Smoking may be on the rise again

Aug 15 2004

Smoking may be on the rise again, especially among adolescents and young adults. The statistics are alarming: About one in five high school seniors smoke cigarettes daily. Yet nearly half a million Americans die prematurely from tobacco-related disease and smoking is projected to in some way kill one third of all smokers.

Two new studies report on how well nicotine replacement therapy (NRT) helps two important groups: teenagers and women. The research appears in the August issue of the Journal of Consulting and Clinical Psychology, which is published by the American Psychological Association (APA).

In the first study, researchers at the Stanford University School of Medicine have found that the nicotine patch seems to work as well, at least initially, for teens as it does for adults. In addition, the patch, the top delivery form of NRT (followed by gum, an inhaler and a nasal spray) worked equally well with or without supplementation by an anti-depressant given to the teens.

The study may be the first randomized controlled trial of drug therapy to help teens stop smoking. Led by psychologist Joel Killen, PhD, researchers randomly assigned 211 smokers, ages 15 to 18, into one of the two treatment groups: a nicotine patch plus the antidepressant drug bupropion SR or a nicotine patch plus a placebo. All teen smokers received behavioral skills training. Because the participants were teens, the authors administered a lower dose of buproprion than is typically given to adult smokers.

At the end of 10 weeks of treatment, 28 percent of the teens who got the patch and skills training had stopped smoking completely – similar to initial quit rates achieved by the nicotine patch in studies of adult smokers and substantially higher than quit rates in previous treatment studies with adolescent smokers. The addition of buproprion appeared to make no difference: Twenty-three percent of teens who received bupropion and nicotine patch stopped smoking by the end of treatment.

However, adult smokers appear better at maintaining abstinence in the longer term. At a 26 week (six month) follow-up, only seven percent of teen smokers in the trial were completely abstinent. However, although most participants did not totally quit, the large majority in both treatment groups cut down to a few cigarettes per day or less. Many managed to avoid going back to daily smoking. Anti-depressant use didn’t affect the outcome, but the authors note that they gave the teenagers a lower dose of this well-tolerated medication than is typically used when treating adults.

The second study, at Texas A&M University, assessed how well NRT has worked for women vs. men. This first meta-analysis (a study of studies) of 21 double-blind, randomized, placebo-controlled studies found clear evidence that in the long term, women using NRT have found it harder than men to quit smoking.

Overall, NRT worked better than any placebo and was about as helpful to men and women after six months. For both sexes, NRT effectiveness declined as follow-up periods grew longer. However, that worrisome decline was statistically significant only in women, for whom abstinence rates dropped more sharply between three and 12 months and even between six month and 12 months. As a result, men who quit using NRT were more likely than women to be abstinent at 12 months. By a year after starting NRT, the therapy worked better for men and it was statistically superior to placebo only in men.

Led by Antonio Cepeda-Benito, PhD, the authors say the results support recommendations, especially for women, to use NRT in conjunction with comprehensive smoking cessation programs rather than as the sole or main component of treatment. The authors suggest that women could benefit from treatment designed to prevent relapse due to widely held expectations that smoking prevents weight gain, regulates mood or has some other desired effect.