Nicotine replacement therapy use among adolescent smokers seeking cessation treatment.

OBJECTIVE: To examine the correlates of prior nicotine replacement therapy (NRT) in an urban sample of adolescent smokers seeking smoking cessation treatment. DESIGN: Adolescents were recruited via radio, TV and print advertisements for participation in treatment studies. Participants completed a structured interview usinga prescreeningquestionnaire. SETTING: Data were collected via a telephone interview by trained research personnel. PARTICIPANTS: A sample (N=1879) cessation treatment-seeking volunteer boys (38.2%) and girls (61.8%) aged 12 to 17 years, from a diverse ethnic background residing in the Baltimore, Maryland metropolitan area. INTERVENTIONS: No interventions were used in this observational study. MAIN OUTCOME MEASURES: Use of NRT in adolescents stratified by age, Fagerstrom Test of Nicotine Dependence (FTND), and race/ethnicity. RESULTS: The sample had a mean FTND score of 5.7 (SD = 2.2). About 41% smoked 11 to 20 cigarettes per day. Adolescent smokers who had used NRT were statistically but only marginally older than those who had not (15.9 vs 15.7 years; t-test= -2.60, P=0.01). FTND score, a measure of nicotine dependence, was higher among those who had used NRT (6.0 vs 5.6; t-test= -3.37, P= .001). African American adolescents were less likely to have used NRT than their European American counterparts (33.0% vs 61.2%; chi2=16.09, P<.003). After stepwise logistic regression analyses, age, FTND and race/ethnicity remained predictors of NRT use. CONCLUSION: Our results show differences in NRT use patterns based on age, FTND, and race/ethnicity. European American youths are more likely than their 'other' counterparts to use NRT, after adjusting for age and smoking severity, whereas, African American youth are less likely than their 'other' counterparts to use NRT. These findings suggest racial/ethnic disparities in accessing smoking cessation modalities among adolescents. Further research is needed to fully elucidate factors contributing to these differences in order to facilitate increased smoking cessation rates among all adolescents.

Puffing behavior during the smoking of a single cigarette in tobacco-dependent adolescents.

INTRODUCTION: Adult and adolescent smokers regulate their nicotine and smoke intake by smoking low-yield cigarettes more intensely than high-yield cigarettes. One likely mechanism of nicotine regulation is altered puffing topography, which has been demonstrated in adult smokers. The purpose of this study was to examine the pattern of puffing behavior during the smoking of a single cigarette in adolescents. METHODS: Tobacco-dependent adolescents (n = 89) were enrolled in a treatment trial testing the efficacy of nicotine replacement therapy. About 1 week before their quit date, participants smoked ad libitum one of their usual brand of cigarettes during a laboratory session. Smoking topography measures included puff volume, puff duration, puff velocity, and interpuff interval. RESULTS: Controlling for sex, race, and number of puffs, puff volume and puff duration decreased 12.8% and 24.5%, respectively, from the first 3 to the last 3 puffs. Puff velocity and interpuff interval increased 14.8% and 13.5%, respectively. Puff volume was positively correlated with puff duration and puff velocity, whereas puff duration and puff velocity were negatively correlated. However, none of the topography measures were correlated with smoking history variables. DISCUSSION: These results suggest that adolescent smokers, like adults, are able to regulate smoke and nicotine intake on a puff-by-puff basis, therefore indicating that this aspect of smoking control is acquired early in the tobacco-dependence process.

Weight gain, related concerns, and treatment outcomes among adolescent smokers enrolled in cessation treatment.

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.

Interest in marijuana treatment programs among teenage smokers and nonsmokers.

Little is known about adolescents' interest in marijuana treatment programs. This question was evaluated by telephone interview in a convenience sample of 575 adolescents responding to advertisements for tobacco research studies. Eighty-one percent of respondents endorsed the need for marijuana treatment programs for adolescents. These adolescents were younger and less likely to smoke tobacco, smoke marijuana, or use alcohol than those not endorsing such a need. Among the 192 marijuana smokers, the 58.8% who endorsed the need for marijuana treatment programs took their first puff of marijuana at a younger age than those who did not endorse the need. Those who were willing to participate in a marijuana treatment program were more likely African American and took their first marijuana puff at a younger age than those not interested in treatment. These findings suggest that most adolescent marijuana smokers endorse the need for and are willing to attend marijuana treatment programs.

A link between adolescent nicotine metabolism and smoking topography.

