Behavioral Intervention for Smoking Cessation in Adolescents and Young Adults
Schepis, Ty Stephen
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Smoking is the leading preventable cause of morbidity and mortality in the United States. The vast majority of adult smokers initiate smoking before the age of 18, and the cumulative risk for initiation does not decline until the middle 20's. Thus, early intervention programs could be of great benefit to public health. Here, we have tested such a program: a smoking cessation treatment named the Modified Brief Office Intervention (M-BOI). The M-BOI is a 10-session cognitivebehaviorally based intervention. Sixty-three participants were consented for treatment, and 38 received M-BOI treatment, in conjunction with randomized double-blind, placebo-controlled bupropion. Of treated participants, 60.5% reduced their baseline level of smoking by half at the end of treatment; overall, treated participants reduced their smoking by 49.8%. Using intent-to-treat analyses, 7.3% of participants achieved biochemically verified cessation, and treatment was associated with a significant decrease in smoking. Treatment did not seem to significantly reduce exhaled carbon monoxide (CO) levels but did reduce urine cotinine. Depression history and baseline level of depressive symptoms had no effect on change in smoking during treatment, but this may have been due to low power to detect differences. Exploratory analyses demonstrated that treatment was associated with an increase in smoking-related self-efficacy, and decreases in maladaptive cognitions related to unpleasant events, nicotine withdrawal symptoms, smoking urges and nicotine dependence symptoms. Finally, there were preliminary indications that treatment ameliorated depressive symptoms in individuals with a history of a depressive disorder. Participants rated treatment as helpful with their cessation efforts and the majority would recommend M-BOI treatment to others. One major limitation of this study is the lack of data on M-BOI treatment without pharmacotherapy. Taken together, this study provides preliminary evidence for the efficacy and acceptability of the M-BOI. Further evaluation is needed to more firmly establish its effects.