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CORK Bibliography: Adolescents and Smoking Cesssation

91 citations. January 2009 to present

Prepared: December 2012

Abrantes AM; Lee CS; MacPherson L; Strong DR; Borrelli B; Brown RA. Health risk behaviors in relation to making a smoking quit attempt among adolescents. Journal of Behavioral Medicine 32(2): 142-149, 2009. (37 refs.)

The primary aim of this study was to examine youth risk behaviors in relation to: (a) making a smoking quit attempt, and (b) successful cessation among adolescent smokers. Data were analyzed from the public use dataset of the 2003 national school-based Youth Risk Behavior Survey. The sample consisted of 2,033 students (weighted mean age of 16.3 years, 49.8% female, 73.6% White) who reported a history of daily smoking. While almost two-thirds (63.5%) of adolescent smokers reported making a quit attempt in the last year, only 10% of those were able to successfully quit. Factors associated with making a quit attempt included depression and participating in sports while high-risk sexual activity and engaging in substance use other than alcohol or marijuana were negatively related to making a quit attempt. Externalizing health behaviors (e.g., fighting, drug use, and high risk sexual activity) were associated with decreased likelihood of cessation. Findings from this study may inform efforts to develop more effective smoking prevention and treatment programs for youth.

Adelman WP. Nicotine nasal spray neither effective nor well-tolerated by adolescent smokers. (editorial). Journal of Pediatrics 154(3): 462-463, 2009. (1 refs.)

Agosti V; Levin FR. Does remission from alcohol and drug use disorders increase the likelihood of smoking cessation among nicotine dependent young adults? Social Psychiatry and Psychiatric Epidemiology 44(2): 120-124, 2009. (39 refs.)

Background This article tests the hypothesis that remission from substance use disorders is associated with smoking cessation in nicotine dependent young adults. Design and methods The sample was composed of 976 young adults with lifetime substance use disorders and nicotine dependence who were subjects in the national epidemiologic survey on alcohol abuse and related conditions (NESARC). The Associated Disabilities Interview Schedule-DSM-IV Version was used to assess lifetime and past year psychiatric disorders. Results Past year nicotine cessation was obtained by self-report. Remission from substance use disorders was defined as the past year absence of DSM-IV substance use disorders. This study found that remission from substance use disorders increased the likelihood of smoking abstinence (OR = 1.7). Conclusions Our study found that remission from substance use disorders increased the likelihood of smoking abstinence in early adulthood. This finding is congruent with results from longitudinal studies.

Aubin HJ; Karila L; Reynaud M. Pharmacotherapy for smoking cessation: Present and future. (review). Current Pharmaceutical Design 17(14): 1343-1350, 2011. (123 refs.)

Tobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. To date, three medications are FDA-approved for smoking cessation: nicotine replacement therapy, sustained-release bupropion, and varenicline. These treatments are effective across a broad range of populations, and are recommended for all smokers, including those with psychiatric or addictive comorbidity. Less is known however concerning the benefit-risk profile of these medications in pregnant women and adolescents. With these limitations in mind, clinicians should encourage and offer counseling and a prescription of pharmacotherapy to every patient willing to make a quit attempt. Despite the relative efficacy of first-line medications, many smokers relapse after one given quit attempt, and alternative pharmacotherapies are needed. Clonidine and nortriptyline have been proposed as second-line medications. In addition, this review identifies a series of promising drugs that hopefully will be available to complete our current armory.

Audrain-McGovern J; Stevens S; Murray PJ; Kinsman S; Zuckoff A; Pletcher J et al. The efficacy of motivational interviewing versus brief advice for adolescent smoking behavior change. Pediatrics 128(1): E101-E111, 2011. (50 refs.)

OBJECTIVE: In this study we sought to evaluate the efficacy of motivational interviewing (MI) compared with structured brief advice (SBA) for adolescent smoking behavior change. METHODS: Participants (N = 355) were randomly assigned to 5 sessions of either MI or SBA. The primary outcomes were attempts to reduce and to quit smoking, smoking reduction, and cotinine-validated 7-day point-prevalence smoking abstinence at the end of treatment (week 12) and the 24-week follow-up. RESULTS: White adolescents were similar to 80% less likely to attempt to cut back (odds ratio [OR]: 0.21; confidence interval [CI]: 0.08-0.53) and >80% less likely to attempt to quit smoking compared with black adolescents (OR: 0.17 [CI: 0.06-0.46]). Adolescents who were at least planning to cut back or quit smoking at baseline were almost 3 times more likely to attempt to cut back (OR: 2.87 [CI: 1.26-6.52]) and to attempt to quit smoking (OR: 3.13 [CI: 1.19-8.26]). Adolescents who received MI were similar to 60% less likely than adolescents who received SBA to try to quit smoking (OR: 0.41 [CI: 0.17-0.97]). However, adolescents who received MI showed a greater reduction in cigarettes smoked per day than adolescents who received SBA (5.3 vs 3.3 fewer cigarettes per day). There were no statistically significant differences between MI and SBA in smoking abstinence (5.7% vs 5.6%, respectively). CONCLUSIONS: The effects of MI on adolescent smoking behavior change are modest, and MI may best fit within a multicomponent smoking cessation treatment approach in which behavior change skills can support and promote smoking behavior change decisions.

Bowles H; Maher A; Sage R. Helping teenagers stop smoking: Comparative observations across youth settings in Cardiff. Health Education Journal 68(2): 111-118, 2009. (8 refs.)

Objective: This paper presents comparative observations between schools/colleges, youth centres, and specialist youth provision, in relation to delivery of the 2tuff2puff six-week smoking cessation and awareness programme to young people in Cardiff. Design A six-week smoking cessation programme was delivered to 12-23 year olds in various youth venues, using weekly records of attendance and compulsory questionnaires delivered by the group facilitator at week one and week six. Setting Twenty-two groups were delivered in 14 youth settings across Cardiff. These settings were categorized into three types: schools/colleges; youth centres; and specialist youth provisions. Method Data collected from 179 young people at week one and 84 young people at week six were used to measure changes in weekly smoking behaviour, weekly expenditure on cigarettes, knowledge about smoking and smoking cessation, attitudes toward smoking, motivation to quit/cut down, and attrition. These were compared across the three different setting types. Youth Health Development Officers rated the three setting types on five factors (ease of access/communication with venue; suitability for sessions/acceptability to young people; supportiveness of environment for making a quit attempt; recruitment of young people; and data collection and evaluation) to reflect their practical experiences of delivering the six-week smoking cessation programme across the different youth settings. Results: Schools/colleges and specialist youth provision had the highest levels of attendance, and positive change in attitude toward quitting was greatest in specialist youth settings (79 per cent of attendees were more determined to quit). Conclusion: Overall, when both practical delivery issues and young peoples' outcome measures were considered, specialist youth provisions were the most effective settings for delivery of this programme. Delivery of smoking awareness as part of a wider health curriculum for groups of excluded young people is also recommended.

Branstetter SA; Blosnich J; Dino G; Nolan J; Horn K. Gender differences in cigarette smoking, social correlates and cessation among adolescents. Addictive Behaviors 37(6): 739-742, 2012. (28 refs.)

Background: Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations. Method: The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Association's Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors. Results: Females were more likely to have parents, siblings and romantic partners who smokes, perceive that those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes. Conclusions: Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers.

Branstetter SA; Horn K; Dino G; Zhang JJ. Beyond quitting: Predictors of teen smoking cessation, reduction and acceleration following a school-based intervention. Drug and Alcohol Dependence 99(1-3): 160-168, 2009. (58 refs.)

There remains a great need for effective, cost-efficient, and acceptable youth smoking cessation interventions. Unfortunately, only a few interventions have been demonstrated to increase quit rates among youth smokers, and little is known about how elements of cessation interventions and participants' psychosocial characteristics and smoking histories interact to influence program outcomes. Additionally, few studies have examined how these variables lead to complete smoking abstinence, reduction or acceleration over the course of a structured cessation intervention. Data for the present investigation were drawn from a sample of teen smokers (n = 5892) who voluntarily participated in either a controlled study or field Study (i.e., no control group) of the American Lung Association's Not On Tobacco (N-O-T) program between 1998 and 2006 in five states. Results suggest that those who reduce smoking (but do not achieve full abstinence) are similar to those who quit on most measures except stage of change. Furthermore, it was found that those who increased smoking were heavier smokers at baseline, more addicted, were more likely to have parents. siblings, and significant others who smoked and reported less confidence in and less motivation for quitting than did those who quit or reduced smoking. Finally, a path model demonstrated how peers, siblings and romantic partners affected tobacco use and cessation outcomes differently for males and females, Implications for interventions are discussed.

Bricker JB; Liu JM; Comstock BA; Peterson AV; Kealey KA; Marek PM. Social cognitive mediators of adolescent smoking cessation: Results from a large randomized intervention trial. Psychology of Addictive Behaviors 24(3): 436-445, 2010. (52 refs.)

Only one prior study has examined why adolescent smoking cessation interventions are effective. To address this understudied and important issue, we examined whether a large adolescent smoking cessation intervention trial's outcomes were mediated by social cognitive theory processes. In a randomized trial (N = 2,151), counselors proactively delivered a telephone intervention to senior year high school smokers. Mediators and smoking status were self-reported at 12-months postintervention eligibility (88.8% retention). At least 6-months abstinence was the outcome. Among all enrolled smokers, increased self-efficacy to resist smoking in (a) social and (b) stressful situations together statistically mediated 55.6% of the intervention's effect on smoking cessation (p < .001). Among baseline daily smokers, increased self-efficacy to resist smoking in stressful situations statistically mediated 56.9% of the intervention's effect (p < .001). Self-efficacy to resist smoking is a possible mediator of the intervention's effect on smoking cessation.

Brook JS; Marcus SE; Zhang CS; Stimmel MA; Balka EB; Brook DW. Adolescent attributes and young adult smoking cessation behavior. Substance Use & Misuse 45(13): 2172-2184, 2010. (37 refs.)

This study collected data five times between 1983 and 2002 from 400 participants who originally came from upstate New York. These participants completed structured interviews as did their mothers three times. LISREL analysis generally supported the hypothesized model. The results indicated that having parents who smoked and having low educational aspirations and expectations were associated with being unconventional, which, in turn, was related to having low emotional control and reporting more internalizing behaviors. Internalizing behaviors were directly associated with a lower likelihood of smoking cessation, as was parental smoking. Research and clinical implications are discussed and the limitations noted.

Brown RA; Strong DR; Abrantes AM; Myers MG; Ramsey SE; Kahler CW. Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization. Addictive Behaviors 34(10, Special Issue): 887-891, 2009. (39 refs.)

The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n = 116) or BA (n = 75). All patients were assessed at baseline, immediately after hospitalization, and at 1-. 3-, 6-. 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD = 18.5) to a high of 15.4% (SD = 30.0) substance use days, whereas in BA, substance use days increased from a low of 8.4% (SD = 20.8) to a high of 21.4% (SD = 35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first 6 months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.

Campbell CI; Chi F; Sterling S; Kohn C; Weisner C. Self-initiated tobacco cessation and substance use outcomes among adolescents entering substance use treatment in a managed care organization. Addictive Behaviors 34(2): 171-179, 2009. (38 refs.)

Purpose: Adolescents with substance use (SU) problems have high rates of tobacco use, yet SU treatment has historically ignored treatment for tobacco use. Barriers to such efforts include the belief that tobacco cessation Could compromise other SU abstinence. This study examines Self-initiated tobacco cessation and 12-month alcohol and drug abstinence in adolescents entering SU treatment in a private, managed care organization. Results: Self-initiated tobacco cessation at 6 months, and at both 6 and 12 months, were related to higher odds of drug abstinence but not alcohol abstinence. Conclusion: Self-initiated tobacco cessation was not related to poor SU outcomes, and may be important to maintaining drug abstinence. Implementing tobacco cessation efforts in SU treatment can be challenging, but Comprised SU Outcomes may not be a barrier. The positive associations for drug abstinence and lack of associations for alcohol abstinence could be due to differences in motivation, medical conditions, or to the illicit nature of drug use. Tobacco use has serious long-term health consequences, and tobacco cessation efforts in adolescent SU treatment programs need further research.

Carpenter MJ; Garrett-Mayer E; Vitoc C; Cartmell K; Biggers S; Alberg AJ. Adolescent nondaily smokers: Favorable views of tobacco yet receptive to cessation. Nicotine & Tobacco Research 11(4): 348-355, 2009. (41 refs.)

