The problem is getting us to stop. What teens say about smoking cessation

Adolescent Tobacco/Nicotine Use and the Potential Role of Contingency Management-based Interventions

ABSTRACT

The high prevalence of tobacco/nicotine use among youth, including e-cigarettes, is a public health problem in the United States. Early exposure leads to an increased risk of dependence and health consequences in adulthood. We reviewed the literature on current treatment approaches for nicotine/tobacco use in adolescents/young adults and highlighted underexplored areas of treatment research. There are no current Food and Drug Administration-approved medications for treatment of nicotine/tobacco use disorders in adolescents. However, in research settings and on a case-to-case basis, clinical practice medications (including nicotine replacement therapy, bupropion, and varenicline) have been prescribed to this population with consideration of risk-benefit analysis when behavioral treatments are not sufficient to address dependence. Among the nonpharmacological interventions, there is evidence to support the potential for expanded use of contingency management in youth. Neural differences predisposing adolescents to substance use, along with higher attentiveness to value of options in decision making (flexible reward system) may enhance the effectiveness of reward-based approaches for treatment of substance use disorders in this population. The overall high rates of nonresponders across psychosocial and pharmacological treatments highlight the importance of considering novel strategies to improve existing interventions. We suggest that future research be done that considers unique characteristics of today's adolescents, such as high social activism and engagement with digital rewards to tailor contingency management for this age group and assess its effectiveness. Adolescents could potentially benefit from rewards administered through digital media (eg, video games, computer-based apps, and social media influencers).

A Systematic Review of Qualitative Studies on Factors Associated With Smoking Cessation Among Adolescents and Young Adults

OBJECTIVE

To summarize findings from qualitative studies on factors associated with smoking cessation among adolescents and young adults.

DATA SOURCES

We searched Pubmed, Psychinfo, CINAHL, Embase, Web of Science, and SCOPUS databases, as well as reference lists, for peer-reviewed articles published in English or French between January 1, 2000, and November 18, 2020. We used keywords such as adolescents, determinants, cessation, smoking, and qualitative methods.

STUDY SELECTION

Of 1724 records identified, we included 39 articles that used qualitative or mixed methods, targeted adolescents and young adults aged 10-24, and aimed to identify factors associated with smoking cessation or smoking reduction.

DATA EXTRACTION

Two authors independently extracted the data using a standardized form. We assessed study quality using the National Institute for Health and Care Excellence checklist for qualitative studies.

DATA SYNTHESIS

We used an aggregative meta-synthesis approach and identified 39 conceptually distinct factors associated with smoking cessation. We grouped them into two categories: (1) environmental factors [tobacco control policies, pro-smoking norms, smoking cessation services and interventions, influence of friends and family], and (2) individual attributes (psychological characteristics, attitudes, pre-quitting smoking behavior, nicotine dependence symptoms, and other substances use). We developed a synthetic framework that captured the factors identified, the links that connect them, and their associations with smoking cessation.

CONCLUSIONS

This qualitative synthesis offers new insights on factors related to smoking cessation services, interventions, and attitudes about cessation (embarrassment when using cessation services) not reported in quantitative reviews, supplementing limited evidence for developing cessation programs for young persons who smoke.

IMPLICATIONS

Using an aggregative meta-synthesis approach, this study identified 39 conceptually distinct factors grouped into two categories: Environmental factors and individual attributes. These findings highlight the importance of considering both environmental and individual factors when developing smoking cessation programs for young persons who smoke. The study also sheds light on self-conscious emotions towards cessation, such as embarrassment when using cessation services, which are often overlooked in quantitative reviews. Overall, this study has important implications for developing effective smoking cessation interventions and policies that address the complex factors influencing smoking behavior among young persons.