Adult slow nicotine metabolizers have lower smoke exposure, carbon monoxide levels, and plasma nicotine levels than normal and fast metabolizers. Emerging evidence suggests nicotine metabolism influences smoking topography. This study investigated the association of nicotine metabolism (the ratio of plasma 3-hydroxycotinine to cotinine; 3OHCOT/COT) with smoking topography in adolescent smokers (n = 85; 65% female, 68% European American; mean age, 15.3 +/- 1.2 years; mean cigarettes per day, 18.5 +/- 8.5; mean Fagerström Test for Nicotine Dependence, 7.0 +/- 1.2) presenting for a nicotine replacement therapy trial. Measures obtained included puff volume, interpuff interval, number of puffs, puff duration, and puff velocity. Linear regression analysis controlling for hormonal contraception use showed that 3OHCOT/COT ratios predicted mean puff volume in the overall sample (t = 2.126; P = 0.037; adjusted R(2) = 0.067). After gender stratification, faster metabolism predicted higher mean puff volume (t = 2.81; P = 0.009; adjusted R(2) = 0.192) but fewer puffs (t = -3.160; P = 0.004; adjusted R(2) = 0.237) and lower mean puff duration (t = -2.06; P = 0.048; adjusted R(2) = 0.101) among boys only, suggesting that as nicotine metabolism increases, puff volume increases but puffing frequency decreases. No significant relationships were found between nicotine metabolism and total puff volume, mean puff duration, interpuff interval, or puff velocity. If confirmed in a broader sample of adolescent smokers, these findings suggest that as among dependent adult smokers, rate of metabolism among adolescent boys is linked to select parameters of puffing behavior that may affect cessation ability.

Age at menarche and weight concerns in relation to smoking trajectory and dependence among adolescent girls enrolled in a smoking cessation trial.

Many girls adopt dieting and other practices (i.e. cigarette smoking) to control weight during puberty. This analysis explored the relationship between age at menarche and onset of daily smoking, and whether this relationship was influenced by weight concerns among treatment seeking female adolescents. The sample consisted of 71 participants enrolled in a smoking cessation trial (age 15.2+/-1.3 years; 74.7% European American, baseline BMI 24.7+/-5.4, age at menarche 11.7+/-1.3 years, Fagerström Test for Nicotine Dependence score 7.0+/-1.2). Over 60% of participants reported weight concerns at baseline, based on responses to the Eating Disorders module from the Diagnostic Interview for Children and Adolescents. Linear regression analyses revealed a significant association between age at menarche and age of onset of daily smoking (beta=0.18+/-0.09, p=0.038). Having weight concerns did not modify the relationships between age at menarche and smoking trajectory/severity or abstinence. Findings support previous research showing that early maturation represents a risk factor for substance use. Further study in larger samples that include non-treatment-seeking adolescent female smokers is warranted.

Time spent with smoking parents and smoking topography in adolescents.

Although the relationship between parental and adolescent smoking has been linked to health consequences of smoking, limited study has explored the specific association between exposure to smoking and adolescent smoking topography (the way a cigarette is smoked). As a first step in this line of enquiry, smoking topography measures were collected from 67 adolescent dependent smokers. Participants smoked one cigarette of their own brand while being monitored by a computer-based smoking-topography unit and completed questionnaires about their time spent daily with parents who smoke. Pearson's correlation analysis revealed that time spent daily with parents who smoke was significantly associated with maximum puff velocity (r=0.285, p=.019), a parameter predicting later pulmonary morbidity. ANOVAs, after a median split, were consistent with correlation analyses. There was a significant group effect on puff velocity (F(2,66)=5.197, p=.008); no significant relationship was found with puff volume (F(2,66)=.617) or puff duration (F(2,66)=.776). A post hoc Tukey HSD test indicated puff velocity was higher in the "high time spent" (M=54.37, SD=12.03) than in the "low time spent" group (M=45.59, SD=9.91) and in the group with non-smoking parents (M=44.96, SD=10.17). Future research with a larger non-treatment seeking sample of adolescents aimed at preventing tobacco smoking related diseases should further examine parental influences on adolescent smoking, including potential modeling effects.

Shorter time to first cigarette of the day in menthol adolescent cigarette smokers.

Menthol smoking is thought to contribute to the addictiveness of smoking. Given the high prevalence of menthol smoking among youth, the aim of the current analysis was to examine differences in consumption and tobacco dependence, including smoking urgency among menthol and non-menthol adolescent smokers. Data for the current analysis were collected from telephone interviews with adolescent smokers applying to a cessation treatment study. Of 572 adolescent smokers (mean age=15.6+/-1.6 years; 55.1% female; 46.9% African American, 48.2% European American), 531 smoked menthol cigarettes and 41 smoked non-menthol as their usual brand. Analysis using Fisher's Exact (one-tailed) Test revealed that menthol smokers had a significantly shorter time to first (TTF) cigarette of the day compared to non-menthol smokers (smoking within the first 5 min of the day, 45% vs. 29%, respectively; p<0.04). Independent t tests revealed no significant difference in number of cigarettes per day (CPD) (mean=12.2+/-8.5 vs. 11.4+/-8.8; p<0.28) or Fagerstrom Test for Nicotine Dependence (FTND) scores (3.4+/-1.4 vs. 3.2+/-1.3; p<0.23). While preliminary, our findings suggest greater smoking urgency among menthol compared to non-menthol adolescent cessation-treatment seekers. Further study in a broader sample of adolescent smokers is warranted to elucidate the mechanisms underlying the effects of menthol smoking for youths.