Favorable views of cigarette use may be a potentiating factor that influences the progression of nicotine dependence among adolescents. Using data from the South Carolina Youth Tobacco Survey (2005-2007), a statewide two-stage cluster sample of students in Grades 6-12 (N = 7,385), we examined attitudes toward smoking and quit behaviors among adolescent smokers across a range of smoking frequencies. Compared with past-30-day nonsmokers, adolescents who smoked 1-2 days in the past month were more likely} to believe that (a) smokers have more friends, (b) smoking looks cool, and (c) it is safe to smoke in the short term and then quit, but less likely to think that (d) tobacco is as addictive as other drugs and (e) smoking few cigarettes per day is harmful. Those who smoked 1-2 days in the past month were similar to more frequent smokers, including those who smoked daily. Similar findings were found for lifetime exposure to smoking. Among those who smoked 1-2 days in the previous month, motivation to quit (54%) and incidence of quit attempts (52% in past year) were slightly higher compared with heavier smokers. Even minimal levels of cigarette use are associated with favorable views of smoking, and adolescents with minimal levels of cigarette use resemble chronic smokers in several key ways. Adolescents at very early stages of cigarette use are at significant risk for chronic use. Tobacco control efforts should capitalize on motivation to quit with focused prevention strategies that arrest the progression from nondaily to daily smoking.

Cavallo DA; Nich C; Schepis TS; Smith AE; Liss TB; McFetridge AK et al. Preliminary examination of adolescent spending in a contingency management-based smoking-cessation program. Journal of Child & Adolescent Substance Abuse 19(4): 335-342, 2010. (14 refs.)

Contingency management (CM) utilizing monetary incentives is efficacious in enhancing abstinence in an adolescent smoking-cessation program, but how adolescents spend their money has not been examined. We assessed spending habits of 38 adolescent smokers in a CM-based smoking-cessation project prior to quitting and during treatment using a questionnaire about spending in a number of categories, including cigarettes, other addictive substances, durable goods, and disposable goods. Our preliminary results indicate that participation in a CM-based program for smoking cessation did not lead to greater spending on cigarettes and other substances and may have produced more socially acceptable spending.

Cengelli S; O'Loughlin J; Lauzon B; Cornuz J. A systematic review of longitudinal population-based studies on the predictors of smoking cessation in adolescent and young adult smokers. (review). Tobacco Control 21(3): 355-362, 2012. (38 refs.)

Objective: To describe the determinants of self-initiated smoking cessation of duration of at least 6 months as identified in longitudinal population-based studies of adolescent and young adult smokers. Methods: A systematic search of the PubMed and EMBASE databases using smoking, tobacco, cessation, quit and stop as keywords was performed. Limits included articles related to humans, in English, published between January 1984 and August 2010, and study population aged 10-29 years. A total of 4502 titles and 871 abstracts were reviewed independently by 2 and 3 reviewers, respectively. Nine articles were retained for data abstraction. Data on study location, timeframe, duration of follow-up, number of data collection points, sample size, age/grade of participants, number of quitters, smoking status at baseline, definition of cessation, covariates and analytic method were abstracted from each article. The number of studies that reported a statistically significant association between each determinant investigated and cessation were tabulated, from among all studies that assessed the determinant. Results: Despite heterogeneity in methods across studies, five factors robustly predicted quitting across studies in which the factor was investigated: not having friends who smoke, not having intentions to smoke in the future, resisting peer pressure to smoke, being older at first use of cigarette and having negative beliefs about smoking. Conclusions: The literature on longitudinal predictors of cessation in adolescent and young adult smokers is not well developed. Cessation interventions for this population will remain less than optimally effective until there is a solid evidence base on which to develop interventions.

Chen PL; Huang WG; Chao KY. Factors associated with Taiwanese junior high school personnel advising students to quit smoking. Journal of School Health 81(2): 91-99, 2011. (35 refs.)

METHODS: School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. RESULTS: Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. CONCLUSIONS: To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel.

Chen XG; Ren YJ; Lin F; MacDonell K; Jiang YF. Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000-08. Evaluation and Program Planning 35(3): 321-328, 2012. (52 refs.)

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control. A national representative sample of youth 12-17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth. More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000-02, to increased quitting and declined initiation in 2003-05, and to initiation, quitting and relapse in 2005-08. Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.

Choi TCK; Toomey TL; Chen V; Forster JL. Awareness and reported consequences of a cigarette tax increase among older adolescents and young adults. American Journal of Health Promotion 25(6): 379-386, 2011. (12 refs.)

Purpose: To determine the prevalence and predictors of the awareness of cigarette price increases following a cigarette tax increase, and assess the association of the tax increase and attempts to quit and reduce smoking among adolescents and young adults. Design: We used a prospective cohort design. Setting: Surveys were conducted in Minnesota before and after a $0.75 cigarette tax increase. Subjects: We surveyed 3167 adolescents and young adults, including a subsample of 781 past-30-day smokers. Measures: Outcome measures were awareness of cigarette price increases and, among past-30-day smokers, reported changes in smoking behaviors because of the tax increase. Predictors included demographics, social factors, and prior smoking behaviors. Analysis: We estimated the prevalence of the outcomes and their associations with the predictors using logistic regression. Results: Among all participants, 42% noticed an increase in cigarette prices after the tax increase, including 76% of past-30-day smokers. Being a heavier smoker, living with smokers, having more smoking close friends, and generally being aware of cigarette price changes prospectively predicted the awareness of the price increase after the tax increase. Among past-30-day smokers, 16.7% reported quit attempts and 24.1% reported reducing smoking because of the tax increase. Conclusion: Because fewer than half of the participants noticed the cigarette tax increase, media campaigns to raise awareness of tax changes may increase their effectiveness.

Chung T; Maisto SA; Mihalo A; Martin CS; Cornelius JR; Clark DB. Brief assessment of readiness to change tobacco use in treated youth. Journal of Substance Abuse Treatment 41(2): 137-147, 2011. (43 refs.)

This study examined the concurrent and predictive validity of four brief measures of readiness to change tobacco use for use with adolescents in clinical practice (Readiness Ruler, Thoughts About Abstinence, motivation to abstain, and confidence to abstain) and a single-item measure of difficulty to abstain. Participants were 154 adolescent smokers recruited from outpatient addictions treatment, who completed assessments shortly after admission and at 6- and 12-month follow-up. Concurrent validity analyses indicated that the four readiness measures were moderately correlated at each time point. Predictive validity analyses indicated that the Ruler and the motivation to abstain ratings predicted number of cigarettes smoked at 6 and 12 months. Perceived difficulty to abstain predicted cigarette use over and above the readiness to change measures. Results:support the clinical utility of the Ruler and motivation to abstain as brief measures of readiness to change, and perceived difficulty to abstain as a tool to aid adolescent tobacco cessation.

Colby SM; Nargiso J; Tevyaw TO; Barnett NP; Metrik J; Lewander W et al. Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: Results from a randomized clinical trial. Addictive Behaviors 37(7): 817-823, 2012. (44 refs.)

Background: Motivational interviewing (MI) is widely used for adolescent smoking cessation but empirical support for this approach is mixed. Methods: Adolescent cigarette smokers 14-18 years old (N = 162) were recruited from medical, school, and community settings and randomly assigned to enhanced MI or brief advice (BA) for smoking cessation. MI comprised an in-person individual session, a telephone booster session one week later, and a brief telephone-based parent intervention. BA consisted of standardized brief advice to quit smoking. Assessments occurred at baseline, post-treatment and at 1-, 3-, and 6-month follow ups. Results: Biochemically-confirmed 7-day point prevalence abstinence rates were low (e.g., 4.5% for MI; 1.4% for BA at 1 month) and did not differ significantly by group at any follow up. Only those in MI reported significant decreases in cigarettes smoked per day (CPD) from baseline to 1 month. At 3 and 6 months, smokers in both groups reported significantly reduced CPD with no differences between groups. MI reduced perceived norms regarding peer and adult smoking rates, while BA had no effect on normative perceptions. No group differences emerged for self-reported motivation or self-efficacy to quit smoking. Conclusions: Findings support the efficacy of MI for addressing normative misperceptions regarding peer and adult smoking and for modestly reducing CPD in the short-term; however, these effects did not translate to greater smoking abstinence. MI may have more promise as a prelude to more intensive smoking intervention with adolescents than as a stand-alone intervention.

Cole J; Stevenson E; Walker R; Logan TK. Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment. Journal of Substance Abuse Treatment 43(1): 20-29, 2012. (82 refs.)

Adolescents in substance abuse treatment have approximately four times higher rates of tobacco use compared with adolescents in the general population, yet many substance abuse treatment programs do not provide tobacco cessation interventions. This study examined change in tobacco use among 151 adolescents in state-funded substance abuse treatment from intake to 12-month follow-up in relation to psychiatric comorbidity and substance use. Most adolescents (67.5%) used tobacco at intake and follow-up. Having a diagnosis of a mood, anxiety, or behavioral disorder was significantly associated with change in tobacco use. Individuals with a psychiatric disorder were less likely to be nonusers of tobacco than to be individuals who continued tobacco use (adjusted odds ratio [OR] = 0.153, 95% confidence interval [Cl] = 0.040-0.587, p < .01), and they were less likely to have initiated tobacco use at follow-up than individuals who continued tobacco use (adjusted OR = 0.320, 95% Cl = 0.105-0.970, p < .05). Contrary to the hypothesis, alcohol use and drug use during the 12-month follow-up was not significantly related to-change in tobacco use. Adolescents in substance abuse treatment with comorbid psychiatric disorders may be particularly vulnerable to continuing tobacco use.

Curry SJ; Mermelstein RJ; Sporer AK. Therapy for specific problems: Youth tobacco cessation. (review). Annual Review of Psychology 60: 229-255, 2009. (155 refs.)

Cigarette smoking is the leading cause of premature morbidity and mortality in the United States. The majority of children smoke their first cigarette in early adolescence, and many older teens have well-established dependence on nicotine. Efforts to promote and support smoking cessation among these youth smokers are critical. The available experimental studies of youth cessation interventions find that behavioral interventions increase the chances of youth smokers achieving successful cessation. Currently there is insufficient evidence for the effectiveness of pharmacological treatments with youth smokers. Many innovative studies have been compromised by challenges in recruiting sufficient numbers of youth, obtaining approval for waivers of parental consent, and high attrition in longitudinal studies. Key areas for future work include bridging the fields of adolescent development and treatment design, matching treatments to developmental trajectories of smoking behavior, better understanding treatment processes and treatment moderators, and building demand for evidence-based cessation treatments.

Curry SJ; Mermelstein RJ; Sporer AK; Emery SL; Berbaum ML; Campbell RT et al. A national evaluation of community-based youth cessation programs: Design and implementation. Evaluation Review 34(6): 487-512, 2010. (20 refs.)

Although widely available, little is known about the effectiveness of youth cessation treatments delivered in real-world settings. The authors recruited a nonprobability sample of 41 community-based group-format programs that treated at least 15 youth per year and included evidence-based treatment components. Data collection included longitudinal surveys of youth participants (n = 878); posttreatment surveys of program leaders (n = 77); and one-time surveys of organizational leaders (n = 64)and community leaders in education, health, and juvenile justice (n = 94). Information about smoking-related ordinances was collected at the state and local levels. The framework, evaluation design, and implementation strategies described in this article provide a template for large-scale real-world program evaluations.

Dalum P; Paludan-Muller G; Engholm G; Kok G. A cluster randomised controlled trial of an adolescent smoking cessation intervention: Short and long-term effects. Scandinavian Journal of Public Health 40(2): 167-176, 2012. (20 refs.)

Background: There is a lack of effective smoking cessation interventions which have a high reach among adolescent smokers. Method: We conducted a randomised controlled trial of an adolescent smoking cessation intervention for students aged 15-21 at 22 continuation schools in Denmark. The intervention was a minimal intervention based on events with short counselling and a range of self-help materials. Our 1-month follow up consisted of 514 baseline daily smokers and the 14-month follow up of 369 daily smokers. Results: We found positive short-term effects regarding smoking cessation (adjusted OR 4.50, 95% CI 1.20-16.86), self-efficacy (p=0.01), and intentions to quit (p=0.004). However, none of these effects were maintained at 1-year follow up. The intervention was successful in reaching more than half of all daily smokers in the target group with more than 30% receiving counselling at least once in the intervention period. Conclusions: This trial shows that a "minimal" intervention can produce short-term effects but that this approach is insufficient in producing long-term effects.

Dalum P; Schaalma H; Kok G. The development of an adolescent smoking cessation intervention: An intervention mapping approach to planning. Health Education Research 27(1): 172-181, 2012. (34 refs.)

The objective of this project was to develop a theory- and evidence-based adolescent smoking cessation intervention using both new and existing materials. We used the Intervention Mapping framework for planning health promotion programmes. Based on a needs assessment, we identified important and changeable determinants of cessation behaviour, specified change objectives for the intervention programme, selected theoretical change methods for accomplishing intervention objectives and finally operationalized change methods into practical intervention strategies. We found that guided practice, modelling, self-monitoring, coping planning, consciousness raising, dramatic relief and decisional balance were suitable methods for adolescent smoking cessation. We selected behavioural journalism, guided practice and Motivational Interviewing as strategies in our intervention. Intervention Mapping helped us to develop as systematic adolescent smoking cessation intervention with a clear link between behavioural goals, theoretical methods, practical strategies and materials and with a strong focus on implementation and recruitment. This paper does not present evaluation data.

de Moor JS; Puleo E; Ford JS; Greenberg M; Hodgson DC; Tyc VL et al. Disseminating a smoking cessation intervention to childhood and young adult cancer survivors: Baseline characteristics and study design of the partnership for health-2 study. BMC Cancer 11(e-article 165), 2011. (40 refs.)

