Project Overview +

Adolescent cigarette smokers have disproportionately high rates of co-occurring psychiatric and substance use disorders, similar to those found in the adult smoking population. In the absence of intervention, adolescent smokers with co-morbid psychopathology are likely to become highly dependent, recalcitrant adult smokers who have extreme difficulty quitting smoking. The overall objective of this research program is to develop effective smoking cessation approaches for these high risk youth, and to advance the applicant's knowledge of the relationship between psychopathology and smoking cessation within the context of a treatment outcome study.

Aims +

Compare the efficacy of: (1) brief advice and self-help materials (BA), or (2) a tailored and sustained, motivational intervention with personalized feedback, relapse prevention and coping skills/mood management training, continued telephone counseling, and a parent-involvement phone intervention (MI+).

Participants +

Consecutive sample (n = 191) of 13-17 year olds, admitted for psychiatric hospitalization, who smoked at least one cigarette per week for the past four weeks, had access to a telephone, and did not meet DSM-IV criteria for current psychotic disorder.

Intervention +

The study tests the comparative efficacy of a maximal, tailored and sustained social learning--based smoking cessation treatment versus a minimal smoking cessation treatment in adolescent cigarette smokers with co-morbid psychopathology. The applicants also test the effects of treatment on intermediate variables and examine individual difference variables as predictors of treatment outcome.

The study is a randomized, two-group design with repeated measures over time, comparing the efficacy of: (1) brief advice and self-help materials (BA), or (2) a tailored and sustained, motivational intervention with personalized feedback, relapse prevention and coping skills/mood management training, continued telephone counseling, and a parent-involvement phone intervention (MI+).

In both conditions, adolescent smokers with clear evidence of nicotine dependence and desire to quit smoking are offered transdermal nicotine patch (TNP) therapy upon hospital discharge; for MI+ subjects, the offer of TNP therapy extends throughout the 6 months post-hospital discharge period.

A sample of 320 regular weekly smokers between the ages of 13 and 17 are recruited into the study. Subjects are followed for one year, and smoking cessation is verified by carbon monoxide and saliva cotinine. This study results in the development of a specialized, efficacious treatment intervention approach for the large percentage of adolescent smokers with comorbid psychiatric and substance use disorders, and therefore has important clinical and public health significance.

Findings +

MI did not lead to better smoking outcomes compared to BA. MI was more effective than BA for increasing self efficacy regarding ability to quit smoking. A significant interaction of treatment with baseline intention to quit smoking was also found. MI was more effective than BA for adolescents with little or no intention to change their smoking, but was actually less effective for adolescents with pre-existing intention to cut down or quit smoking. However, the effects on these variables were relatively modest and only moderately related to outcome. Adolescents with comorbid substance use disorders smoked more during follow up while those with anxiety disorders smoked less and were more likely to be abstinent.

Conclusion +

The positive effect of MI on self efficacy for quitting and the increase in intention to change in those with initially low levels of intentions suggest the benefits of such an intervention. However, the effects on these variables were relatively modest and only moderately related to outcome. The lack of overall effect of MI on smoking cessation outcomes suggests the need to further enhance and intensify this type of treatment approach for adolescent smokers with psychiatric co-morbidity.

Comorbid Psychopathology - Teen Smoking Cessation

01/01/1999 - 07/31/1999

Sponsor(s)

National Cancer Institute

Principal Investigator:

Richard A. Brown, PhD

Co-Investigator(s):

Unto E. Pallonen, PhD

Publications: