Approximately 40-80 percent of adolescent daily smokers have tried to quit smoking, but have been unsuccessful. Present treatments for adolescent smokers have not produced high rates of tobacco abstinence. On the other hand, a significant number of young smokers who have failed to achieve abstinence have been able to reduce their levels of smoking. Few studies have examined the course of these outcomes and whether intervention focusing on reducing or sustaining reduced smoking among the adolescent who cannot quit would produce more effective long-term treatment results. The goal of this grant proposal is to determine whether treatment aimed at smoking reduction among adolescents unable to quit is a viable method of intervention. Two studies are proposed. The first study will determine effective methods for smoking reduction. Adolescents uninterested in quitting will be randomized to one of four conditions for a period of 4 weeks: 1) placebo medication, 2) nicotine patch, 3) nicotine gum, and 4) bupropion. Outcome measures will include compliance to the method of treatment and extent of smoking reduction. The second study will involve a tobacco exposure reduction intervention among those adolescents unable to quit smoking. All adolescents enrolled in the study will be provided smoking cessation treatment. Those adolescents who are unsuccessful will be randomly assigned to an intervention focusing on reduction of smoking or usual care. Those assigned to the reduced smoking intervention will be provided the treatment method(s) that are demonstrated to be efficacious in reducing smoking in the first study. The usual care group will be seen for the same frequency of treatment visits as the reduction group to control for clinic contacts. Follow-up will occur with all groups (successful abstainers and those randomly assigned to interventions) at 12, 26 and 52 weeks. The outcome measures will include a comparison between the reduction intervention group and the usual care on: (1) extent of cigarette reduction and percent who reduce by > 50 percent of baseline; (2) the percent of adolescent smokers who eventually become abstinent from smoking; and (3) the course of treatment outcome. We hypothesize that those individuals who are assigned to tobacco reduction treatment condition compared to the usual care condition will sustain a reduced level of smoking and experience greater eventual success in achieving abstinence.
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