Background: Partnership for Health-2 (PFH-2) is a web-based version of Partnership for Health, an evidence-based smoking cessation intervention for childhood cancer survivors. This paper describes the PFH-2 intervention and baseline data collection. Methods: 374 childhood and young adult cancer survivors were recruited from five cancer centers and participated in the baseline assessment. At baseline, participants completed measures of their smoking behavior, self-efficacy and stage of change for quitting smoking as well as psychological and environmental factors that could impact their smoking behavior. Results: At baseline, 93% of survivors smoked in the past seven days; however, 89% smoked a pack or less during this period. Forty-seven percent were nicotine dependent, and 55% had made at least one quit attempt in the previous year. Twenty-two percent of survivors were in contemplation for quitting smoking; of those 45% were somewhat or very confident that they could quit within six months. Sixty-three percent were in preparation for quitting smoking; however, they had relatively low levels of confidence that they could quit smoking in the next month. In multivariate analyses, stage of change, self-efficacy, social support for smoking cessation, smoking policy at work and home, fear of cancer recurrence, perceived vulnerability, depression, BMI, and contact with the healthcare system were associated with survivors' smoking behavior. Discussions/Conclusions: A large proportion of the sample was nicotine dependent, yet motivated to quit. Individual- interpersonal- and environmental-level factors were associated with survivors' smoking behavior. Smoking is particularly dangerous for childhood and young adult cancer survivors. This population may benefit from a smoking cessation intervention designed to build self-efficacy and address other known predictors of smoking behavior.

Emery S; Lee J; Curry SJ; Johnson T; Sporer AK; Mermelstein R; Flay B; Warnecke R. Finding needles in a haystack: A methodology for identifying and sampling community-based youth smoking cessation programs. Evaluation Review 34(1): 35-51, 2010. (9 refs.)

Background: Surveys of community-based programs are difficult to conduct when there is virtually no information about the number or locations of the programs of interest. This article describes the methodology used by the Helping Young Smokers Quit (HYSQ) initiative to identify and profile community-based youth smoking cessation programs in the absence of a defined sample frame. Methods: We developed a two-stage sampling design, with counties as the first-stage probability sampling units. The second stage used snowball sampling to saturation, to identify individuals who administered youth smoking cessation programs across three economic sectors in each county. Multivariate analyses modeled the relationship between program screening, eligibility, and response rates and economic sector and stratification criteria. Cumulative logit models analyzed the relationship between the number of contacts in a county and the number of programs screened, eligible, or profiled in a county. Results: The snowball process yielded 9,983 unique and traceable contacts. Urban and high-income counties yielded significantly more screened program administrators; urban counties produced significantly more eligible programs, but there was no significant association between the county characteristics and program response rate. There is a positive relationship between the number of informants initially located and the number of programs screened, eligible, and profiled in a county. Discussion: Our strategy to identify youth tobacco cessation programs could be used to create a sample frame for other nonprofit organizations that are difficult to identify due to a lack of existing directories, lists, or other traditional sample frames.

Engels RCME; Van Zundert RMP; Kleinjan M. Smoking cessation-specific parenting and parental smoking as precursors of adolescent smoking cognitions and quitting. Addictive Behaviors 37(7): 831-837, 2012. (63 refs.)

Relatively little is known about if and through which mechanisms parents influence adolescents' smoking cessation. The present study used Social Cognitive Theory as a theoretical framework to test whether parental smoking and smoking cessation-specific parenting (SCSP) predicted readiness to quit smoking and actual smoking cessation one year later. Both direct paths between parent factors and outcomes, and indirect paths via adolescents' smoking-specific cognitions (pros of smoking and quitting, and self-efficacy) were examined in a sample of 530 adolescents in the ages of 13 to 18 who smoked daily and weekly at baseline. The main findings show that although parental smoking and SCSP were significantly associated with cognitions (cross-sectionally), neither the parent factors nor cognitions predicted readiness to quit smoking or actual cessation one year later. Baseline SCSP did predict readiness to quit one year later. Parents may be more influential in shaping adolescents' beliefs and readiness to quit than in facilitating actual cessation.

Evans WD; Uhrig J; Davis K; McCormack L. Efficacy methods to evaluate health communication and marketing campaigns. Journal of Health Communication 14(4): 315-330, 2009. (53 refs.)

Communication and marketing are growing areas of health research, but relatively few rigorous efficacy studies have been conducted in these fields. In this article, we review recent health communication and marketing efficacy research, present two case studies that illustrate some of the considerations in making efficacy design choices, and advocate for greater emphasis on rigorous health communication and marketing efficacy research and the development of a research agenda. Much of the outcomes research in health communication and marketing, especially mass media, utilizes effectiveness designs conducted in real time, in the media markets or communities in which messages are delivered. Such evaluations may be impractical or impossible, however, imiting opportunities to advance the state of health communication and marketing research and the knowledge base on effective campaign strategies, messages, and channels. Efficacy and effectiveness studies use similar measures of behavior change. Efficacy studies, however, offer greater opportunities for experimental control, message exposure, and testing of health communication and marketing theory. By examining the literature and two in-depth case studies, we identify advantages and limitations to efficacy studies. We also identify considerations for when to adopt efficacy and effectiveness methods, alone or in combination. Finally, we outline a research agenda to investigate issues of internal and external validity, mode of message presentation, differences between marketing and message strategies, and behavioral outcomes.

Fortuna LR; Porche MV; Alam N; Douglass KM; Kim SS. Smoking and co-occurring disorders: Implications for smoking cessation interventions for adolescents in residential addiction treatment. Journal of Dual Diagnosis 8(2, special issue): 133-139, 2012. (28 refs.)

Objective: Co-occurring disorders are important to consider in planning smoking cessation interventions with adolescents. We identify factors associated with smoking and predictors for smoking cessation readiness in a group of adolescents in a residential addiction treatment program. Methods: We conducted a chart review study of 400 clinical records of adolescents aged 13 to 18 at a short-term residential addiction treatment program. We examined the relationships of smoking with use of other drugs, psychiatric disorders, and adverse events. Results: The rate of smoking in the total sample was 79%. Smoking onset was positively associated with the onset of alcohol and other drugs of abuse but followed the onset of cannabis use for over half the sample. Heavy smoking, defined as smoking 10 cigarettes per day on average, was correlated with cocaine and opiate addiction. Over half of the sample (56%) was precontemplative about smoking cessation, whereas 30% were in the contemplative stage (ready to stop in 6 months); 12% were in preparation stage (ready to stop in 30 days); and 2% reported that they already had stopped. Heavy smoking was associated with being precontemplative as was earlier onset of drinking relative to smoking and bipolar diagnosis. Conclusions: Smoking is common in adolescents seeking drug and alcohol treatment and is correlated with the onset and progression of other drug use. Increasing motivation for change and addressing the interface of nicotine, other drugs, and mental health are important for smoking cessation interventions for adolescents in residential addiction treatment settings.

Go MH; Green HD; Kennedy DP; Pollard M; Tucker JS. Peer influence and selection effects on adolescent smoking. Drug and Alcohol Dependence 109(1-3): 239-242, 2010. (18 refs.)

Background: Studies showing that adolescents are more likely to smoke if they have friends who smoke typically infer that this is the result of peer influence. However, it may also be due to adolescents choosing friends who have smoking behaviors similar to their own (i.e., selection). One of the most influential studies of influence and selection effects on smoking concluded that these processes contribute about equally to peer group homogeneity in adolescent smoking (Ennett and Bauman, 1994). The goal of this study was to conduct a partial replication of these findings. Methods: Data are from 1223 participants in the National Longitudinal Study of Adolescent Health. Spectral decomposition techniques identified friendship cliques, which were then used as the unit of analysis to examine influence and selection effects over a one-year period. Results: Non-smokers were more likely to become smokers if they initially belonged to a smoking (vs. non-smoking) group, and smokers were more likely to become non-smokers if they initially belonged to a non-smoking (vs. smoking) group, indicating an influence effect on both initiation and cessation. Further, group members who changed groups between waves were more likely to select groups with smoking behavior congruent to their own, providing evidence of a selection effect. Conclusions: While our results generally replicate the group analyses reported by Ennett and Bauman (1994), they suggest that peer influence and selection effects on adolescent smoking may be much weaker than assumed based on this earlier research.

Gray KM; Carpenter MJ; Baker NL; Hartwell KJ; Lewis AL; Hiott DW et al. Bupropion SR and contingency management for adolescent smoking cessation. Journal of Substance Abuse Treatment 40(1): 77-86, 2011. (46 refs.)

There is a significant need for evidence-based treatments for adolescent smoking cessation. Prior research, although limited, has suggested potential roles for bupropion sustained-release (SR) and contingency management (CM), but no previous studies have assessed their combined effect. In a double-blind, placebo-controlled design, 134 adolescent smokers were randomized to receive a 6-week course of bupropion SR + CM, bupropion SR + non-CM, placebo + CM, or placebo + non-CM, with final follow-up at 12 weeks. The primary outcome was 7-day cotinine-verified point prevalence abstinence, allowing for a 2-week grace period. Combined bupropion SR + CM treatment yielded significantly superior abstinence rates during active treatment when compared with placebo + non-CM treatment. In addition, combined treatment showed greater efficacy at multiple time points than did either bupropion SR + non-CM or placebo + CM treatment. Combined bupropion SR and CM appears efficacious, at least in the short-term, for adolescent smoking cessation and may be superior to either intervention alone.

Guo B; Aveyard P; Fielding A; Sutton S. The factor structure and factorial invariance for the decisional balance scale for adolescent smoking. International Journal of Behavioral Medicine 16(2): 158-163, 2009. (23 refs.)

The transtheoretical model is a framework to explain smoking uptake and cessation in adolescence. Decisional balance is proposed as a driver of stage movement. The purpose of this study was to examine the factor structure and measurement equivalence/invariance (ME/I) of the decisional balance scale. In this study, we used confirmatory factor analysis followed by measurement equivalence/invariance testing to examine the factorial validity of the decisional balance scale in adolescent smokers and nonsmokers. Unlike previous studies, we found that a four-factor solution splitting cons into esthetic and health cons significantly improved the fit of model to the data. ME/I testing showed that the same structure and measurement model held for both smokers and nonsmokers, girls and boys, and across the three occasions the scale was administered. Cons showed strong evidence that it constituted two separate first order factors. Decisional balance for smoking in adolescence has good evidence of factorial validity.

Guo Q; Unger JB; Azen SP; Li CY; Spruijt-Metz D; Palmer PH; Chou CP et al. Cognitive attributions for smoking among adolescents in China. Addictive Behaviors 35(2): 95-101, 2010. (46 refs.)

To design more effective health communication messages for smoking cessation and prevention. it is important to understand people's own perceptions of the factors that influence their decisions to smoke. Studies have examined cognitive attributions for smoking in Western countries but not in the Chinese cultural context. In a study of 14,434 Chinese adolescents, exploratory factor analysis grouped 17 cognitive attributions into 8 factors: curiosity, coping, social image, social belonging, engagement, autonomy, mental enhancement, and weight control. The factors were ranked based on the participants' self-reports of importance and by the strength of their associations with smoking behavior. Among all smokers, curiosity was the most frequently-ranked attribution factor at the early stages of smoking but not for daily smoking. Coping was highly-ranked across smoking stages. Social image and social belonging were more highly-ranked at earlier stages, whereas engagement and mental enhancement were ranked more highly at later stages of smoking. More attributions were associated with smoking among males than among females. This information could be useful for the development of evidence-based anti-smoking programs in China.

Harakeh Z; Engels R; Blokland ED; Scholte R; Vermulst A. Parental communication appears not to be an effective strategy to reduce smoking in a sample of Dutch adolescents. Psychology & Health 24(7): 823-841, 2009. (33 refs.)

This longitudinal study examined the reciprocal effects of the frequency of parent-adolescent communication on tobacco-related issues (smoking-specific communication), and adolescents' smoking. Participants were 428 Dutch older and younger siblings between 13 and 16 years old. Smoking-specific communication did not affect youth smoking in general; however, among younger, but not older, siblings, smoking-specific communication was associated with a higher likelihood of smoking over time. In addition, when adolescents already smoked parents started to talk more frequently about smoking-related issues with their older and younger adolescents later on. Neither the quality of smoking-specific communication, the quality of parent-adolescent relationship, nor parental smoking moderated these reciprocal effects. In conclusion, prevention campaigns encouraging parents to undertake smoking-specific communication might not be desirable.

