Tobacco use and addiction is an enormous economic and public health burden on our society and the Healthy People 2010 goal is to reduce tobacco use rates to 16%. For the majority of smokers, smoking habits are initiated and established during adolescence. The CDC estimates that approximately 5 million adolescents will die prematurely in adulthood due to smoking-related illnesses (MMWR, 2000). Despite this knowledge, the rates of current smoking in high school adolescents remain as high as 34.5%. Recent surveys indicate that the majority of adolescent smokers, 61%, report wanting to quit smoking and 59.3% report that they had made a quit attempt in the past 12 months (MMWR, 2001). Despite the obvious interest in quitting smoking, there is a dearth of empirically supported smoking cessation interventions for this high risk population of smokers. Our group is conducting a systematic series of studies on the use of contingency reinforcement procedures to recruit and motivate abstinence in adolescents who want to quit smoking. Results from an ongoing pilot study that is evaluating the effect of combining a progressive contingency management (CM) reinforcement schedule with weekly CBT sessions, suggests great promise for the use of CM for adolescent smoking cessation (6/9 adolescents who received CM+CBT versus 1/8 adolescents who received CBT alone were abstinent at the end of the treatment period). In the current proposal, which will advance this line of research, we will first conduct two pre-pilots that will address the following questions 1) What is the most appropriate schedule of CBT skills training to serve as a platform for the CM intervention and 2) What is the most effective length of the CM + CBT intervention for promoting more durable smoking abstinence? The results of these pre-pilots will determine the skills training and length of intervention to be used in the third study, which will be a Stage lb trial that will evaluate the potential efficacy of CM of abstinence (i.e. reinforcing adolescents for not smoking on a progressively increasing schedule) versus non-contingent reinforcement for attendance on a similar progressive-ratio schedule. The primary outcomes will be biochemically-verified abstinence rates during and at the end of the treatment period. The results of this proposal will set the stage for a larger Stage II trial which will continue this promising line of investigation.
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