Dropout, response, and abstinence outcomes of a national text-messaging smoking cessation intervention for teens, SmokeFreeTeen

Although text-messaging interventions are effective for smoking cessation, few target teens in the USA and little is known about their effectiveness. The purpose of this manuscript is to examine correlates of dropout, response to smoking status prompts, and abstinence rates among subscribers of SmokeFreeTeen, a free, publicly available text-messaging smoking cessation intervention sponsored by the National Cancer Institute's SmokeFree.Gov initiative, on quit day through 1 month follow-up. In a sample of teens (N = 2,685), aged 13-19, we examined demographics, smoking frequency, cigarettes smoked per day, prequit intervention time (i.e., maximum of 14 days of prequit day preparation), and number of quit attempts as correlates of response and abstinence rates among program initiators (i.e., participants who reached quit day but dropped out on or before intervention end) and completers (i.e., participants who reached quit day and completed the intervention). We also conducted Cox regression analysis of time from quit day to dropout by daily and nondaily smoking status. Two-thirds (n = 1,733, 64.54%) dropped out before the intervention ended, with dropout rates peaking on quit day (n = 289, 13.10%). Response rate to smoking status prompts remained below 30% throughout the intervention. At intervention end and 1 month follow-up, abstinence was 2.63% and 2.55% among program initiators, whereas abstinence was 6.09% and 6.01% among program completers. Dropout, response, and abstinence rates did not consistently differ by subscriber characteristics. Prequit time was associated with decreased likelihood of dropping out (adjusted hazards ratio: 0.94, confidence interval [CI]: 0.93-0.95), responding to smoking status prompts (adjusted odds ratio [aOR]: 0.94, CI: 0.92-0.96), and being abstinent (aOR: 0.96, CI: 0.93-0.99) on quit day. Two or more quit attempts were associated with increased response (aOR: 1.61, CI: 1.16-2.23) and abstinence (aOR: 1.91, CI: 1.25-2.92) rates on Day 7. In a first assessment of SmokeFreeTeen outcomes, we document high dropouts and low response and abstinence rates. SmokeFreeTeen produced abstinence rates lower than comparable text-messaging interventions targeting teens and young adults. Improving SmokeFreeTeen's reach, engagement, and effectiveness is needed.

Feasibility of a Smartphone App with Mindfulness Training for Adolescent Smoking Cessation: Craving to Quit (C2Q)-Teen

Objectives

The use of mobile technology for smoking cessation holds promise for adolescents, who do not typically access traditional treatments, but most are not grounded in theory or mechanism. Operant conditioning theory suggests an addictive smoking loop is formed between nicotine use and affective states, leading to habitual cue-induced craving and automatic behavior; mindfulness training may bring automated smoking behavior into awareness, so smokers may work mindfully with cravings. Mindfulness training delivered via smartphone technology therefore has potential to help adolescent smokers break this addictive loop and quit smoking. This pair-matched cluster-randomized controlled school-based pilot study evaluated program feasibility and preliminary smoking outcomes in relation to intervention engagement.

Methods

Six high schools were pair matched and randomly assigned to one of three interventions: (1) mindfulness training delivered via mobile smoking cessation application (Craving to Quit, C2Q), (2) NCI's QuitSTART smoking cessation application (NCI), and (3) written cessation materials (Materials). Adolescents (n = 146) smoking 5 or more cigarettes per day were recruited. Interventions were implemented over four weeks and study assessments were collected at baseline and 3- and 6- month follow-up, including self-reported 7-day point prevalence abstinence, program usage, smoking-related measures, and psychosocial factors.

Results

Overall cotinine-validated abstinence at 6 months was 15.8% and was similar between conditions. Odds of abstinence increased with each quartile increase in app/materials use with no significant differences between conditions (OR=1.60 (C2Q), 1.66 (Materials), and 2.69 (NCI)). Of participants still smoking at 6 months, for each quartile increase in engagement the number of cigarettes smoked in the previous 7 days showed a significantly greater decline in the C2Q condition (-5.71) compared to the Materials (-0.95) and NCI (+7.73) condition (p=0.02 for differences between conditions).

Conclusions

Cotinine-validated abstinence was similar between intervention conditions and tended to increase with greater engagement in each condition. Greater C2Q app engagement among continuing smokers was associated with a significantly greater decline in number of cigarettes smoked compared to the other conditions. The Craving to Quit (C2Q) mobile smoking cessation application with mindfulness training was feasible to use and has promise in assisting adolescents to quit or decrease cigarette smoking.

Clinical Trial Registration

Developing a Smartphone App with Mindfulness Training for Teen Smoking Cessation: ClinicalTrials.gov Identifier: NCT02218281.

Culturally-tailored text-messaging intervention for smoking cessation in rural American Indian communities: Rationale, design, and methods

BACKGROUND

American Indian (AI) and Alaska Native (AN) communities experience disproportionately high rates of tobacco use when compared to the overall U.S. population, especially among rural populations.

METHODS

We implemented a single-blind, randomized clinical trial of a text messaging-based smoking cessation intervention through the tobacco quitlines of five states (Alaska, Minnesota, New Mexico, Oklahoma, and Wisconsin) with high percentages of AI residents. We partnered with state quitlines and Optum, a multi-state entity that manages quitlines. Participants who called the quitlines and identified as AI/AN were given the option to enroll in this trial. Upon consent, they were randomly assigned to either the standard quitline program (control) or a program culturally tailored for AI/ANs (intervention), which used a text messaging intervention to encourage smoking cessation. We adapted the text messages based on key informant and focus group input. Baseline data was analyzed for differences across age, sex, and the Fagerström Test for Nicotine Dependence.

RESULTS

We recruited n = 487 AIs into the trial. Participants had an average age of 41.9 years (SD = 11.7) and 66% were female. The average Fagerström Test for Nicotine Dependence score was 5.38 (SD = 2.37). The intervention and control arms did not significantly differ across any of the baseline characteristics.

CONCLUSION

Implementation of this trial illustrated important lessons in adapting, implementing, and evaluating trials in collaboration with AI communities and local and national organizations. This work will inform future efforts to implement culturally-tailored interventions with AI/ANs and advance our knowledge about adapting and implementing smoking cessation interventions.

Nicotine dependence among adolescents in the European Union: How many and who are affected?

Background

Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups.

Methods

The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset.

Results

We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence.

Conclusion

According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.

State-of-the-art office-based interventions to eliminate youth tobacco use: the past decade

Tobacco use and tobacco smoke exposure are among the most important preventable causes of premature disease, disability, and death and therefore constitute a major pediatric health concern. The pediatric primary care setting offers excellent opportunities to prevent tobacco use in youth and to deliver cessation-related treatment to youth and parents who use tobacco. This report updates a "state-of-the-art" article published a decade ago on office-based interventions to address these issues. Since then there has been marked progress in understanding the nature, onset, and trajectories of tobacco use and nicotine addiction in youth with implications for clinical practice. In addition, clinicians need to remain abreast of emerging nicotine delivery systems, such as electronic cigarettes, that may influence uptake or continuation of smoking. Although evidence-based practice guidelines for treating nicotine addiction in youth are not yet available, research continues to build the evidence base toward that goal. In the interim, practical guidelines are available to assist clinicians in addressing nicotine addiction in the pediatric clinical setting. This article reports current practices in addressing tobacco in pediatric primary care settings. It reviews our increasing understanding of youth nicotine addiction, summarizes research efforts on intervention in the past decade and additional research needed going forward, and provides practical guidelines for pediatric health care providers to integrate tobacco use prevention and treatment into their clinical practice. Pediatric providers can and should play an important role in addressing tobacco use and dependence, both in the youth they care for and in parents who use tobacco.