Haug S; Meyer C; Dymalski A; Lippke S; John U. Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial. BMC Public Health 12: article 51, 2012. (25 refs.)

Background: Particularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem. There is limited evidence of effective smoking cessation interventions in this group. Individualised text messaging (SMS) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit. The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices. Methods/Design: A two-arm cluster-randomised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation in adolescents and young adults compared to an assessment only control group. A total of 910 daily or occasional (>= 4 cigarettes in the preceding month and >= 1 cigarette in the preceding week) smoking apprentices will be proactively recruited in vocational school classes and, using school class as a randomisation unit, randomly assigned to an intervention group (n = 455) receiving the SMS based intervention or an assessment only control group (n = 455). Individualised text messages taking into account demographic data and the individuals' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months. Participants will receive two text messages promoting smoking cessation per week. Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse. The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up. The research assistants conducting the baseline and the follow-up assessments will be blinded regarding group assignment. Discussion: It is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit.

Heikkinen AM; Broms U; Pitkaniemi J; Koskenvuo M; Meurman J. Key factors in smoking cessation intervention among 15-16-year-olds. Behavioral Medicine 35(3): 93-99, 2009. (52 refs.)

The authors aimed to investigate factors associated with smoking cessation among adolescents after tobacco intervention. They examined smokers (n = 127), from one birth cohort (n = 545) in the city of Kotka in Finland. These smokers were randomized in 3 intervention groups the dentist (n = 44) and the school nurse (n = 42 groups), and a control group (n = 39). After 2 months, the authors sent a follow-up questionnaire to the initial smokers to find out who had quit. The authors found that those whose best friend was a nonsmoker were more likely to stop smoking (relative risk RR 7.0 95% Cl 4.6-10.7). Moreover, the nicotine-dependent participants (measured according to the Fagerstrom Test for Nicotine Dependence(36)) were less likely to stop (RR 0.1 95% Cl 0.08-0.11) compared to non-nicotine dependent participants. Last, of the diurnal types, the morning types found it easier to quit smoking than the evening types (RR 2.2 95% Cl 1.4-3.6). Thus, the authors concluded that the best friend's influence, nicotine dependence, and diurnal type could be taken more into account in individual counseling on smoking cessation.

Herzog T; Komarla R. How distinct are the stages of change for smoking cessation? A comparison of the stages of change and the contemplation ladder using an adolescent sample. Journal of Drug Issues 41(2): 419-438, 2011. (28 refs.)

The stage of change approach to smoking cessation posits that smokers can be divided into categories based on the extent to which they are motivated to quit smoking. Recent research, however, suggests that the stage of change algorithm systematically misclassifies smokers by underestimating motivation to quit. The hypothesis of the current study was that the systematic misclassification by the stages of change results in stages that blend together smokers varying widely in motivation to quit. We tested this hypothesis by contrasting the stages of change with the contemplation ladder (an alternative measure of motivation to quit smoking) using cross-sectional data on ten cessation-relevant variables. The sample consisted of 401 adolescent smokers. The results were consistent with the hypothesis. The cross-sectional analyses indicated that the contemplation ladder is a more discriminating measure of motivation to quit, and that the stage of change algorithm is an unnecessarily imprecise instrument.

Horn K; Dino G; Branstetter SA; Zhang JJ; Noerachmanto N; Jarrett T et al. Effects of physical activity on teen smoking cessation. Pediatrics 128(4): E801-E811, 2011. (51 refs.)

OBJECTIVE: To understand the influence of physical activity on teen smoking-cessation outcomes. METHODS: Teens (N = 233; 14-19 years of age) from West Virginia high schools who smoked >1 cigarette in the previous 30 days were included. High schools with >300 students were selected randomly and assigned to brief intervention (BI), Not on Tobacco (N-O-T) (a proven teen cessation program), or N-O-T plus a physical activity module (N-O-T + FIT). Quit rates were determined 3 and 6 months after baseline by using self-classified and 7-day point prevalence quit rates, and carbon monoxide validation was obtained at the 3-month follow-up evaluation. RESULTS: Trends for observed and imputed self-classified and 7-day point prevalence rates indicated that teens in the N-O-T + FIT group had significantly higher cessation rates compared with those in the N-O-T and BI groups. Effect sizes were large. Overall, girls quit more successfully with N-O-T compared with BI (relative risk [RR]: >infinity) 3 months after baseline, and boys responded better to N-O-T + FIT than to BI (RR: 2-3) or to N-O-T (RR: 1-2). Youths in the N-O-T + FIT group, compared with those in the N-O-T group, had greater likelihood of cessation (RR: 1.48) at 6 months. The control group included an unusually large proportion of participants in the precontemplation stage at enrollment, but there were no significant differences in outcomes between BI and N-O-T (z = 0.94; P = .17) or N-O-T + FIT (z = 1.12; P = .13) participants in the precontemplation stage. CONCLUSIONS: Adding physical activity to N-O-T may enhance cessation success, particularly among boys.

Horn K; Noerachmanto N; Dino G; Manzo K; Brayboy M. Who wants to quit? Characteristics of American Indian youth who seek smoking cessation intervention. Journal of Community Health 34(2): 153-163, 2009. (41 refs.)

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1-6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.

Houser-Marko L; Curry SJ; Mermelstein RJ; Emery S; Pugach O. A comparison of mandated versus volunteer adolescent participants in youth tobacco cessation programs. Addictive Behaviors 36(9): 937-940, 2011. (14 refs.)

A national evaluation of community-based youth cessation programs delivered in group format provided the opportunity to compare mandated and volunteer program participants on demographics, smoking patterns, other health behaviors and motivation to quit. A total of 857 youth participants completed surveys prior to the start of their treatment program. Mandated youth comprised 24% of the sample (n = 202). Both bivariate and multivariate comparisons were conducted. Mandated participants reported lower levels of stress, higher extrinsic motivation and lower intrinsic motivation to quit, and were more likely to be in the earlier (precontemplation) stage of readiness to quit. Mandated and volunteer smokers did not differ in their smoking patterns, school-related smoking behaviors, or binge drinking. Rates of smoking, school problems, and binge drinking were higher among cessation program participants than in general samples of youth. Programs with mixed voluntaty-mandatory participation may benefit from extra attention to motivational issues.

Hum AM; Robinson LA; Jackson AA; Ali KS. Physician communication regarding smoking and adolescent tobacco use. Pediatrics 127(6): E1368-E1374, 2011. (27 refs.)

BACKGROUND: Physician advice increases quit rates 1% to 3% above unassisted quit rates among adults, an increase sufficient to be ranked as a high-priority, evidence-based preventive service. However, there is little research on the potential impact of physician advice on adolescent smoking. OBJECTIVE: The purpose of this study was to examine the association between recalled physician communication and adolescents' attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. METHODS: This study was a retrospective observational study of 5154 students (82.9% black, 17.1% white) from an urban, mid-South school system. Outcome variables included adolescents' self-rated attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. RESULTS: Physician advice and the combination of screening and advice were associated with healthier attitudes about smoking. Physician screening and advice were also associated with a more accurate knowledge regarding tobacco-related damage. Among current smokers, recalled physician advice was also associated with reduced intentions to smoke in 5 years. Importantly, advised teens were more likely to plan to quit smoking in 6 months. Furthermore, teens who were screened by their physician reported significantly more quit attempts than those who were neither screened nor advised (P = .007). CONCLUSIONS: Physician's tobacco-related interactions with adolescents seemed to positively impact their attitudes, knowledge, intentions to smoke, and quitting behaviors. Brief physician interventions have the potential to be a key intervention on a public health level through the prevention, cessation, and reduction of smoking and smoking-related disease.

Jarrett T; Horn K; Zhang JJ. Teen perceptions of facilitator characteristics in a school-based smoking cessation program. Journal of School Health 79(7): 297-303, 2009. (27 refs.)

Facilitators are often responsible for the implementation of public health programs, yet little is known about how they influence outcomes. Not-On-Tobacco (N-O-T) is a youth smoking-cessation program implemented by trained facilitators. The purpose of this study was to investigate teens' perceptions of facilitator characteristics and the relationship between those perceptions and program outcomes. Data were collected from N-O-T participants aged 14 to 19 who completed a survey about perceptions of facilitator characteristics that were linked to program outcomes 3 months post-baseline (n = 769). Eight facilitator characteristics were ordered, based on importance to participants. Chi-square tests measured differences in perceptions of facilitator characteristics according to race and sex, and an aggregate facilitator favorability score was created and analyzed in relation to program outcomes (smoking reduction or cessation vs increase/no change). Logistic regression was used to analyze facilitator characteristics' relationship to outcomes, controlling for race and sex. Participants rated facilitator characteristics of trustworthy, cares about students, and confidential as most important. Girls consistently ranked facilitator characteristics as more important than did boys. There were few significant differences based on race, except that white students rated nonjudgmental to be more important than did nonwhite students. There were no significant findings from the logistic regression, but there was a significant relationship between the aggregate facilitator favorability score and favorable changes in smoking outcomes (reduction or cessation). This study provides insights into the facilitator characteristics that are important to teen participants. It demonstrates that teens' overall perceptions of facilitators contribute to their perception of how the program contributes to their success and program outcomes.

Joffe A; McNeely C; Colantuoni E; An MW; Wang WW; Scharfstein D. Evaluation of school-based smoking-cessation interventions for self-described adolescent smokers. Pediatrics 124(2): E187-E194, 2009. (21 refs.)

OBJECTIVE: The goal was to compare the efficacy of school-based, multisession, group smoking-cessation interventions versus a single group session in increasing quit rates among adolescent smokers. METHODS: Eight schools were assigned randomly to use 1 of 2 group smoking-cessation programs previously shown to increase quit rates among adolescents (Not on Tobacco [NOT] or Kickin' Butts). We reformatted the programs to twice-weekly 25- to 30-minute sessions delivered during lunch periods. Smoking status was assessed at end of program (EOP) and 1, 3, 6, and 12 months later. Self-reported quit status was confirmed with salivary cotinine levels. RESULTS: A total of 407 students (56% black and 52% female; mean age: 16 years) participated. Kickin' Butts participants were no more likely to quit than control subjects. In the conservative analysis (students with missing follow-up data classified as smokers), NOT participants were 1.92 times (95% confidence interval [CI]: 1.09-3.40 times) more likely to self-report quitting at 1 month. In the Bayesian analysis ( missing follow-up data imputed by using all available data), NOT participants were significantly more likely than control subjects to self-report quitting at EOP (relative risk [RR]: 1.26 [95% CI: 1.10-1.43]), 1 month (RR: 2.07 [95% CI: 1.68-2.56]), and 12 months (RR: 1.58 [95% CI: 1.22- 2.04]). Cotinine-confirmed quit rates were significantly greater among NOT participants, compared with control subjects, at EOP and 1 month. CONCLUSIONS: The reformatted NOT program had a modest effect on adolescents interested in quitting. Kickin' Butts, as reformatted for this project, did not have any effect on quit rates.

Johnson JL; Eaton DK; Pederson LL; Lowry R. Associations of trying to lose weight, weight control behaviors, and current cigarette use among US high school students. Journal of School Health 79(8): 355-360, 2009. (22 refs.)

BACKGROUND: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States. METHODS: Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2). RESULTS: In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not. CONCLUSION: Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Kalkhuis-Beam S; Stevens SL; Baumritter A; Carlson EC; Pletcher JR; Rodriguez D et al. Participant- and study-related characteristics predicting treatment completion and study retention in an adolescent smoking cessation trial. Journal of Adolescent Health 49(4): 371-378, 2011. (38 refs.)

Purpose: To determine which factors predict smoking cessation treatment completion and retention among adolescents. Methods: In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14-18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention. Results: In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention. Conclusions: High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.

Kealey KA; Ludman EJ; Marek PM; Mann SL; Bricker JB; Peterson AV. Design and implementation of an effective telephone counseling intervention for adolescent smoking cessation. Journal of the National Cancer Institute 101(20): 1393-1405, 2009. (85 refs.)

Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST). We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor's calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code. Among identified smokers, 948 (89.6%) were eligible for intervention by age (>= 18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors' calls demonstrated that more than 85% of counselors' calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%). An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers.

Kerr DCR; Owen LD; Capaldi DM. The timing of smoking onset, prolonged abstinence and relapse in men: A prospective study from ages 18 to 32 years. Addiction 106(11): 2031-2038, 2011. (19 refs.)

