Aug. 16, 2004 STANFORD, Calif. - Nicotine patches may work as well for teens trying to kick the smoking habit as they do for adults, say researchers from the Stanford University School of Medicine and Lucile Packard Children's Hospital. The findings suggest that physicians should consider the popular therapy for teenaged patients who routinely light up but want to quit.
The researchers also found that the patches were equally effective in adolescents regardless of whether they were combined with an antidepressant often used to help adults stop smoking. All teens in the study also received behavioral skills training to help them identify and manage trigger situations that usually had them reaching for a cigarette.
"We're encouraged because in our study the initial quit rates for kids treated with nicotine patches and skills training were similar to those seen in adults," said Joel Killen, PhD, professor (research) of medicine at the Stanford Prevention Research Center and lead author of the study. "Just as importantly, most of the kids in the study were able to substantially reduce their tobacco usage, which has not been seen in previous studies."
The study, published in the August issue of the Journal of Consulting and Clinical Psychology, is the first randomly controlled trial of medication to help young smokers quit and is the first to compare success rates of the patch with and without antidepressant medication in this age group.
Despite a national effort to shield kids from the lure of tobacco, one in five U.S. high school seniors smokes daily. Reasons for lighting up for the first time can run the gamut from mimicking family members to deliberate risk taking to weight control. The desire to stop can be equally complex.
"Kids tend to think they can quit whenever they want, that they're bulletproof," said Killen. But a rising awareness of the unpleasant aspects of smoking, coupled with tight pocketbooks and rising cigarette costs, is spurring more teens to reduce or stop smoking.
"A lot of teens realize that it's a nasty habit," said study co-author and adolescent medicine specialist Seth Ammerman, MD. "Some have noticed that they have poor stamina or have seen relatives die from smoking-related causes. Others have friends who are encouraging them to stop." Ammerman is the medical director of Lucile Packard Children's Hospital's Teen Health Van, which provides care for homeless youth.
Quitting can be much more difficult than a teen had expected, however. And those who turn to their doctors for help may not always be getting the support they need. "Most pediatricians who work with kids are not used to treating a drug addiction," said Ammerman. "We're used to giving a kid medicine and then they do well and move on, but treating tobacco addiction takes repeated time and effort."
In the study, the authors tested the effect of the nicotine patch on 211 teens between the ages of 15 and 18 who smoked at least 10 cigarettes a day and had been smoking for the previous six months. The volunteers had all made at least one failed attempt to stop smoking and scored highly on a questionnaire that rates nicotine dependence. Teens were recruited from nine continuation high schools in the San Francisco area.
Participants were divided into two groups, one treated with the nicotine patch plus the antidepressant bupropion, and one with the nicotine patch plus placebo. Bupropion, which is also approved as a smoking-cessation aid in adults, is thought to help reduce the depressive symptoms and cravings that can accompany nicotine withdrawal. All of the teens attended weekly group counseling sessions to cope with smoking urges.
Every participant was required to stop smoking two weeks after the first counseling session. All patients received the nicotine patch in tapering strengths for eight weeks. Starting levels were tailored to the daily number of cigarettes a teen had been smoking. Those randomized to receive bupropion began one week before quitting, and continued treatment for nine weeks. Medication and smoking status was confirmed through blood, urine and breath tests.
After 10 weeks of treatment, 23 percent of the teens using both the patch and the antidepressant had stopped smoking completely and 28 percent of teens using the patch plus placebo had kicked the habit - a statistically insignificant difference. Maintaining abstinence was even more difficult for teens than it is for adults, however: only 8 percent of teens on both medications and 7 percent of teens on the patch plus placebo were still abstinent after 26 weeks.
Although it was tough to turn down cigarettes for good, most of the kids in both treatment groups were able to reduce and maintain their cigarette intake to just a few cigarettes per day, indicating that the treatment had at least some benefit for nearly all the participants.
"Physicians used to believe that they didn't have the appropriate skills to help teens stop smoking," said Killen. "Nicotine-replacement therapies may be a valuable tool for these doctors. This finding gives us a platform to build on, whereas before doctors threw up their hands when faced with teen smokers."
The study was funded by the National Cancer Institute. Medication was provided by GlaxoSmithKline.
Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.
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