reported initiating use due largely to experimentation and peer influence, continuing use due to liking the effects and assistance with coping, and quitting due to negative appraisals and effects. Reasons differed by level of care.

van Zundert RMP; Engels RCME; Kleinjan M; van den Eijnden RJJM. An integration of parents and best friends smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: A comparison between adolescents with and without asthma. Journal of Pediatric Psychology 33(8): 821-832, 2008. (52 refs.)

Objective: To study the impact of parents and best friends smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma. Methods: Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma. Results Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma. Conclusions: Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Wakefield M; Durrant R. Effects of exposure of youths at risk for smoking to television advertising for nicotine replacement therapy and Zyban (R): An experimental study. Health Communication 19(3): 253-258, 2006. (12 refs.)

Television advertising for nicotine replacement therapy (NRT) and Zyban (R) exposes the entire population, including adolescents, to persuasive messages about these smoking-cessation products. There is a risk that adolescents exposed to the advertising might underestimate addictiveness or perceive an unintended message that it is easy to quit smoking. This is of concern because optimism about quitting is a major predictor of trial and progression to heavier smoking among youths. We randomly allocated 492 youths age 12 to 14 years to one of three viewing conditions in which they viewed either (a) 4 NRT ads, (b) 4 Zyban ads, or (c) 4 ads promoting nonpharmacologic cessation services, such as telephone quitlines. After viewing each ad twice, participants completed a I-page rating form. After all ads had been viewed, youths completed a questionnaire that measured intentions to smoke in the future, perceived addictiveness of smoking, perceived risks and benefits of smoking, and perceived need for pharmaceutical products and services. There were no differences in the composition of groups by age, gender, or smoking uptake. Youths were more likely to agree that the NRT and Zyban ads, compared with the quitline ads, made it seem easy to quit smoking (p < .001). However, there were no systematic differences between groups in perceived addictiveness of smoking, intentions to smoke, or other outcomes. This study suggests that although ads for NRT and Zyban may create "face value" impressions that it is easier to quit, at least in an experimental context in which exposure to ads for telephone quitlines is equal, such appraisals do not undermine more enduring perceptions about smoking. Field research taking into account the relatively high volume of pharmaceutical cessation product advertising is needed.