The effectiveness of an integrated multicomponent program for adolescent smoking cessation in Taiwan

If adolescents do not receive appropriate assistance in quitting smoking, they are highly likely to become regular smokers when they enter adulthood. Thus, an effective smoking-cessation program is required. A program was designed based on both the smoking-cessation barriers reported by students and effective strategies derived from the literature. We assigned 143 student smokers from 6 vocational high schools to intervention (n=78) and comparison groups (n=65). Data were collected at the baseline, the end of the program, and 1- and 4-month follow-up time points. For the intervention group, the smoking-abstinence rates confirmed using the urine cotinine test were 22.73% at the end of the program and 20.75% at the 4-month follow-up point. Days smoked in the past month, number of cigarettes smoked per day, and the Fagerström Test for Nicotine Dependence score of the intervention group decreased at all of the time points. The group differences in these variables were statistically significant; the magnitude of effect sizes ranged from 0.44 to 0.95. Multicomponent programs addressing smoking-cessation barriers that students encounter can help adolescents quit smoking.

Smoking beliefs and behavior among youth in South Korea, Taiwan, and Thailand

BACKGROUND

Beliefs about smoking are important predictors of smoking behavior among adolescents, and adolescents who hold positive beliefs about the benefits of smoking are at an increased risk of smoking initiation. An alarming fact is the rising smoking prevalence in Asian countries, particularly the increasing trend in smoking during adolescence.

PURPOSE

This cross-sectional study examined smoking beliefs and behavior among a nationally representative sample of youth in South Korea, Taiwan, and Thailand.

METHODS

Descriptive statistics, linear regression, and logistic regression methods were used to analyze data from 13-15-year-old adolescents who participated in the 2005 Global Youth Tobacco Survey (GYTS) in South Korea (N = 4,765) and Thailand (N = 15,420) and the 2007 GYTS in Taiwan (N = 3,955).

RESULTS

The rate of ever smoking among youth was similar in all three countries and ranged from 26.7 to 28.0 %. The prevalence of current smoking among youth in Thailand (11.4 %) was nearly double the prevalence in South Korea (6.6 %) and Taiwan (6.5 %). Pro-tobacco advertising exposure, as well as older ages, was a positive and significant predictor of positive beliefs about smoking among youth in all three countries. Additionally, youth who reported increased positive smoking-related beliefs, greater pro-tobacco advertising exposure, and were male were more likely to be current smokers in all three countries.

CONCLUSION

Results suggest that greater attention be directed to understanding beliefs and attitudes about smoking among youth. Exploring the relationship between these factors and smoking behavior can provide a strong starting point in the development of effective smoking prevention interventions and tobacco control policies in this region.

Comparing tailored and untailored text messages for smoking cessation: a randomized controlled trial among adolescent and young adult smokers

The aim was to compare the effectiveness of untailored text messages for smoking cessation to tailored text messages delivered at a higher frequency. From February 2007 to August 2009, 2030 users of an internet-based smoking cessation program with optional text message support aged 15-25 years were consecutively randomized to versions of the program that offered either tailored or untailored text messages. Thirty-day point abstinence from smoking was measured self-reportedly at 12-months follow-up. Response rates were 36.3% and 38.1% in the tailored and untailored group, respectively. We analyzed the entire study population, as well as those opting for text messages (n = 1619). In intention-to-treat analysis with multiple imputation of missing data, the odds ratio for 30-day point abstinence was 1.28 (95% CI 0.91-2.08) for the tailored compared with untailored messages. When restricting the analysis to those who had chosen to receive text messages, the corresponding odds ratio was 1.45 (95% CI 1.01-2.08). The higher long-term quit rates in the group receiving the tailored text messages compared with untailored text messages in the restricted analysis indicated that tailoring and higher frequency of text messages increases quit rates among young smokers.

What Do Young New Zealanders Want in Terms of Smoking Cessation?

