Although cigarette smoking has recently declined in adolescents, it remains a major health concern because adolescence is a critical period for smoking initiation. Most adult smokers (80%) initiate smoking prior to age 18. Cigarette smoking not only causes significant morbidity and mortality, but also leads to a significant economic burden. Fifty percent of all smokers die due to smoking related illnesses. Even though adolescence is a crucial period for initiation of smoking and progression to regular smoking, there is a lack of evidence for effective treatments for adolescent smokers. Several approaches have been tried with equivocal results. Buproprion SR is efficacious in promoting smoking cessation in adult smokers. Our pilot data suggests that buproprion may ALSO be efficacious in adolescents. Contingency management (CM) has been shown to be efficacious in the treatment of a number of substance use disorders in adults, including smoking cessation. CM has also been shown to be efficacious for increasing retention of subjects in treatment trials. The use of CM in adolescents is under explored. The objective of this proposal is to examine the relative efficacy of medication (buproprion SR), CM and medication + CM for smoking cessation and treatment retention for smoking cessation in adolescents.
The specific aims of the proposed project are: 1) to examine the efficacy of treatment with buproprion SR in adolescents with nicotine dependence. 2) To examine the efficacy of contingency management (CM) + buproprion SR for improving retention and smoking cessation outcomes as compared to buproprion SR treatment alone, in adolescent smokers. 3) To examine the efficacy of treatment with CM in adolescent smokers. The proposed design is a 2x2 balanced factorial design with four treatment groups: 1) buproprion SR only, 2) buproprion SR + CM, 3) CM + placebo, 4) placebo only. Two hundred and sixteen participants will be urn randomized to one of the four conditions. Primary dependent variable will be continuous abstinence and salivary cotinine levels. The total duration of the study will be 12 weeks (1-week medication titration, 4 weeks of active intervention and a 12-week follow-up. Results of the study will help improve the current state of knowledge for smoking cessation in adolescent smokers.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1-MXV-P (26))
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Grossman, Debra
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Medical University of South Carolina
Schools of Medicine
United States
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Lewis, A Lee; Klintworth, Erin M; Hinton, Jessica O et al. (2013) Adolescent Medication Misuse: Results from the MUSC Inventory of Medication Experiences (MIME). Adolesc Psychiatry (Hilversum) 3:184-189
Lewis, A Lee; Baker, Nathaniel; Carpenter, Matthew et al. (2013) Does physician continuity within a clinical trial increase retention and compliance among adolescent smokers? Adolesc Psychiatry (Hilversum) 3:
Gray, Kevin M; Carpenter, Matthew J; Baker, Nathaniel L et al. (2011) Bupropion SR and contingency management for adolescent smoking cessation. J Subst Abuse Treat 40:77-86
Gray, Kevin M; Baker, Nathaniel L; Carpenter, Matthew J et al. (2010) Attention-deficit/hyperactivity disorder confounds nicotine withdrawal self-report in adolescent smokers. Am J Addict 19:325-31
Carpenter, Matthew J; Baker, Nathaniel L; Gray, Kevin M et al. (2010) Assessment of nicotine dependence among adolescent and young adult smokers: a comparison of measures. Addict Behav 35:977-82
Gray, Kevin M; Upadhyaya, Himanshu P (2009) Tobacco smoking in individuals with attention-deficit hyperactivity disorder: epidemiology and pharmacological approaches to cessation. CNS Drugs 23:661-8
Upadhyaya, Himanshu P; Carpenter, Matthew J (2008) Is attention deficit hyperactivity disorder (ADHD) symptom severity associated with tobacco use? Am J Addict 17:195-8
Upadhyaya, Himanshu P (2007) Managing attention-deficit/hyperactivity disorder in the presence of substance use disorder. J Clin Psychiatry 68 Suppl 11:23-30
Upadhyaya, Himanshu P; Rose, Kelly; Wang, Wei et al. (2005) Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults. J Child Adolesc Psychopharmacol 15:799-809
Upadhyaya, Himanshu; Deas, Deborah; Brady, Kathleen (2005) A practical clinical approach to the treatment of nicotine dependence in adolescents. J Am Acad Child Adolesc Psychiatry 44:942-6