ORLANDO — Adolescent smokers are a difficult population to reach, but researchers are trying some novel approaches to combat smoking in that group including reduction, instead of cessation, and financial incentives.
“To date the field has been frustrated by relatively low success rates,” Robin Mermelstein, Ph.D., of the University of Illinois at Chicago, said at the annual meeting of the Society for Research on Nicotine and Tobacco.
With adolescents, researchers need to consider innovative approaches and target programs where the teens are—in schools, she said.
Some researchers are aiming to do just that. For example, Ping Sun, Ph.D., of the University of Southern California, Los Angeles, and his colleagues are examining the combination of a cessation and prevention curriculum in a single school-based program. In a recent study, Dr. Sun modified the existing Project EX program for application in the classroom.
The program targets at-risk, high school students in California and includes eight learning sessions over a 6-week period. The classroom sessions cover the effects of tobacco on lifestyle, the health impact of tobacco use, and how to avoid smoking relapses.
The intervention also includes unique aspects such as a mock talk show, yoga, and meditation.
More than 1,000 students were randomly assigned to either the cessation and prevention program or standard care, which is whatever curriculum would normally be taught in the students' health class.
Preliminary results show that the effects of the intervention on knowledge, weekly smoking, and daily smoking were all favorable, Dr. Sun said. A post-test survey also showed that most students liked the program and especially enjoyed the meditation component, he said.
These preliminary findings illustrate that it is possible to combine prevention and cessation in a single classroom program and that the approach works equally well for smokers and nonsmokers, Dr. Sun said.
Since smoking cessation is difficult to achieve with adolescent smokers, researchers are also considering ways to reduce smoking in individuals who don't want to quit.
Karen Hanson, Ph.D., and her colleagues at the University of Minnesota recruited teens from 14 high schools in the Minneapolis/St. Paul area who smoked five cigarettes a day and had no intention to quit.
As part of the pilot study, students received either the nicotine patch, nicotine gum, or a placebo. In addition, all the students received cognitive-behavioral therapy sessions that lasted 10–15 minutes and focused on strategies including limiting smoking in certain situations and increasing intervals between cigarettes.
More than 100 adolescents with a mean age of 17 years completed the study. At baseline, participants smoked a mean of 12 cigarettes per day. By the study's completion, 58% of participants cut their smoking intake by at least half. The nicotine-patch group reduced smoking significantly, compared with the other treatment groups, she said.
The 7-day abstinence rates were 4% at the end of treatment, 9% at 3 months, and 7% at 6 months; there were no significant differences between treatment groups, she said.
“Reducing smoking is feasible but it's not an end goal because unless treatment is sustained, reduction was not maintained,” Dr. Hanson said.
Another strategy that works well with adolescents is to offer them cash incentives to quit, according to Suchitra Krishnan-Sarin, Ph.D., of Yale University, New Haven, Conn.
Dr. Krishnan-Sarin tested the idea that contingency management-based intervention—in this case money—could act as a nondrug reinforcer to bolster smoking cessation.
In the preliminary phase, Dr. Krishnan-Sarin and her colleagues recruited students from two high schools to participate in either weekly cognitive-behavioral therapy plus contingency management, or weekly cognitive-behavioral therapy alone.
Smoking abstinence was reinforced on an escalating scale. Participants could earn more than $300 in 1 month plus vouchers for attendance. The control group received about $120 in total for providing breath carbon monoxide (CO) samples plus vouchers for attendance. Both groups provided breath CO samples as evidence of abstinence.
A higher percentage of those students who received contingency management plus cognitive-behavioral therapy completed treatment. In the first week, there were significant differences between the groups. The contingency management plus cognitive-behavioral therapy group had achieved a 77% abstinence rate, compared with 7% for the therapy-only group.
At 1 month, 53% of the intervention group was abstinent, compared with 0% for the control group.
The results show that contingency-management techniques can increase retention and abstinence, Dr. Krishnan-Sarin said, and can be implemented in a school-based setting.
In the second phase of the study, the researchers plan to waive parental consent since in many cases parents don't know that their teens are smoking. They are also considering a briefer version of the cognitive-behavioral therapy component, Dr. Krishnan-Sarin said.