Adolescent smokers screened for a nicotine replacement treatment trial: Correlates of eligibility and enrollment ? We describe and evaluate the screening process for enrolling adolescent smokers into the randomized clinical trial of nicotine replacement therapy (NRT). Adolescent smokers obtained the recruitment call-in number (1-800-NO-SMOKE) via media and other advertisements. Trained recruitment staff collected information using an internally-developed, targeted telephone screening interview, which was used to determine pre-eligibility for the clinical trial. Correlates of qualification and of study enrollment were determined. Among 1347 adolescents screened, 24.4% (3291347) were eligible to participate in the trial. Light smoking (39.1%) and lack of parental support (14.8%) were the biggest contributors to ineligibility. Eligible adolescents were more likely to be female (66.9% vs. 58.2%, p0.0052) and more likely to be European American (63.5% vs. 52.2%, p0.0003). The higher rates of ineligibility for African Americans and boys were partially explained by lower FTND scores. Of those eligible to participate in the trial, 48.3% (159329) enrolled. Results underscore the need for screening instruments that are measurement-invariant across ethnicities and gender, and enrollment strategies that maximize inclusion of eligible participants.? ? Ethnoracial differences among adolescent dependent smokers were also explored. Variations in nicotine metabolism are thought to contribute to differences in cigarette consumption between African Americans and Caucasian adult smokers. To investigate the potential mechanism of previously documented lower smoking rates among African American adolescent smokers seeking cessation treatment, we measured nicotine metabolite ratios as markers of the metabolic disposition of nicotine, which is generally considered to be under the influence of cytochrome P450 (CYP) 2A6. Plasma ratios of trans-3-hydroxycotinine (3HC) to cotinine (COT) were examined in ninety-two cessation treatment seeking adolescents (mean age 15.2 SD 1.3, 69% female, 31% African American, mean Fagerstrvm Test for Nicotine Dependence (FTND) 6.5, SD 1.6, mean years smoked 2.6 SD 1.6). Groups were similar in age, gender distribution and mean FTND score. Analysis using independent t-tests revealed significantly lower number of cigarettes per day (CPD) (15.1 SD 7.6 vs. 19.6 SD 8.0, p0.013) and nicotine metabolite ratios (0.27 SD 0.15 vs. 0.35 SD 0.16, p0.026) in African American compared to Caucasian adolescent smokers. Consistent with metabolic variation, mean COTCPD ratio was significantly higher in African American compared to Caucasian adolescents. Results remained statistically significant after controlling for menthol brand smoking. These findings are consistent with those found among adult smokers and provide a putative mechanism for reported ethnoracial differences in adolescent cigarette consumption. Our results underscore the need for measures independent of consumption for determining degree of nicotine dependence and treatment selection across ethnicities, even among youths.? ? We examined the predictive value of pre-treatment smoking rates and topography variables for abstinence outcomes among 66 adolescents enrolled in a three-month smoking-cessation trial using nicotine replacement and cognitive-behavioral therapy. Pre-treatment variables included cigarettes per day (CPD), puff volume, puff duration, and several youth-adapted Fagerstrvm-derived questionnaire scores. Outcome measures included prolonged abstinence at end of treatment and point-prevalent abstinence three months after the end of the trial. Logistic regression controlling for treatment group showed that increases in baseline cigarettes per day (OR1.438, 95% CI 1.051-1.967) and average puff volume (OR1.168, 95% CI 1.030-1.326) predicted continued smoking at the end of treatment. Puff volume (p0.013), but not CPD, predicted abstinence at the three-month follow-up. None of the youth-adapted Fagerstrvm questionnaires predicted outcome on either abstinence measure. If confirmed in a larger sample, our findings suggest that puff topography and possibly CPD may predict cessation outcome better than Fagerstrvm scores in adolescent smokers.? ? Of 572 adolescent smokers (mean age 15.6 1 1.6 yrs; 55.1% female; 46.9% African American, 48.2% European American), 531 smoked menthol cigarettes and 41 smoked non-menthol as their usual brand. Analysis using Fisher.s Exact (one- tailed) test revealed that menthol smokers had a significantly shorter time to first (TTF) cigarette of the day compared to non-menthol smokers (smoking within the first 5 minutes of the day, 45% vs 29%, respectively, p< 0.04). Independent t tests revealed no significant difference in cigarettes per day (CPD) (means 12.2 1 8.5 vs. 11.4 1 8.8 p< 0.28) or Fagerstrom Test for Nicotine Dependence (FTND) scores (3.4 1 1.4 vs. 3.2 1 1.3 p< 0.23). While preliminary, our findings suggest greater smoking urgency among menthol compared to non-menthol adolescent cessation-treatment seekers. Further study in a broader sample of adolescent smokers is warranted to elucidate the mechanisms underlying the effects of menthol smoking for youths. ? ? Although adult alcohol use is negatively associated with tobacco cessation, this relationship has not been reported for adolescents. We assessed the relationship between alcohol use and point prevalence abstinence from smoking in a sample of tobacco-dependent adolescents undergoing cessation treatment. Alcohol use both at baseline and) during tobacco cessation treatment was examined as predicting smoking abstinence in 101 adolescents (age 15.1 SD 1.31 years, age at first cigarette 11.3 SD 1.93 years, age at first drink 12.01 SD 2.87 years) attending a total of 642 treatment visits. Mixed regression analysis showed that participants who reported alcohol use during tobacco cessation treatment were significantly less likely to abstain from tobacco smoking (OR0.42, 95% CI 0.23-0.78, t-2.78, df540, p0.0057). However, pre-enrollment alcohol use was not significantly associated with either short or long-term tobacco abstinence. If confirmed in a larger group of adolescents, our findings suggest that youths attempting to quit smoking should abstain from alcohol.? ? Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean 14.9yrs), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p .013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p<.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.
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