DESCRIPTION: (Applicant's Description)
Adolescent cigarette smokers have disproportionately high rates of
co-occurring psychiatric and substance use disorders, similar to those found
in the adult smoking population. In the absence of intervention, adolescent
smokers with comorbid psychopathology are likely to become highly dependent,
recalcitrant adult smokers who have extreme difficulty quitting smoking.
The overall objective of this research program is to develop effective
smoking cessation approaches for these high risk youth, and to advance the
applicant's knowledge of the relationship between psychopathology and
smoking cessation within the context of a treatment outcome study.
The proposed study will test the comparative efficacy of a maximal, tailored
and sustained social learning--based smoking cessation treatment versus a
minimal smoking cessation treatment in adolescent cigarette smokers with
comorbid psychopathology. The applicants will also test the effects of
treatment on intermediate variables and examine individual difference
variables as predictors of treatment outcome.
The study is a randomized (by cohort), two-group design with repeated
measures over time, comparing the efficacy of: (1) brief advice and
self-help materials (BA), or (2) a tailored and sustained, motivational
intervention with personalized feedback, relapse prevention and coping
skills/mood management training, continued telephone counseling, and a
parent-involvement phone intervention (MI+). In both conditions, adolescent
smokers with clear evidence of nicotine dependence and desire to quit
smoking will be offered transdermal nicotine patch (TNP) therapy upon
hospital discharge; for MI+ subjects, the offer of TNP therapy will extend
throughout the 6 months post-hospital discharge period. A sample of 320
regular weekly smokers between the ages of 13 and 17 will be recruited into
the study. Subjects will be followed for one year, and smoking cessation
will be verified by carbon monoxide and saliva cotinine.
The applicants expect that this study will result in the development of a
specialized, efficacious treatment intervention approach for the large
percentage of adolescent smokers with comorbid psychiatric and substance use
disorders, and will therefore have important clinical and public health
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