Aim: To describe the rate and timing of smoking onset, prolonged abstinence (>= 1 year) and relapses from ages 18 to 32 years in initially smoking and non-smoking men. Design: A 23-year longitudinal study. Setting Untreated community sample. Participants: A total of 154 American boys were recruited at age 10 years to a larger study (n = 206) of delinquency risk; 71 participants who smoked cigarettes and did not use smokeless tobacco and 83 participants who initially did not use tobacco were followed from age 18 to 32 years. Measurements Frequency of tobacco use and weekly cigarettes smoked in the past year were assessed annually. Onset (>6 cigarettes/week), abstinence (0 tobacco uses in the past year) and relapse (>0 cigarettes/week) were tracked annually. Findings: Of smokers, 36% achieved 1 or more years of abstinence by age 32 years; 52% who reached abstinence relapsed at least once. One-half of men who showed onset after age 18 years were smoking at the end of the study, compared to nearly three-quarters of men who were smokers at age 18 years. Risk for relapse following prolonged abstinence was strongest initially and diminished thereafter. Transition probabilities were stronger for the second period of abstinence than for the first. Models were limited by sample size and statistical power. Conclusions: Relapses continue to erode men's quit success even after long periods of abstinence from smoking. Long-term abstinence, despite intervening relapse, bodes well for eventual abstinence. Adolescent onset appears relevant to the likelihood of adult abstinence and relapse patterns.

Khowaja LA; Khuwaja AK; Nayani P; Jessani S; Khowaja MP; Khowaja S. Quit smoking for life: Social marketing strategy for youth. A case for Pakistan. Journal of Cancer Education 25(4): 637-642, 2010. (31 refs.)

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth.

Kim Y; Myung SK; Jeon YJ; Lee EH; Park CH; Seo HG et al. Effectiveness of pharmacologic therapy for smoking cessation in adolescent smokers: Meta-analysis of randomized controlled trials. American Journal of Health-System Pharmacy 68(3): 219-226, 2011. (41 refs.)

Purpose. The effectiveness of pharmacologic therapy for smoking cessation in adolescent smokers was evaluated. Methods. In this meta-analysis, the medical literature was searched for randomized controlled trials (RCTs) investigating the effect of pharmacologic therapy for smoking cessation in smokers age 20 years or younger. The overall effect of pharmacologic therapy was based on the longest follow-up data available in each study. The effects of pharmacologic therapy by follow-up period, type of pharmacologic therapy, and type of strategy analysis were also compared among RCTs. Secondary outcome measures were adverse events reported from each study. Results. Six RCTs involving 816 smokers age 12-20 years were included in the final analysis. No significant increase in abstinence rates was detected with pharmacologic therapy (relative risk [RR], 1.38; 95% confidence interval [CI], 0.92-2.07; I(2) = 0.0%) in a fixed-effects meta-analysis. Similarly, no significant increase in abstinence rates was found in subgroup meta-analyses of studies with both short-term (<= 12 weeks) (RR, 1.23; 95% CI, 0.92-1.65) and mid-term (26 weeks) follow-up periods (RR, 1.60; 95% CI, 0.90-2.82). Although few serious adverse events were reported, there was no evidence directly linking these effects to the pharmacologic therapy used. Conclusion. A meta-analysis found that pharmacologic therapy for smoking cessation among adolescent smokers did not have a significant effect on abstinence rates at short-term and mid-term follow-up times of <26 weeks, and the RCTs examined found few adverse events. However, the results may have been affected by the limited number of participants in published trials.

Kleinjan M; Engels RCME; van Leeuwe J; Brug J; van Zundert RMP; van den Eijnden RJJM. Mechanisms of adolescent smoking cessation: Roles of readiness to quit, nicotine dependence, and smoking of parents and peers. Drug and Alcohol Dependence 99(1-3): 204-214, 2009. (88 refs.)

Multiple levels of influence should be considered in interventions aimed at the adolescent smoker, including psychological, addiction, peer and parental influences. However, the mechanism by which these variables influence the process of smoking cessation in adolescents is not well elucidated. Therefore, this prospective study tested two models among 850 adolescent smokers, specifying the direct and indirect relations between adolescents' readiness to quit smoking, levels of nicotine dependence, and smoking behavior of their parents and friends. One year later smoking cessation was assessed. Results showed that, among adolescent smokers, readiness to quit was positively associated with quit attempts, while nicotine dependence was inversely associated with successful cessation. Instead of a direct relation, parental and peers' smoking were inversely related to smoking cessation through nicotine dependence. The findings emphasize that interventions should be developed and tested within and outside the school setting, as well as within the family situation. In addition, the strong impact of nicotine dependence on successful cessation indicates that a more direct approach is needed to lower nicotine dependence among adolescents.

Kleinjan M; Visser AF; Engels RCME. Examining nicotine craving during abstinence among adolescent smokers: The roles of general perceived stress and temptation-coping strategies. Journal of Substance Use 17(3): 249-259, 2012. (53 refs.)

The present study examined the effects of general perceived stress and temptation-coping strategies on the occurrence of nicotine craving among 125 daily-smoking adolescents. General perceived stress was measured at baseline. Craving was assessed at baseline and directly after a 24-hour period of abstinence. After the period of abstinence, respondents also reported the temptation-coping strategies they used during abstinence. The use of cognitive and behavioural temptation-coping strategies was associated with less craving during abstinence. Stress interacted with the use of temptation-coping strategies. Cognitive and behavioural temptation-coping strategies can help adolescents deal with craving during abstinence from smoking, especially when general stress levels are high.

Kleinjan M; Wanner B; Vitaro F; Van den Eijnden RJJM; Brug J; Engels RCAE. Nicotine dependence subtypes among adolescent smokers: Examining the occurrence, development and validity of distinct symptom profiles. Psychology of Addictive Behaviors 24(1): 61-74, 2010. (57 refs.)

To increase understanding of the etiology and epidemiology of nicotine dependence among adolescent smokers, the present study examined the occurrence and development of distinct nicotine dependence symptom profiles in a sample of adolescent smokers. A total of 25 secondary schools throughout the Netherlands participated in a I-year longitudinal study. Multiple dimensions of nicotine dependence were assessed, at two time points, among 641 adolescents (aged 14-17 years) who were classified as smokers. Results showed 4 distinct, yet stable, nicotine dependence subtypes that could be characterized by quantitative as well as qualitative differences. The symptom profiles were similar for males and females but differentially associated with previously identified correlates of nicotine dependence, namely parental smoking, peer smoking, and depressive mood. Finally, differential links of the 4 subtypes were found with regard to smoking uptake and cessation. The finding of qualitative different subgroups of adolescent smokers may have important implications for intervention efforts regarding nicotine dependence and smoking cessation. Such efforts may need to be tailored to the specific subgroups' needs.

Knudsen HK. Smoking cessation services in adolescent substance abuse treatment: Opportunities missed? Journal of Drug Issues 39(2): 257-276, 2009. (54 refs.)

The majority of adolescents receiving substance abuse treatment also use tobacco, yet there are few data regarding the adoption of tobacco use assessment and smoking cessation services by adolescent treatment programs. Using data from a national sample of adolescent-only treatment programs (n = 154), this research measures the adoption of aspects of assessment and treatment from the Public Health Service's (2000) guideline, Treating Tobacco Use and Dependence. When adoption of four intake/assessment practices was measured, adoption appeared high, but only 45% of programs had adopted all four practices. About 43% of programs offered some type of smoking cessation services. However, there was no association between adoption of intake procedures and the odds of availability of smoking cessation services, suggesting a lack of connection between the identification of treatment needs and the availability of services. The lack of smoking cessation services may represent a missed opportunity for early intervention with this population.

Lane NE; Leatherdale ST; Dubin JA; Hammond D. Student and school characteristics associated with use of nicotine replacement therapy: A multilevel analysis among Canadian youth. Addictive Behaviors 37(7): 811-816, 2012. (29 refs.)

Background: Research indicates that it is common for youths to use nicotine replacement therapy (NRT) despite limited empirical evidence for its effectiveness within this population. Since very little is known about the characteristics associated with NRT use by youth, the current study examined the association between ever and current use of NRT as a function of student characteristics and the characteristics of the schools they attend. Methods: This study used nationally representative student-level data from 29,296 grade 9 to 12 students who participated in the 2008-2009 Canadian Youth Smoking Survey (YSS). School-level data on the built environment surrounding schools were provided by DMTI-Spatial, and data on school location were provided by the Canadian Census. Two multilevel logistic regression models were used to predict ever use of NRT and current use of NRT as a function of student and school characteristics among current smokers. Results: Overall, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of ever and current NRT use were highest among daily smokers and boys, while youths who had made multiple quit attempts or participated in a quit and win contest were more likely to be ever NRT users. Attending a school located within an urban area increased youths' odds of ever and current NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with current NRT use. Conclusions: Characteristics of students and the schools they attend were associated with the likelihood of youth smokers using NRT. Significant between-school differences in NRT use exist, however further research is needed to identify which school characteristics account for these differences and understand how youth are accessing NRT.

Langley TE; Huang Y; Lewis S; McNeill A; Coleman T; Szatkowski L. Prescribing of nicotine replacement therapy to adolescents in England. Addiction 106(8): 1513-1519, 2011. (24 refs.)

Aims: In November 2005, the indications for nicotine replacement therapy (NRT) were broadened in the United Kingdom, making all forms available to 12-17-year-olds. This study aimed to estimate the effects of this change on prescribing of NRT to adolescents in England. Design Segmented regression analysis of primary care data on prescribing of nicotine replacement therapy using general additive mixed models. Setting A total of 350 general practices in England included in The Health Improvement Network (THIN), a database of UK electronic primary care records. Participants All 12-17-year-old patients registered with a THIN practice in England. Measurements Monthly rates of prescribing of NRT per 100 000 12-17-year-old patients registered with a THIN practice between January 2002 and June 2009. Findings Prescribing of NRT was highest in 16-17-year-olds and extremely low in 12-13-year-olds, generally fewer than 10 prescriptions per 100 000 adolescents per month. Girls tended to be prescribed NRT more frequently than boys. In 12-17-year-olds rates of prescribing were increasing prior to the broadening of indications, and there was no step change, but the rate of increase was lower, after the indications were broadened. Conclusions: Recent changes to the marketing licence for nicotine replacement therapy in England to include adolescents appear to have had little or no effect on prescribing practices.

Larzelere MM; Williams DE. Promoting smoking cessation. American Family Physician 85(6): 591-598, 2012. (45 refs.)

Cigarette smoking causes significant morbidity and mortality in the United States. Physicians can use the five A's framework (ask, advise, assess, assist, arrange) to promote smoking cessation. All patients should be asked about tobacco use and assessed for motivation to quit at every clinical encounter. Physicians should strongly advise patients to quit smoking, and use motivational interviewing techniques for patients who are not yet willing to stop smoking. Clinical contacts with unmotivated patients should emphasize the rewards and relevance of quitting, as well as the risks of smoking and anticipated barriers to abstinence. These messages should be repeated at every opportunity. Appropriate patients should be offered pharmacologic assistance in quitting, such as nicotine replacement therapies, bupropion, and varenicline. Use of pharmacologic support during smoking cessation can double the rate of successful abstinence. Using more than one type of nicotine replacement therapy ("patch plus" method) and combining these therapies with bupropion provide additional benefit. However, special populations pose unique challenges in pharmacotherapy for smoking cessation. Nicotine replacement therapies increase the risk of birth defects and should not be used during pregnancy. They are usually safe in patients with cardiovascular conditions, except for those with unstable angina or within two weeks of a coronary event. Varenidine may increase the risk of coronary events. Nicotine replacement therapies are safe for use in adolescents; however, they are less effective than in adults. Physicians also should arrange to have repeated contact with smokers around their quit date to reinforce cessation messages.

Lim MK; Kim HJ; Yun EH; Oh JK; Park EY; Shin SH et al. Role of quit supporters and other factors associated with smoking abstinence in adolescent smokers: A prospective study on Quit line users in the Republic of Korea. Addictive Behaviors 37(3): 342-345, 2012. (25 refs.)

The aim of this study elucidated the effectiveness of Quitline among adolescent smokers, as well as other factors associated with adolescent smoking cessation in the Republic of Korea. For 642 adolescent Quitline users aged 13-19 years, the information on demographic characteristics, smoking and cessation related factors, and cessation outcome was collected. Cox proportional hazard models were applied. 13.4% of boys and 6.6% of girls maintained smoking cessation for 1 year. Having a high level of self-efficacy had a preventive effect on relapse in both genders. Boys with parents or other family members as quit supporters, and boys with a higher number of past cessation attempts, were more likely to relapse. It was even more pronounced among boys who reported low self-efficacy. Relapse was increased with marginal significance among girls with parents or other family members as quit supporters. It is evident that Quitline is an effective way to encourage adolescent smoking cessation in Korea. Reinforcing self-efficacy and enhancing the cooperative behaviors of parents or other family member quit supporters could be additional contributors for maintaining cessation among adolescent smokers who want to quit.

MacPherson L; Myers MG. Examination of a process model of adolescent smoking self-change efforts in relation to gender. Journal of Child & Adolescent Substance Abuse 19(1): 48-65, 2010. (64 refs.)