This study examines young New Zealand smokers’ views of what would help them quit smoking. A qualitative investigation using 10 focus groups with 66 current young smokers, aged between 15 and 17 years, was conducted throughout New Zealand, in late 2011. Transcripts from the focus groups were analysed using NVivo, and common themes and categories within themes were identified. Around half the participants had made a quit attempt in the past, some had tried multiple times using a range of methods; all were unsuccessful. They described both mental and physical difficulties for young people quitting. The participants developed an array of ideas for how to help young people quit smoking, encompassing having supportive people around them, making personal changes and adopting alternative behaviours to smoking, legislative changes, and ideas that were unique to young people. Cessation strategies which reach high risk smokers such as young people, Māori and Pacific peoples, are going to be vital for achieving a smokefree Aotearoa by 2025.

Mobile phone-based interventions for smoking cessation

BACKGROUND

Innovative effective smoking cessation interventions are required to appeal to those who are not accessing traditional cessation services. Mobile phones are widely used and are now well integrated into the daily lives of many, particularly young adults. Mobile phones are a potential medium for the delivery of health programmes such as smoking cessation.

OBJECTIVES

To determine whether mobile phone-based interventions are effective at helping people who smoke, to quit.

SEARCH STRATEGY

We searched MEDLINE, EMBASE, Cinahl, PsycINFO, The Cochrane Library, the National Research Register and the ClinicalTrials register, with no restrictions placed on language or publication date.

SELECTION CRITERIA

We included randomized or quasi-randomized trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention. This included any intervention aimed at mobile phone users, based around delivery via mobile phone, and using any functions or applications that can be used or sent via a mobile phone.

DATA COLLECTION AND ANALYSIS

Information on the specified quality criteria and methodological details was extracted using a standardised form. Participants who dropped out of the trials or were lost to follow up were considered to be smoking. Meta-analysis of the included studies was undertaken using the Mantel-Haenszel Risk Ratio fixed-effect method provided that there was no evidence of substantial statistical heterogeneity as assessed by the I(2) statistic. Where meta-analysis was not possible, summary and descriptive statistics are presented.

MAIN RESULTS

Four studies were excluded as they were small non-randomized feasibility studies, and two studies were excluded because follow up was less than six months. Four trials (reported in five papers) are included: a text message programme in New Zealand; a text message programme in the UK; and an Internet and mobile phone programme involving two different groups in Norway. The different types of interventions are analysed separately. When combined by meta-analysis the text message programme trials showed a significant increase in short-term self-reported quitting (RR 2.18, 95% CI 1.80 to 2.65). However, there was considerable heterogeneity in long-term outcomes, with the much larger trial having problems with misclassification of outcomes; therefore these data were not combined. When the data from the Internet and mobile phone programmes were pooled we found statistically significant increases in both short and long-term self-reported quitting (RR 2.03, 95% CI 1.40 to 2.94).

AUTHORS' CONCLUSIONS

The current evidence shows no effect of mobile phone-based smoking cessation interventions on long-term outcome. While short-term results are positive, more rigorous studies of the long-term effects of mobile phone-based smoking cessation interventions are needed.

How adolescents experience smoking cessation

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.

Sociodemographic and smoking-related psychosocial predictors of smoking behavior change among high school smokers

The purpose of the study was to explore whether sociodemographic characteristics and baseline psychosocial factors were related to short-term smoking cessation and reduction, after controlling for the effects of participating in a virtual world, Internet chat room intervention. Results indicate that smoking-related psychosocial factors are important predictors of adolescent smoking cessation and reduction, independent of the effects of participating in the intervention. Self-efficacy for quitting, social support, and perceived benefits of quitting was related to positive short-term changes in smoking behavior.

What modifiable factors are associated with cessation intentions among smoking youth?

PURPOSE

To examine how smoking behaviour and beliefs, physical activity and weight, and social influences are associated with intentions to quit smoking among youth.

METHODS

This cross-sectional study used self-reported data collected from 26,379 grade 9 to 12 students in Ontario, Canada.

RESULTS

Intending to quit smoking was positively associated with students believing that they could quit smoking, being moderately active, and having smoking friends. Male smokers were less likely to intend to quit smoking than female smokers. Intending to quit smoking in the next 30 days was positively associated with students believing that they could quit smoking and being highly active, and negatively associated with being overweight and having three or more smoking friends.

CONCLUSION

These findings provide insight for researchers and practitioners interested in understanding the factors which may promote smoking cessation among smoking school-aged populations.

Evaluation of an Internet virtual world chat room for adolescent smoking cessation

The goal of this longitudinal study was to test an innovative approach to smoking cessation that might be particularly attractive to adolescent smokers. The study was a participatory research effort between academic and school partners. The intervention used an Internet-based, virtual reality world combined with motivational interviewing conducted in real-time by a smoking cessation counselor. Participants were 136 adolescent smokers recruited from high schools randomized to the intervention or a measurement-only control condition. Those who participated in the program were significantly more likely than controls to report at the immediate post-intervention assessment that they had abstained from smoking during the past week (p<or=.01), smoked fewer days in the past week (p<or=.001), smoked fewer cigarettes in the past week (p<or=.01), and considered themselves a former smoke (p<or=.05). Only the number of times quit was statistically significant at a one-year follow-up assessment (p<or=.05). The lack of longer-term results is discussed, as are methodological challenges in conducting a cluster-randomized smoking cessation study.

Smoking cessation and stress among teenagers

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

Getting it right: designing adolescent-centred smoking cessation services

AIMS

To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services.

DESIGN

Structured qualitative interviews drawing on means-end theory.

SETTING

Three youth-clubs and two secondary schools in south-east Wales.

PARTICIPANTS

Twenty-five male and female 13-18-year-olds, mainly daily smokers.

FINDINGS

Interviewees did not assume immediately that a smoking cessation service is something that will be available to them, and therefore they initially encountered difficulties in identifying attributes of such support. With further prompting interviewees were able to express a preference for support attributes, but these were not attributes that traditionally form part of cessation provision. Their main preference was for support from friends and family, access to nicotine replacement therapy and non-school-based, flexible support and guidance.

CONCLUSION

The results re-emphasize the inadequacies of existing cessation provision for meeting adolescent preferences and suggest that developing more adolescent-appropriate support requires a reconceptualization of existing interventions, with service users situated at the core of intervention design. The study highlights a number of service development points for intervention planners including: rethinking the timing and location of provision; placing more emphasis on the selection of facilitators; harnessing support from friends and family; and rooting these developments in broader tobacco control strategies.

Youth smokers' beliefs about different cessation approaches: are we providing cessation interventions they never intend to use?

INTRODUCTION

Most youth smokers intend to quit, but the majority is neither aware nor interested in most conventional cessation approaches. As such, a critical first step in understanding youth cessation is to better understand the beliefs youth have about different cessation options.

METHODS

This cross-sectional study used self-reported data collected from 26,379 grade 9 to 12 students in Ontario, Canada. We examined both the attitudes of youth smokers toward common smoking cessation approaches and factors associated with intentions to join a school-based cessation program.

RESULTS

The majority of youth smokers intend to quit smoking but tend to have negative attitudes toward most formal smoking cessation approaches; Nicotine Replacement Therapy (NRT) was an exception. Among occasional smokers, self-identification as a smoker and being physically active were positively associated with intending to join a school-based cessation program. Having tried to quit smoking at least once in the past year more than doubled the likelihood of being interested in a school-based program among both occasional and daily smokers.

CONCLUSION

Findings have the potential for informing the development of more effective campaigns for engaging adolescent smokers into smoking cessation treatment. Results also reinforce the need for programmatic innovation within and beyond school settings.

Predictors of smoking cessation processes among secondary school students

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

What is behind smoking among pharmacy students: a quantitative and qualitative study from Turkey

This study, performed in two phases, compared the smoking status of first- and last-year pharmacy students and identified underlying factors of smoking using both "quantitative" and "qualitative" research techniques. The quantitative phase was a cross-sectional study with 207 students (of these, 102 were first-year and 105 were last-year students). The mean age at which first-year students tried tobacco/tobacco products was 14.1 +/- 3.2 and for last-year students, 16.0 +/- 2.4. The students completed an 18-item questionnaire at the end of the spring semester in May 2004. Chi-square and t-test analyses were used for statistical comparisons. Furthermore, focus group discussion techniques were used to find out the underlying factors of smoking in the second phase.

