) Adolescent cigarette smokers have disproportionately high rates of co-occurring psychiatric and substance use disorders, similar to those found in the adult smoking population. In the absence of intervention, adolescent smokers with comorbid psychopathology are likely to become highly dependent, recalcitrant adult smokers who have extreme difficulty quitting smoking. The overall objective of this research program is to develop effective smoking cessation approaches for these high risk youth, and to advance the applicant's knowledge of the relationship between psychopathology and smoking cessation within the context of a treatment outcome study. The proposed study will test the comparative efficacy of a maximal, tailored and sustained social learning--based smoking cessation treatment versus a minimal smoking cessation treatment in adolescent cigarette smokers with comorbid psychopathology. The applicants will also test the effects of treatment on intermediate variables and examine individual difference variables as predictors of treatment outcome. The study is a randomized (by cohort), two-group design with repeated measures over time, comparing the efficacy of: (1) brief advice and self-help materials (BA), or (2) a tailored and sustained, motivational intervention with personalized feedback, relapse prevention and coping skills/mood management training, continued telephone counseling, and a parent-involvement phone intervention (MI+). In both conditions, adolescent smokers with clear evidence of nicotine dependence and desire to quit smoking will be offered transdermal nicotine patch (TNP) therapy upon hospital discharge; for MI+ subjects, the offer of TNP therapy will extend throughout the 6 months post-hospital discharge period. A sample of 320 regular weekly smokers between the ages of 13 and 17 will be recruited into the study. Subjects will be followed for one year, and smoking cessation will be verified by carbon monoxide and saliva cotinine. The applicants expect that this study will result in the development of a specialized, efficacious treatment intervention approach for the large percentage of adolescent smokers with comorbid psychiatric and substance use disorders, and will therefore have important clinical and public health significance.
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