Are you in or out? Recruitment of adolescent smokers into a behavioral smoking cessation intervention

Even though many adolescent smokers want to quit, it is difficult to recruit them into smoking cessation interventions. Little is known about which adolescent smokers are currently reached by these measures. In this study we compare participants of a group-based, cognitive behavioral smoking cessation intervention with adolescent smokers who decided against participating.

Within a non-randomized controlled trial, data of 1053 smokers (age 11–19) from 42 German secondary schools were analyzed. Of these smokers, 272 were recruited into 47 courses of the intervention. An in-class information session, individually addressing potential participants, and incentives were used as means of recruitment. Personal predictors of participation were analyzed using regression analyses and multivariate path analyses to test for mediation. In the path analysis model, nicotine dependence, quit motivation, and a previous quit attempt were directly positively related to participation. Heavier smoking behavior was indirectly positively associated with participation through nicotine dependence and negatively through quit motivation, yielding an overall positive indirect effect. The positive effect of a previous quit attempt on participation was partially mediated through nicotine dependence and quit motivation. The proportion of smoking friends were indirectly positively related to participation, mediated through nicotine dependence.

Since adolescents with heavier smoking behavior and stronger nicotine dependence are less likely to undertake a successful unassisted quit attempt, the reach of these young smokers with professional cessation interventions is desirable. Further measures to improve the recruitment of those currently not motivated to quit have to be examined in future studies.

Update of Adolescent Smoking Cessation Interventions: 2009-2014

The treatment of adolescent tobacco dependence is an imperative public health goal. Adolescent-focused smoking cessation interventions have shown modest results at most, indicating the need for the development of innovative and effective interventions for this vulnerable population. This review aims to provide an update of smoking cessation interventions for youth by reviewing the literature published between 2009 and November 2014 evaluating psychosocial and pharmacological interventions. Based on this examination, future directions for research in advancing the development of adolescent-focused tobacco treatments are provided.

Addiction research centres and the nurturing of creativity: IFT Institut für Therapieforschung in Munich, Germany

This paper describes the history and current structure of the Institut für Therapieforschung (IFT) [Institute for Therapy Research] in Munich, as well as major research topics and factors which might contribute to a creative structure and atmosphere for innovative research in the addiction field. The institute was founded in 1973 as a non-profit non-governmental organization (NGO) with a focus on applied research. Starting with behaviour therapy-based development and evaluation of programmes for alcohol, illicit drugs and smoking and the evaluation of treatment services, the institute gradually expanded its topics, covering prevention (1985) and epidemiology and policy evaluation (1990), and participated throughout this period in the development of guidelines and screening, diagnostic and clinical instruments. Later, the IFT tried to bridge the gap between basic sciences, applied research, health-care services and health policy, with a network of national and international contacts, including its own university engagements and collaborations with foreign research groups and national and European Union (EU) agencies. Possible creativity-promoting factors on the institutional and individual levels are discussed, e.g. the collaboration of experienced senior researchers with carefully selected innovative doctoral students, considerable in-house and external training of young researchers and the early participation and presentation of their work at international conferences, independence from stakeholders in the field and the refusal of project funds which require external clearance of publications.

The role of participants' self-selected future smoking goals in adolescent smoking cessation interventions

BACKGROUND

There is an implicit assumption that abstinence is the treatment goal of young smokers that deliberately participate in cessation interventions, but this may not always be the case. To gain information on subgroups of adolescent intervention participants, we compare participants who want to achieve smoking abstinence (Abst) with those stating a non-abstinence future smoking goal (NAbst), with regard to baseline characteristics, reasons for participation, quit motivation, retention, goal attainment, and smoking abstinence.

METHODS

The sample consisted of 202 adolescent smokers (49.5% female). At baseline, 118 (58.4%) indicated abstinence as future smoking goal and 84 (41.6%) indicated non-abstinence. All participants received a behavioral smoking cessation intervention. Assessments took place before, during, and after treatment, and at 6-month follow-up. Regression analyses were conducted.

RESULTS

Abst and NAbst participants reported similar baseline characteristics. Abst participants, however, were more likely to report a previous quit attempt and indicated a higher quit motivation before and during treatment. Abst participants were more likely to participate based on own initiative and NAbst participants because of participating friends. Both groups attended a similar number of intervention sessions and were equally likely to attain their self-selected smoking goal. However, more Abst participants reported a successful quit attempt during treatment and abstinence at post-treatment and follow-up.

CONCLUSIONS

NAbst participants may represent a substantial subgroup in smoking cessation interventions for adolescents. Results indicate that future smoking goals can influence treatment outcomes. NAbst participants in treatment may benefit from additional information on the negative health consequences of light smoking.

Efficacy of a text message-based smoking cessation intervention for young people: a cluster randomized controlled trial

Background

Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population.

Objective

To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)–based intervention for smoking cessation in young people.

Methods

A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers.

Results

A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group.

Conclusions

This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 19739792; http://www.controlled-trials.com/ISRCTN19739792 (Archived by WebCite at http://webcitation.org/6IGETTHmr).

Smoking cessation with teenagers: the relationship between impulsivity, emotional problems, program retention and effectiveness

AIMS

This study examines whether individual differences in impulsivity and emotional problems in adolescent smokers are related to initial smoking characteristics of participants, acceptance, retention and outcome of a school-based smoking cessation program.

DESIGN

The data was obtained from a feasibility study of a youth-specific, cognitive-behavioral and motivation enhancing program at 22 schools with 139 participating teenage smokers in Germany. A one-group-pre-posttest design was realized.

MEASUREMENT

Impulsivity levels were assessed by use of the impulsivity scale of the IVE ("Inventar zur Erfassung von Impulsivität, Risikoverhalten und Empathie", Stadler, Janke, & Schmeck, 2004). To evaluate the extent of emotional problems, the corresponding 5-items scale of the SDQ-Deu ("Strength and difficulties questionnaire", Klasen et al., 2000) was applied. Smoking behavior and acceptance of the program were assessed by students' self-reports.

FINDINGS

Acceptance and retention did not differ with regard to impulsivity and emotional problems, but initial smoking status did. Cessation rates varied with level of impulsivity: compared to non-impulsive participants, impulsive adolescents succeeded in quitting smoking less often. Emotional problems were not related to the rate of quitting.

CONCLUSIONS

Impulsive adolescents were similarly compliant to the offered cessation intervention as less impulsive smokers. In spite of their general positive evaluation, impulsive adolescents seem to benefit less from a smoking cessation program than their non-impulsive counterparts. Specific elements supporting impulsive teenage smokers in their goal to quit should be incorporated into youth-specific cessation programs.