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Am Fam Physician. 2000;61(10):3111-3112

A 1998 national survey revealed that 35.1 percent of high school seniors reported they had smoked cigarettes in the previous 30 days. The few studies of smoking cessation interventions in adolescents indicate a low abstinence rate, ranging from zero to 11 percent. Hurt and colleagues evaluated the effectiveness of nicotine patch therapy in 101 adolescents (61 males and 40 females) who were 13 to 17 years of age.

The adolescents in the study smoked at least 10 cigarettes per day for at least one year. Exclusion criteria included pregnancy, current use of antipsychotic or antidepressant medications, recent use of any nicotine replacement product and current use of other tobacco products. A 15-mg nicotine patch was used, 16 hours per day, for six weeks.

Before initiating nicotine patch therapy, physicians talked with each subject about smoking cessation according to guidelines from the National Cancer Institute. Baseline expired-air carbon monoxide (CO) and plasma cotinine levels were obtained. The subjects kept a diary of their withdrawal symptoms, including the desire to smoke, feelings of anger, frustration, irritability, anxiety and nervousness, difficulty concentrating, hunger, awakening at night and depression. Additional individual counseling for 10 to 15 minutes was provided at the subject's request.

At each weekly visit, the diaries were collected, and the expired-air CO level was determined. Plasma cotinine levels were obtained in the third and sixth weeks of nicotine patch therapy. Smoking abstinence was considered to have been achieved if the adolescent had not smoked during the previous seven days and had an expired CO level of no more than 8 ppm. Follow-up visits also occurred at weeks 12 and 26, at which time self-reported smoking status was documented, and the expired-air CO level testing was determined. Adolescents who completed the study were paid $100.

The average age of the adolescents was 16 years, and they had been smoking for a median of three years. Ninety-one adolescents returned for at least one follow-up visit, and 71 completed the full six weeks of nicotine patch therapy. Fifty-eight returned for the six-month follow-up visit. The data were analyzed on an intent-to-treat basis, which accounted for all 101 smokers.

A breakdown of the weekly smoking abstinence rates during the study is outlined in the accompanying table. By the third week of nicotine patch therapy, 15 (14.9 percent) of the adolescents were not smoking. However, by the end of the sixth week, only 11 (10.9 percent) of the adolescents were abstinent. At weeks 12 and 26, only five (5.0 percent) were still not smoking. On a positive note, expired-air CO and serum cotinine levels decreased throughout the entire six months of the study, indicating a significant decline in the number of cigarettes smoked.

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The authors conclude that the use of a nicotine patch along with brief counseling is not highly effective in helping adolescents stop smoking. The overall six-month success rate was only 5 percent. They recommend that other pharmacologic and behavioral interventions be tried in this age group.

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