) The Healthy People 2000 objectives for tobacco use among adolescents set as targets a smoking prevalence of no more than 15% and a spit tobacco (ST) use prevalence of no more than 4%. The latest data indicate that we will not meet these goals. Besides the need for better tobacco use prevention programs for children and adolescents, we also need effective cessation programs for those adolescents who are already suffering some degree of nicotine addiction. None of the major voluntary health organizations have developed tobacco cessation programs designed specifically for adolescents. The PATCH Project proposes to develop a cessation program for school-based and community-based use that combines known effective strategies for working with youth, and a pharmacological adjunct previously used with adults. Subjects for this study will be youth of ages 14-17 residing within a 100 mile radius of Little Rock, AR, who have been using tobacco for at least one year and who want to quit. The educational materials to be used will be designed especially for smokers or ST users aged 14-17 and will be combined with the use of nicotine patches or placebo patches. The study design is a pre-test, post-test, randomized, placebo-controlled, double-blind clinical trial. A control group will receive a 3-5 minute counseling session followed by a phone call 2 weeks later. One intervention group will receive an age-appropriate, pilot-ested 6-week educational program combined with nicotine replacement therapy while the second intervention group will receive the same educational program but will receive a placebo patch. Both patch groups will receive frequent follow-up telephone counseling sessions. All 3 groups' tobacco use status will be determined at the end of years 1 and 2. If this program is found to be effective it will provide the basis for significantly reducing the prevalence of tobacco use among adolescents and will be able to be offered at both schools and community sites.
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