Little information describes how adolescents change their smoking behavior. This study investigated the role of gender in the relationship of motivation and cognitive variables with adolescent smoking self-change efforts. Self-report and semi-structured interview data from a prospective study of smoking self-change efforts were examined among 98 adolescent smokers ages 14 to 18 (55% female). Social disapproval motives and short-term consequence reasons for quitting, quit self-efficacy, and intentions to quit were modeled in relation to prospective self-quit attempts assessed at a six-month follow-up, separately by gender. Hypothesized mediating relationships were not supported although gender differences were noted. Social influence motives related to intention to quit and prospective self-quit attempts among girls. For boys, intention to quit predicted making a self-quit attempt. Findings emphasize the importance of examining adolescent models separately by gender and contribute to understanding of mechanisms involved in adolescent smoking change efforts.

Mcvea KLSP; Miller DL; Creswell JW; McEntarrfer R; Coleman MJ. How adolescents experience smoking cessation. Qualitative Health Research 19(5): 580-592, 2009. (32 refs.)

In this study we develop a model of how youth experience smoking cessation attempts. We followed 15 adolescent smokers twice monthly over three months. Through six semistructured interviews, we explored participants' subjective experiences of making a "quit" attempt. We analyzed transcript data using grounded theory procedures, beginning with open coding, axial coding, construction of matrices, and development of a preliminary theory or model of this phenomenon. We found that only emotionally compelling and inescapable quit reasons were truly motivating. Few parents actively supported their child during quit attempts; smoking friends and other peers undermined them. All successful quitters established new, nonsmoking friends and completely redefined themselves. The quit experience was physically uncomfortable, emotionally distressful, and socially isolating. Greater motivation, mature problem-solving skills, and a willingness to supplant their smoking friends characterized successful quitters. Further research is needed to test this model's efficacy in the adolescent population.

Murnaghan DA; Blanchard C; Rodgers W; La Rosa J; Macquarrie C; Maclellan D et al. The influence of student-level normative, control and behavioral beliefs on staying smoke-free: An application of Ajzen's theory of planned behavior. Addiction Research & Theory 17(5): 469-480, 2009. (40 refs.)

This study, the first to examine the utility of the Theory of Planned Behavior (TPB) in explaining intentions and behavior to remain smoke-free, generated smoke-free related beliefs in adolescents and examined their association to the TPB global constructs (i.e., attitudes, subjective norm, perceived behavioral control (PBC), intention, and behavior) 1 month later in a population of intermediate students (N = 214) in Prince Edward Island, Canada. The results showed that intentions to remain smoke-free were significantly predicted by attitudes and PBC, whereas smoke-free behavior was determined by PBC. From a global TPB perspective, PBC appears to be the dominant variable within the TPB framework on which to guide a smoke-free adolescent intervention. These results have the potential to inform new interventions that address remaining smoke-free that are relevant to adolescents. However, the preliminary nature of these findings warrant further study before any firm conclusions can be drawn.

Myers MG; Gwaltney CJ; Strong DR; Ramsey SE; Brown RA; Monti PM et al. Adolescent first lapse following smoking cessation: Situation characteristics, precipitants and proximal influences. Addictive Behaviors 36(12): 1253-1260, 2011. (46 refs.)

Despite increased attention to adolescent smoking cessation, little is known about adolescent relapse following a quit attempt. To address this issue, the present study was designed to provide initial information regarding the characteristics of adolescent lapses to smoking following abstinence. Included in the present study were 204 adolescent participants in four independent smoking cessation trials. For the full sample, participants averaged 15.99 (1.27) years of age; 56% were female and 78% were white. Lapse characteristics and precipitants were assessed using the Adolescent Smoking Relapse Review. Three domains of the lapse experience were assessed: lapse situation characteristics. precipitants of use in the situation, and proximal influences (i.e., potential precipitants occurring on the same day, prior to the lapse situation). Participant reports indicated that the modal lapse situation occurred in the evening while socializing with friends at home. Urges or cravings and social pressure were commonly endorsed as occurring in lapse situations. The most frequently reported proximal influence was desire for a cigarette, followed by abstinence-violation cognitions (okay to smoke occasionally, wanted to see what it would be like) and negative emotions. The findings indicate that a broad range of factors appear to influence adolescent smoking lapse and commend the value of incorporating content relevant to managing social and affective cues, strategies for inhibiting the prepotent response to ask for a cigarette, addressing cognitions regarding the difficulty of not smoking (i.e., cessation expectancies) and combating perceptions of the ability to smoke occasionally.

Myers MG; MacPherson L. Coping with temptations and adolescent smoking cessation: An initial investigation. Nicotine & Tobacco Research 11(8): 940-944, 2009. (32 refs.)

Introduction: Although a great deal of research focuses on adolescent cigarette smoking, little is known about the process by which adolescents attempt to stop smoking. Resisting temptations to smoke is one of the key challenges encountered by individuals who attempt smoking cessation. A large body of literature has examined coping with temptation among adult smokers, and research on this issue for adolescents is lacking. To further our understanding in this area, the present study reports on an initial examination of the Smoking Temptation Coping Questionnaire (STCQ). The STCQ, which assesses coping in a social pressure situation involving cigarettes, was adapted from the Temptation Coping Questionnaire, a brief self-report measure of adolescent coping with temptations to use alcohol and other drugs. Methods: The present study included 109 adolescent participants (aged 14-19 years) in a naturalistic study of smoking self-change. Participants completed baseline and 6-month follow-up interviews. Results: Exploratory factor analysis of the STCQ coping scale yielded a single factor including six strategies for coping with temptations. Analyses provided support for the concurrent, predictive, and construct validity of the STCQ. In particular, the coping scale score significantly predicted prospective duration of abstinence for adolescents who engaged in smoking cessation efforts. Discussion: These results provide preliminary support for the utility of the STCQ. In addition, findings support the role of temptation coping in the adolescent smoking cessation process.

Nagler RH; Puleo E; Sprunck-Harrild K; Emmons KM. Internet use among childhood and young adult cancer survivors who smoke: Implications for cessation interventions. Cancer Causes & Control 23(4): 647-652, 2012. (27 refs.)

Objective To identify patterns of Internet use among childhood and young adult cancer survivors who smoke. Methods Baseline assessment data were collected from 2005 to 2008 for the Partnership for Health-2 (PFH-2) study, a web-based smoking cessation intervention for childhood and young adult cancer survivors. Participants were surveyed about their Internet access and use. Sociodemographic, clinical, and psychosocial data also were collected. Results Internet access and use was widespread among PFH-2 participants. However, older, less-educated, and female survivors reported less frequent Internet use, even when they had access to the Internet at home and/or at work. These associations were significant in multivariable analyses. Conclusions Although the digital divide is narrowing, Internet use and engagement remains socially patterned. Web-based prevention interventions are a promising method of reaching this geographically dispersed, high-risk population, but certain subgroups-particularly older and lower socioeconomic status survivors-might be missed by this approach.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The NSDUH Report: State Estimates of Adolescent Cigarette Use and Perceptions of Risk from Smoking. (June 2010). Rockville MD: Substance Abuse and Mental Health Administration, 2010. (8 refs.)

Cigarette smoking causes more than 400,000 deaths every year and imposes substantial health and financial costs on our Nation and States. Strides have been made in reducing adolescent smoking, but there is still much work left to be done. This issue of The NSDUH Report uses data from the combined 2007 and 2008 National Surveys on Drug Use and Health (NSDUHs) to present estimates for the States and the District of Columbia of past month cigarette use and perceptions of great risk of harm from smoking one or more packs of cigarettes per day among persons aged 12 to 17. These estimates are rank ordered from highest to lowest and divided into quintiles (fifths). Additionally, the combined 2007 and 2008 data are compared with the combined 2002 and 2003 data to examine changes in these measures over time. Combined 2007 and 2008 data indicate that the rates of past month cigarette use among adolescents aged 12 to 17 ranged from a low of 5.8% in Utah to a high of 14.5% in Kentucky. Rates of perceptions of great risk of harm from smoking one or more packs of cigarettes per day ranged from a low of 63.3% in Alabama to a high of 77.% percent in Utah. Comparisons of combined 2002 and 2003 data with combined 2007 and 2008 data showed that 35 States experienced a statistically significant reduction in the rate of adolescent past month cigarette use, and 35 States and the District of Columbia had an increase in the percentage of adolescents perceiving great risk from smoking; 27 States experienced both of these trends, and there were no States with a statistically significant increase in adolescent smoking or decrease in perceived risk.

Public Domain

O'Loughlin J; Gervais A; Dugas E; Meshefedjian G. Milestones in the process of cessation among novice adolescent smokers. American Journal of Public Health 99(3): 499-504, 2009. (16 refs.)

Objectives. We sought to document the sequence and timing of milestones in the process of smoking cessation by prospectively studied cessation milestones among novice adolescent smokers. Methods. Participants, aged 12 to 13 years in 1999 (n = 1293), completed self-report questionnaires every 3 months during the school year over 5 years. We ascertained time after first puff to attain 5 cessation milestones among 319 participants who initiated cigarette smoking during follow-up. Results. The cumulative probability of first reports of a serious desire to quit and perceived permanent cessation was 25% at 1.5 months (95% confidence interval [CI] = 1.5, 2.5) after the first puff. The first serious quit attempt occurred at 2.5 months (95% CI=2.5, 5.4), lack of confidence about quitting followed at 18.4 months (95% CI= 18.4, 26.8), and awareness of the difficulty of quitting occurred at 32.2 months (95% CI = 19.2, 38.4). Conclusions. Desire and attempts to quit began soon after smoking onset. Novice smokers progressed through several stages in their perception of the difficulty of quitting. Increased understanding of the cessation process may help in developing effective tobacco control interventions for novice smokers.

Patten CA; Enoch C; Renner CC; Offord KP; Nevak C; Kelley SF et al. Focus groups of Alaska native adolescent tobacco users: Preferences for tobacco cessation interventions and barriers to participation. Health Education & Behavior 36(4): 711-723, 2009. (24 refs.)

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e. g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non-tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.

Patten CA; Hughes CA; Lopez KN; Thomas JL; Brockman TA; Smith CM et al. Web-based intervention for adolescent nonsmokers to help parents stop smoking: A pilot feasibility study. Addictive Behaviors 37(1): 85-91, 2012. (38 refs.)

A novel approach to tobacco control is to engage adolescent nonsmokers in support roles to encourage and help their parents stop smoking. This pilot study examined the feasibility and potential efficacy of a web-based support skills training (SST) intervention for adolescents to help a parent stop smoking. Forty nonsmoking adolescents 13-19 years of age (70% female, 93% White) were enrolled and randomly assigned to a health education (HE) control group (n = 20) or SST (n = 20). Both consisted of written materials and five weekly, 30 min, web-based, counselor-facilitated group sessions. Parents were enrolled for assessments only. Adolescents and parents completed assessments at baseline, week 6 (post-treatment), week 12 and 6-months follow-up. Both interventions were feasible based on treatment acceptability ratings, study retention and treatment compliance. The biochemically confirmed 6-month smoking abstinence rate was higher for parents linked to teens in HE (35%, 7/20) than in SST (10%, 2/20), p = 0.13. About half of parents in each group reported a quit attempt since study enrollment. Teens can be engaged to help parents stop smoking. Future research is warranted on determining effective intervention approaches.

Pbert L; Druker S; DiFranza JR; Gorak D; Reed G; Magner R et al. Effectiveness of a school nurse-delivered smoking-cessation intervention for adolescents. Pediatrics 128(5): 926-936, 2011. (34 refs.)

OBJECTIVE: To evaluate the effectiveness of a school nurse-delivered smoking-cessation intervention in increasing abstinence among adolescent smokers. METHODS: Thirty-five high schools were pair-matched and randomly assigned to 1 of 2 conditions, each of which consisted of 4 visits with the school nurse: (1) counseling intervention using the 5 A's model and cognitive-behavioral techniques; or (2) an information-attention control condition. Adolescents (n = 1068) who reported past 30-day smoking and interest in quitting completed surveys at baseline and at 3 and 12 months and provided saliva samples for biochemical validation of reported smoking abstinence. RESULTS: Intervention condition participants were almost twice as likely to be abstinent per self-report at 3 months (odds ratio: 1.90 [95% confidence interval: 1.12-3.24]; P = .017) compared with control participants; at 12 months there were no differences. The difference at 3 months was driven by quit rates in male students (15.0% [intervention] vs 4.9% [control]; odds ratio: 3.23 [95% confidence interval: 1.63-6.43]; P = .001); there was no intervention effect in female students at either time point (6.6% vs 7.0% at 3 months and 16.6% vs 15.5% at 12 months) and no intervention effect in male students at 12 months (13.9% vs 13.2%). Smoking amount and frequency decreased significantly in intervention compared with control schools at 3 but not at 12 months. CONCLUSIONS: A school nurse-delivered smoking-cessation intervention proved feasible and effective in improving short-term abstinence among adolescent boys and short-term reductions in smoking amount and frequency in both genders. Additional research is needed to enhance both cessation and maintained abstinence.

