Exercise helps teens quit smoking

By Dr. Ananya Mandal, MDSep 20 2011

Research has shown that a program that combines counseling with physical activity may offer teens a more effective way to stop smoking. Less than 5 percent of those who were assigned to a brief smoking cessation intervention had quit smoking after three months. But, in the group of teens that received smoking cessation counseling coupled with physical activity, almost 14 percent were off cigarettes at the three-month mark. And, the findings were most dramatic for boys. Nearly a quarter of the boys in the combination group had quit smoking at the end of three months.

“Oftentimes people believe that kids aren't interested in quitting and that they won't take part in an intervention. This study offers a strong case that it is possible to effectively intervene with teen smokers,” said study author Kimberly Horn, a professor in the department of community medicine at West Virginia School of Medicine in Morgantown.

“Physical activity, even in small or moderate doses, can greatly increase the odds of quitting. And, this type of approach attempts to change more than one behavior,” explained Horn. “In West Virginia, we have tremendous health disparities around obesity and tobacco use. If we can target and reduce those health risk behaviors simultaneously, the burden on the health care system could be reduced,” she said.

The findings are to be published in the October issue of Pediatrics, and were released online on Sept. 19.

Slightly more than 17 percent of American teenagers are current smokers, according to the U.S. Centers for Disease Control and Prevention. Teen smokers are more likely to use alcohol and illegal drugs, according to the CDC. And, about one-third of teen smokers will continue to smoke and will die in later life from a smoking-related disease, reports the CDC.

Researchers wrote that while there have been numerous studies on what's effective in smoking cessation for adults, there hasn't been much written about teens quitting.

One program that has been designed for teens is called Not on Tobacco, or N-O-T. This program involves counseling on healthy lifestyles, getting support and managing stress. For this study the researchers randomly selected teens from different schools to one of three groups: the N-O-T group, N-O-T plus physical activity (N-O-T + FIT) and a group that was given a brief intervention. The brief intervention group was given about 15 minutes of smoking cessation advice. The N-O-T group was given a brief counseling session at the start of the study, and then teens were offered a group session once a week. The N-O-T + FIT group were offered everything available to the N-O-T group, plus a log book and a pedometer to record their daily steps. They also received an additional five minutes of encouragement each week. The participants were 233 West Virginia students between the ages of 16 ½ and 19.

At the start of the study, the teens were averaging a half a pack of cigarettes on weekdays and a pack a day on the weekends, according to the study. The researchers recorded quit rates at three months and six months (defined as having quit for seven days). At three months, the self-reported smoking status was confirmed with carbon monoxide validation. The researchers did not have sufficient funding to repeat the validation test at six months. At six months, almost 16 percent of the teens in the brief intervention group said they weren't smoking. More than 21 percent of the teens in the N-O-T group reported quitting, and 31 percent of the teens in the N-O-T + FIT group were still not smoking.

Adolescent medicine specialist Dr. Jonathan Pletcher, from Children's Hospital of Pittsburgh explained, “There's a lot about smoking and adolescents that's very different than smoking and adults. Teens pick up smoking for a whole variety of reasons. Smoking may be the norm in your peer group, or you may be dating someone who smokes. Smoking may be a way to rebel against parents. Nicotine addiction often isn't the driving factor… If teens are going to stop smoking, they have to know why they're smoking and institute new behaviors to replace the old ones.” And, exercise can be a great replacement activity. “Exercise and in particular, cardiovascular exercise, is an excellent way to help kids move toward being tobacco-free. It can change their routine. Exercise can build feelings of self-efficacy, and make teens feel like they can change their behavior. It also causes the release of lactic acid from the muscles and endorphins, which can replace some of those internal reinforcers that come from smoking,” he said.

The bottom line, said Horn, is, “If we give them the right services, they will quit. Teens will stick with it.” “We're very hopeful that it may not require a big dose of extra time to get these kids thinking about changing their physical activity behaviors and their smoking behavior at the same time,” she said. “In these times of tight funding and limited resources, if we can target two health behaviors with a single intervention, then we can make a great impact on health and health economics.”