Youth smoking cessation: an update for primary care physicians

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

Evaluation of an adolescent smoking-cessation media campaign: GottaQuit.com

OBJECTIVE

To evaluate the impact of a smoking-cessation media campaign for teens on utilization of a cessation Web site, GottaQuit.com.

METHODS

Telephone surveys were conducted before and after the implementation of a countywide media campaign to promote the use of a smoking-cessation Web site for youths. The surveys were designed to assess teen awareness and utilization of the Web site, as well as tobacco use and cessation attempts. Supplemental 2003 Youth Risk Behavior Survey items also assessed use of the Web site.

RESULTS

Most teen smokers reported that they wanted to quit smoking. Almost all teens reported exposure to GottaQuit.com ads and accurately identified GottaQuit.com as a Web site that offers cessation help for youths. Nearly 1 in 4 smokers who were trying to quit had visited GottaQuit.com or another Web site for cessation assistance.

CONCLUSIONS

The GottaQuit.com campaign effectively reached almost all teens, regardless of smoking status. Smokers were more likely than nonsmokers to have visited the Web site for help with quitting. Web adjuncts are likely to be used by adolescents who seek assistance in quitting.

Smoking habits in adolescents with mild to moderate asthma

To study the impact of mild to moderate asthma on smoking habits in adolescents. Specifically, we tested the hypothesis that asthma does not prevent adolescents from smoking. A research questionnaire, filled by a systematic sample of military personnel upon enrollment to service in the Israeli Defense Force (IDF), was analyzed. Conscripts were asked to voluntarily fill (after obtaining a signed informed consent) a research questionnaire about their medical history, and several health related topics including smoking. This database was matched with the military medical profile of the soldier, which includes the patient asthma status. Overall, 38,047 young adults were included in this study. There was a significant increase in the rate of mild to moderate asthma, from the mid-1980's to date. During the 1980's and early 1990's, asthmatics smoked significantly less frequently (20-22%) than non-asthmatics (25-27%). In the mid- to late-1990's, the smoking rates increased relatively more in asthmatics, to the point that in the last 8 years of this study, they were found to be almost identical in both groups, at a rate of approximately 30%. The presence of asthma is not a powerful motivating agent to prevent from smoking. It is likely that smoking asthmatic teenagers are at risk for suboptimal lung growth, and as young adults, they will become at greater risk of lung function deterioration. We suggest that primary care physicians, caring for asthma in children, adolescents, and young adults, should explain the particular risks generated by tobacco smoking.

Adolescent smoking cessation

PURPOSE OF REVIEW

Approximately 25% of high school students report current cigarette use, 85% of adolescents think about quitting, and around 80% of current smokers made a quit attempt in the past year. This review analyzes recent additions to the adolescent smoking cessation literature from June 1, 2003 to May 1, 2003.

RECENT FINDINGS

Adolescent attitudes toward smoking cessation are largely affected by their smoking history. Youth cessation interventions largely focus on behavioral interventions, and research concerning these interventions has yielded mixed results. Little data exist about the effectiveness of nicotine replacement therapy in adolescents, but there is growing evidence that youth use this pharmacotherapy. Recent research has explored the use of nicotine replacement therapy as an adjunct for enhanced smoking reduction in adults, and future research may focus on this tactic for youth as well. Internet cessation adjuncts and telephone quit lines also serve as future frontiers for adolescent smoking cessation research.

SUMMARY

Information concerning adolescent smoking behaviors, effective interventions, and smoking cessation therapy continue to grow and provide data that improve our understanding of adolescent smoking cessation. Although we cannot directly extrapolate the adult findings to this population, adult cessation research continues to inform future adolescent cessation efforts.