Peterson AV; Kealey KA; Mann SL; Marek PM; Ludman EJ; Liu JM et al. Group-randomized trial of a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Journal of the National Cancer Institute 101(20): 1378-1392, 2009. (98 refs.)

The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.

Prokhorov AV; Kelder SH; Shegog R; Conroy JL; Murray N; Peters R et al. Project ASPIRE: An Interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high school students. Substance Use & Misuse 45(6): 983-1006, 2009. (61 refs.)

A Smoking Prevention Interactive Experience (ASPIRE) is an innovative, computer-based smoking prevention and cessation intervention delivered to a culturally diverse population of high school students. Founded in the Transtheoretical Model of Change, five main and two "booster" sessions comprise the interactive intervention. Here we describe the intervention and the baseline characteristics from our study sample of 1,574 10th graders from 16 high schools in Houston, Texas. Environmental and behavioral smoking risk factors were assessed, and the two intervention groups were comparable with respect to most measured variables. The intervention program holds considerable promise in its ability to reduce smoking among teens.

Ramo DE; Prochaska JJ; Myers MG. Intentions to quit smoking among youth in substance abuse treatment. Drug and Alcohol Dependence 106(1): 48-51, 2010. (31 refs.)

Introduction: Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SLID) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SLID treatment. Methods: Participants were 178 adolescents who were in inpatient (n = 90) or outpatient (n = 88) SLID treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD = 1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale). Results: SUD youth intention to quit smoking averaged 4.9 out of 10 (SD = 3.2). comparable to intention to quit drinking (M = 5.3, SD = 3.6), but lower than their intention to quit using drugs (M = 6.0. SD = 3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r = -.30, p < .01) and smoking cessation related self-efficacy (r = .36, p < .01), but not with pretreatment substance use severity (r = -.15). Controlling for nicotine dependence. teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr = .26, p < .01) and intention to quit using illicit drugs (pr = .15, p < .05), but unrelated to intention to quit drinking. Discussion: Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.

Richards J; Mousseau A. Community-based participatory research to improve preconception health among Northern Plains American Indian adolescent women. American Indian and Alaska Native Mental Health Research 19(1, special issue): 154-185, 2012. (31 refs.)

Background: Sacred Beginnings is a community-based participatory research project that examines the effectiveness of a culturally appropriate preconception health educational intervention developed by tribal community members and elders. The primary goal is to increase knowledge of preconception health and its benefits among adolescent females and tribal communities. Preconception health is an area of considerable concern among American Indians (AIs) in the Northern Plains region, as there are high rates of birth, infant mortality, unintended pregnancy, teen pregnancy, and sexually transmitted diseases in this area. We examined the effectiveness of implementing this intervention during a residential summer program for AI high school students. Materials and Methods: The educational intervention consisted of 15 preconception health education sessions and was piloted during a summer high school residential academic program. The intervention (N = 39) and non-intervention (N = 38) groups were comprised of incoming AI female freshmen representing comparable demographics. A pre- and post-intervention survey was administered to both groups. Results: Results indicated a significant difference in Time 2 (T2; post-intervention) scores, with the intervention group scoring higher than the non-intervention group in overall preconception health knowledge and obesity knowledge. In terms of intra-group score analysis between Time 1 (T1; pre-intervention) and T2, there were significant changes within the intervention group in knowledge of obesity and diabetes. Knowledge changes in smoking were approaching significance. Within the non-intervention group, there was a significant change from T1 to T2 in scores for diabetes knowledge only. Discussion: The key finding was that the intervention group had higher overall preconception health knowledge at T2 compared to the non-intervention group. Intervention participants demonstrated an understanding of how preconception behaviors may affect birth outcomes and maternal health. Another key finding was that, among participants in the intervention group, the change in knowledge regarding smoking beliefs between T1 and T2 were approaching significance. Because smoking during pregnancy is a risk factor for poor birth outcomes, this finding emphasizes that future curriculum modification should address the effects of smoking, and the benefits of smoking cessation, prior to or during pregnancy. Study limitations such as small sample size, high baseline health knowledge, the need to add traditional knowledge variables, and shortened implementation timeframe reveal key areas for improvement. Possible future intervention modifications include expanding on areas that reached or approached significance, implementing the intervention over a longer period of time, identifying ways to translate traditional knowledge into quantifiable survey measures, and implementing the intervention with high-risk, reservation-based populations of AI youth.

Robinson LM; Vail SR. An integrative review of adolescent smoking cessation using the transtheoretical model of change. (review). Journal of Pediatric Health Care 26(5): 336-345, 2012. (28 refs.)

Introduction: The purpose of this literature review is to report the effectiveness of trials using the Transtheoretical Model of Change for achieving smoking cessation among adolescents. Method: An integrative literature review was performed. Two reviewers searched the Internet for randomized, controlled trials or observational studies of adolescent smoking cessation trials reported between 1999 and June 2009 that used the Transtheoretical Model of Change. Results: Six randomized controlled trials remained after all inclusion and exclusion criteria were met. Each study was reviewed qualitatively and odds ratio and quit rates were calculated. Four studies demonstrated an odds ratio of greater than 1.0, and in four studies significantly better quit rates were found in the intervention arm versus the control arm at the endpoint evaluation. Discussion: Evidence exists for the effectiveness of stage-based interventions in promoting smoking cessation in adolescents.

Schepis TS; McFetridge A; Chaplin TM; Sinha R; Krishnan-Sarin S. A pilot examination of stress-related changes in impulsivity and risk taking as related to smoking status and cessation outcome in adolescents. Nicotine & Tobacco Research 13(7): 611-615, 2011. (32 refs.)

Introduction: Psychosocial stress and impulsivity are each associated with smoking in adolescents. There is also evidence that stress can increase impulsive responding, and impulsive adolescent smokers attempting cessation are at greater risk of relapse. We performed a pilot investigation to examine stress-induced changes in response inhibition, inattention, and risk taking as related to smoking status and posttreatment smoking abstinence. Methods: Twelve adolescent smokers participating in a smoking cessation intervention and 15 adolescent nonsmokers completed a 2-session protocol assessing stress-related change in response inhibition and inattention (on the Conners' Continuous Performance Test-II), risk taking (on the Balloon Analogue Risk Task), nicotine withdrawal symptoms, and self-reported stress. Results: At baseline, smokers had greater inattentive responding and risk taking when compared with nonsmokers. Stress exposure led to significant increases in stress, anger, and depression in all participants and also increased nicotine craving (on the Minnesota Nicotine Withdrawal Scale item) and impulsive responding in smokers. After covarying for baseline differences in impulsivity/risk taking, smokers who were not abstinent at the end of treatment experienced greater stress-induced risk taking when compared with those who were abstinent. Conclusions: In all, it appears that response inhibition and risk taking may be differentially altered by stress exposure in adolescent smokers and nonsmokers and that adolescent smoking cessation success may be associated with less risk taking in the face of stress.

Schuck K; Otten R; Engels RCME; Kleinjan M. The relative role of nicotine dependence and smoking-related cognitions in adolescents' process of smoking cessation. Psychology & Health 26(10): 1310-1326, 2011. (54 refs.)

The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14-16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.

Solomon LJ; Bunn JY; Flynn BS; Pirie PL; Worden JK; Ashikaga T. Mass media for smoking cessation in adolescents. Health Education & Behavior 36(4): 642-659, 2009. (36 refs.)

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear.

Stein-Seroussi A; Stockton L; Brodish P; Meyer M. Randomized controlled trial of the ACTION smoking cessation curriculum in tobacco-growing communities. Addictive Behaviors 34(9): 737-743, 2009. (27 refs.)

We conducted a group randomized trial of an interactive, games-based tobacco cessation program (ACTION) designed to help adolescents who live in tobacco-growing communities to stop using tobacco. More than 260 high school students participated in this study, in 14 schools across three states. We collected self-reported measures of cigarette and smokeless tobacco use and conducted biochemical validation of self-reported use at three time points (pre-test, immediate post-test, and 90-day follow-up). We used multi-level modeling to account for intraclass clustering at the school and classroom levels, and we analyzed our results using an intent-to-treat approach and a per protocol approach. Using the per protocol analytic approach, ACTION participants were more likely than comparison participants to achieve abstinence at 90-day follow-up. We found no program effects on our secondary outcomes or mediating factors. This study suggests that ACTION has promise as a relatively effective adolescent cessation program, although the overall limited effectiveness of cessation programs for adolescents must be acknowledged.

Sterling KL; Curry SJ; Emery S; Sporer AK; Mermelstein RJ; Berbaum M et al. Internally-developed teen smoking cessation programs: Characterizing the unique features of programs developed by community-based organizations. International Journal of Environmental Research and Public Health 6(3): 1026-1040, 2009. (18 refs.)

We have compared the unique features of teen tobacco cessation programs developed internally by community-based organizations (N=75) to prepackaged programs disseminated nationally (N=234) to expand our knowledge of treatment options for teen smokers. Internally-developed programs were more likely offered in response to the sponsoring organization's initiative (OR=2.16, p<0.05); had fewer trained cessation counselors (OR=0.31, p<0.01); and were more likely found in urban areas (OR=2.89, p=0.01). Internally-developed programs more often provided other substance-abuse treatment services than prepackaged programs and addressed other youth-specific problem behaviors (p <= 0.05). Studies that examine the effectiveness of internally-developed programs in reducing smoking and maintaining cessation for teen smokers are warranted.

Suls JM; Luger TM; Curry SJ; Mermelstein RJ; Sporer AK; An LC. Efficacy of smoking-cessation interventions for young adults: A meta-analysis. (review). American Journal of Preventive Medicine 42(6): 655-662, 2012. (33 refs.)

Context: Approximately 22% of U.S. young adults (aged 18-24 years) are smokers. Young adults typically display an interest in quitting, but it is unknown whether the evidence-based cessation programs designed for adults will be equally effective for young adults. This meta-analysis investigated the efficacy of smoking-cessation programs for this population. Evidence acquisition: In 2009-2011, studies published between 2004 and 2008 that investigated smoking cessation were first found through the DHHS Clinical Practice Guidelines for Treating Tobacco Use and Dependence as well as a PubMed search (2009-2010) and were then subjected to a rigorous inclusion process. Authors were contacted to glean raw data for young adults. Fourteen studies provided data that were coded for descriptive information and aggregated using the Comprehensive Meta-Analysis, version 2.0. Evidence synthesis: Among young adults, any type of intervention was more effective in producing successful smoking cessation than the control. This was the case for intent-to-treat analyses as well as complete cases. When interventions were effective for the larger adult sample, they were also effective for the younger adult sample. Conclusions: Although young adults tend to underutilize evidence-based cessation treatments, the current meta-analysis showed that these treatments should be as effective for young adults as they are for the general adult population. Thus, it may be useful to focus on motivating young adults to seek cessation treatment to increase utilization.

Thorner-Bantug E; Jaszyna-Gasior M; Schroeder JR; Collins CC; Moolchan ET. Weight gain, related concerns, and treatment outcomes among adolescent smokers enrolled in cessation treatment. Journal of the National Medical Association 101(10): 1009-1014, 2009. (20 refs.)

We examined associations of weight concerns and weight gain with adolescent tobacco cessation treatment and whether these effects differed by gender or ethnoracial group. Participants were 115 urban adolescents recruited for a randomized clinical trial of nicotine replacement therapy. Baseline weight gain concerns were assessed using the Eating Disorders module from the Diagnostic Interview for the Child and Adolescent DICA-IV). The average weight gain during the trial was 0.59 +/- 2.85 kg among the 43.5% of participants who completed the treatment study. As indicated by the DICA, baseline weight gain concerns were not associated with weight gain during treatment, study completion, or abstinence from smoking at 3-month posttreatment follow-up; these results did not vary by gender or ethnoracial group. Adolescents who quit smoking gained no more weight during the trial than those who smoked.

Tohid H; Ishak NM; Muhammad NA; Abu Hassan H; Ahmad FNM; Omar K. What determines teenagers' smoking behaviour? A qualitative study. International Medical Journal 18(3): 194-198, 2011. (35 refs.)

Objective: The study aimed to explore smoking behaviour among Malaysian teenagers that were related to their smoking initiation, cigarette consumption, quit intention, and quit attempts. Methods: It was a qualitative study that used multiple case study design, involving 26 teenagers (23 smokers and three former smokers) from three public schools. Data was collected via questionnaires, three focus group interviews and three in-depth interviews over 20 months. A standardised semi-structured interview protocol was utilised. Results: Among the participants, 74% of them started smoking after the age of 12 years old. The majority (20/23) of the teenage smokers admitted to smoking every day and 74% of them smoked not more than 5 cigarettes a day. All of the smokers had the intention to quit but only 22 out of the 23 teenage smokers had attempted quitting. Sixty percent of these teenagers had more than three quit attempts. In general, this study captured the complexity of the teenagers' smoking behaviour that could be influenced by multiple factors, including behavioural (e.g. nicotine addiction), personal (e.g. conception of smoking and quitting, curiosity, sensation seeking, knowledge about smoking cessation, stress, maintaining athletic performance, and finance.) and environmental (e.g. socialisation, peer pressure, parental smoking, parental disapproval, and boy- or girlfriend aversion) factors. Conclusions: This study described the complex and multidimensional nature of teenage smoking behaviour. The findings also correspondingly matched the Social Cognitive Theory (SCT), therefore suggesting the theory's suitability in elucidating smoking behaviour among the Malaysian teenagers.

Toljamo T; Hamari A; Nieminen P; Kinnula VL. Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts. Scandinavian Journal of Primary Health Care 30(3): 183-188, 2012. (40 refs.)

Objective. Previous studies on smoking cessation have generally been conducted with adolescents or adults. Very little is known about the cessation attempts, their success, and/or use of pharmacological aids in young adult smokers who want to quit. The present study aimed to investigate quitting attempts in a group of both young male daily and occasional smokers. Design and subjects. 614 male smokers aged 18-26 years completed a standardized questionnaire about their smoking habits, quit attempts, and aids used in smoking cessation. Results. Nearly all daily smokers (95.3%, 95% CI 93.1-96.8) were nicotine addicted to some extend according to the standardized questionnaire, and the more addicted they were, the more often they had tried to quit (p = 0.025). Of the daily smokers, 55.6% (95% CI 51.3-59.9) had made quit attempts and 36.2% (95% CI 32.1-40.4) had used nicotine replacement therapy (NRT). In all, 34.1% (95% CI 25.2-44.3) of all occasional smokers reported having intended to quit but they had seldom made more than one attempt whereas 20.2% of daily smokers had made at least three attempts. The stronger the nicotine dependence in daily smokers was, the more likely the subject was to have attempted to use NRT (quite dependent 23.8% vs. totally dependent 48.9%) (p < 0.001). Conclusions. A high proportion of young male daily smokers were nicotine addicted. Young smokers make many unsuccessful attempts to stop smoking using nicotine replacement therapy (NRT) on their own. A better availability of professional cessation services directed to young adult smokers is needed.

Tworek C; Yamaguchi R; Kloska DD; Emery S; Barker DC; Giovino GA et al. State-level tobacco control policies and youth smoking cessation measures. Health Policy 97(2-3): 136-144, 2010. (57 refs.)

Objective: Research on the effects of state-level tobacco control policies targeted at youth has been mixed, with little on the effects of these policies and youth smoking cessation. This study explored the association between state-level tobacco control policies and youth smoking cessation behaviors from 1991 to 2006. Methods: The study design was a population-based, nested survey of students within states. Study participants were 8th, 10th, and 12th graders who reported smoking "regularly in the past" or "regularly now" from the Monitoring the Future study. Main cessation outcome measures were: any quit attempt; want to quit; non-continuation of smoking; and discontinuation of smoking. Results: Results showed that cigarette price was positively associated with a majority of cessation-related measures among high school smokers. Strength of sales to minors' laws was also associated with adolescent non-continuation of smoking among 10th and 12th graders. Conclusions: Findings suggest that increasing cigarette price can encourage cessation-related behaviors among high school smokers. Evidence-based policy, such as tax increases on tobacco products, should be included as an important part of comprehensive tobacco control policy, which can have a positive effect on decreasing smoking prevalence and increasing smoking cessation among youth.

Van Zundert RM; Ferguson SG; Shiffman S; Engels R. Dynamic effects of craving and negative affect on adolescent smoking relapse. Health Psychology 31(2): 226-234, 2012. (68 refs.)

Objective: This study examined dynamic effects of daily variations in craving and negative affect on the next-day risk of the first lapse and relapse among 149 adolescent daily smokers who achieved at least 24 hr of abstinence. Method: Participants completed real-time assessments of their smoking, craving, and negative affect 3 times per day during the 3 weeks after their quit attempt. The main outcome measures included the first lapse and relapse after at least 24 hr of abstinence from smoking.. Results: Cox regression analyses with time-varying covariates showed that daily increases in craving predicted the risk of lapsing and relapsing on the following day, even after accounting for concurrent smoking and baseline levels of craving and nicotine dependence. Day-to-day variations in negative affect did not predict time to first lapse or relapse. Individual differences in baseline craving, nicotine dependence, and depressive symptoms also did not predict the first lapse or relapse. Conclusions: The findings challenge the significance of adolescents' negative affect during cessation and emphasize the need to assess dynamic effects of craving in addition to baseline ratings of craving and nicotine dependence, as the latter may not be sufficient to explain adolescent smoking cessation outcomes.

van Zundert RMP; Engels RCME. Parental factors in association with adolescent smoking relapse. European Addiction Research 15(4): 209-215, 2009. (35 refs.)

The present study examined the role of parents in smoking relapse among adolescents who embarked on a serious attempt to quit. Participants were 135 adolescents aged 15-20 years who smoked daily and participated in an ecological momentary assessment study. Daily questions about their quitting experiences were administered during 4 weeks. Longitudinal logistic regression analyses were applied to test whether parental smoking, expected parental support, parental norms about cessation, and smoking cessation-specific parenting at baseline predicted the first lapse into smoking as well as mild and heavy relapse during the 4-week period, and abstinence at follow-up 2 months later. Neither parental smoking nor hardly any of the parenting variables explained successful smoking cessation among adolescents, except for expected parental support. Although parents have been found to be influential in the development of adolescent smoking, our findings suggest that parents' influence is limited when it concerns actual smoking cessation and relapse.

Van Zundert RMP; Engels RCME; Kuntsche E. Contextual correlates of adolescents' self-efficacy after smoking cessation. Psychology of Addictive Behaviors 25(2): 301-311, 2011. (55 refs.)

Recent research has shown that daily changes in self-efficacy predict lapses and relapse into smoking after quitting among adolescent daily smokers, but it is not known if and how momentary self-efficacy is associated with affect-motivational states and external contexts. In the present study, 134 adolescent daily smokers were monitored daily during 1 week prior to and 3 weeks after they began their quit attempt. Participants completed questions on smoking, self-efficacy, affect-motivational states (craving and negative affect), and external contexts (seeing others smoke, experiencing a stressful event, and alcohol and coffee consumption) three times a day. Affect-motivational states as well as all external contexts (except for coffee consumption) were associated with lower self-efficacy when participants were still abstinent, but also after they had lapsed. Associations between the situational contexts and self-efficacy did not largely depend on individual characteristics such as baseline self-efficacy and age. Among girls, however, the negative associations between self-efficacy and negative affect and drinking alcohol were found to be stronger. These results show that adolescents' self-efficacy during a quit attempt may be responsive to affect-motivational states and external contexts, both before and after lapsing.

Walsh MM; Langer TJ; Kavanagh N; Mansell C; MacDougal W; Kavanagh C et al. Smokeless tobacco cessation cluster randomized trial with rural high school males: Intervention interaction with baseline smoking. Nicotine & Tobacco Research 12(6): 543-550, 2010. (34 refs.)

Adolescent males in rural areas use smokeless tobacco (ST). We assessed the efficacy of a school-based nurse-directed ST intervention among rural high school males. Study high schools were randomly selected from a public high school list of California rural counties. Consenting high schools were stratified by school size and randomly assigned within strata to intervention or no-intervention groups. After gaining parental consent, male students completed baseline and 1-year follow-up questionnaires. The intervention included peer-led educational sessions and an oral exam by the school nurse who also provided brief tobacco cessation counseling. We used binary generalized estimating equation (GEE) models accounting for clustering within schools to test no difference between groups after adjusting for year in high school using both completers only and multiple imputation for those lost to follow-up. Subgroup analyses assessed Baseline Factor x Group interaction in GEE models. Twenty-one rural counties (72%), 41 randomly selected high schools (56%), and 4,731 male students (50%) participated with 65% retention. Nonsmoking ST users in the intervention group were significantly more likely to stop using ST at follow-up than those in the no-intervention group; there was no intervention effect among baseline ST users who also smoked. A higher percentage of baseline nonsmoking ST users reported smoking at follow-up than baseline non-ST-using smokers who reported using ST. A school-based nurse-directed ST cessation program was efficacious among rural nonsmoking ST-using high school males. The potential program reach holds significant public health value. Baseline ST use facilitated smoking at follow-up.

Wegmann L; Buhler A; Strunk M; Lang P; Nowak D. Smoking cessation with teenagers: The relationship between impulsivity, emotional problems, program retention and effectiveness. Addictive Behaviors 37(4): 463-468, 2012. (36 refs.)

Aims: This study examines whether individual differences in impulsivity and emotional problems in adolescent smokers are related to initial smoking characteristics of participants, acceptance, retention and outcome of a school-based smoking cessation program. Design: The data was obtained from a feasibility study of a youth-specific, cognitive-behavioral and motivation enhancing program at 22 schools with 139 participating teenage smokers in Germany. A one-group-pre-posttest design was realized. Measurement: Impulsivity levels were assessed by use of the impulsivity scale of the IVE ("Inventar zur Erfassung von Impulsivitat, Risikoverhalten und Empathie", Stadler, Janke, & Schmeck, 2004). To evaluate the extent of emotional problems, the corresponding 5-items scale of the SDQ-Deu ("Strength and difficulties questionnaire", 'Klasen et al., 2000) was applied. Smoking behavior and acceptance of the program were assessed by students' self-reports. Findings: Acceptance and retention did not differ with regard to impulsivity and emotional problems, but initial smoking status did. Cessation rates varied with level of impulsivity: compared to non-impulsive participants, impulsive adolescents succeeded in quitting smoking less often. Emotional problems were not related to the rate of quitting. Conclusions: Impulsive adolescents were similarly compliant to the offered cessation intervention as less impulsive smokers. In spite of their general positive evaluation, impulsive adolescents seem to benefit less from a smoking cessation program than their non-impulsive counterparts. Specific elements supporting impulsive teenage smokers in their goal to quit should be incorporated into youth-specific cessation programs.

Wong DCN; Chan SSC; Fong DYT; Leung AYM; Lam DOB; Lam TH. Patterns and predictors of quitting among youth quitline callers in Hong Kong. Nicotine & Tobacco Research 13(1): 14-21, 2011. (47 refs.)

To examine the time patterns and predictors of initiating a quit attempt and subsequent sustained abstinence among youth smokers after receiving a telephone smoking cessation intervention. This was a longitudinal study of 408 current youth smokers aged 12-25 years who called a smoking cessation hotline in Hong Kong. Telephone surveys were conducted at baseline; 1week; and 1, 3, and 6 months to assess smoking status and other risk factors. Nonparametric Kaplan-Meier methods and hierarchical Cox's proportional odds models were applied to explore the time patterns and predictors of the quitting process. Half of the youth smokers initiated a quit attempt within 1 month after receiving the baseline telephone intervention, while the likelihood of further quit attempts decreased over time. Two thirds relapsed within the first 7 days after starting a quit attempt. Intention to quit, previous quit attempts, perceived physical unfitness, and other factors could predict the initiation of a quit attempt. Sustained abstinence was facilitated by making an immediate attempt to quit, adopting self-help strategies, and a perceived improvement in physical health. Our findings support the "catastrophic" pathway of youth smokers initiating a quit attempt. Counselors should capture the quitting momentum and motivate youth smokers to quit immediately. Interventions should include a health assessment and discussion of smokers' physical fitness. During the first week of abstinence, intensive monitoring of withdrawal symptoms, together with booster counseling, is helpful in preventing smoking relapse and could remotivate those who fail to sustain their quit attempt.

Wong DCN; Chan SSC; Ho SY; Fong DYT; Lam TH. Predictors of intention to quit smoking in Hong Kong secondary school children. Journal of Public Health 32(3): 360-371, 2010. (53 refs.)

Behavioral theories suggest that a past quit attempt influences psycho-social determinants to predict smokers' intention to quit, although no study has tested the hypothesis among youth smokers. A sample of 1561 Chinese secondary students, who were current smokers, were collected in a cross-sectional school-based survey in Hong Kong. For the 943 students with past quit attempts, those with lower daily cigarette consumption; who perceived smoking would not elicit positive social responses from others; who had one parent/teacher who prohibited them to smoke; who were aware of the health hazards of smoking and being male smokers, were more likely to have an intention to quit smoking. For the 618 students without a past quit attempt, those who did not perceive any benefit from smoking; who had parents and teachers to prohibit them to smoke and who received social support to quit, were more likely to have an intention to quit smoking. Strengthening the prohibition of smoking and providing social support may help initiate the intention to quit among youth smokers without a past quit attempt, while de-normalizing social images of smoking, providing information about the health hazards of smoking and relieving nicotine addiction may sustain quitting intentions among youth smokers with past quit attempts.