Treatment of adolescent smokers with the nicotine patch

Department of Psychiatry, University of Minnesota, Minneapolis, MN 55414, USA.
Nicotine & Tobacco Research (Impact Factor: 3.3). 09/2003; 5(4):515-26. DOI: 10.1080/14622200307243
Source: PubMed


This study examined the effects of the nicotine patch on craving and withdrawal symptoms, safety, and compliance among adolescents. The secondary goal was to conduct a preliminary investigation of the effectiveness of the nicotine patch in helping adolescents quit smoking. The study design was a double-blind, placebo-controlled, randomized trial of the nicotine patch. The intervention also provided intensive cognitive-behavioral therapy and a contingency-management procedure. Participants (n=100) attended 10 treatment visits over 13 weeks. Compared with the placebo patch group, the active nicotine patch group experienced a significantly lower craving score and overall withdrawal symptom score (p=.011 and p=.025, respectively), as well as a time trend toward lower scores (p<.001) in craving only. Moreover, the nicotine patch appeared safe for adolescents to use. No differences by treatment group were found in experiencing adverse events, except that the participants in the placebo patch group reported more headaches than those in the active nicotine patch group. As another measure of safety, the overall mean salivary cotinine levels were significantly lower at 1, 6, 8, and 10 weeks postquit (all p<.05) compared with baseline levels, although these results were confounded by dropouts. Additionally, a significant number of participants were compliant with using the nicotine patch daily. Finally, point prevalence (7-day and 30-day abstinence rates) and survival analysis of participant abstinence indicated no significant differences between treatment groups. The results of this study suggest that the nicotine patch is a promising medication and a larger clinical trial of the nicotine patch among adolescents is warranted.

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    • "Indeed, NRT exhibits a wide safety profile and can be administered during pregnancy after failure of nonpharmacological interventions, in patients with cardiovascular diseases and in smokers aged 12 years and over (Schroder et al., 2002; Coleman et al., 2011; Thomas 2012; Hanson et al., 2003); though many healthcare professionals would be, based on conventional wisdom, unclear or hesitant to initiate this. Hence again, it is crucial for healthcare practitioners to keep abreast in order to successfully assist smokers in quitting. "
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    ABSTRACT: With the emerging role of pharmacists in implementing smoking cessation services and the recent evidence about smoking cessation pharmacotherapies, a needs analysis to assess baseline knowledge about current smoking cessation practice is needed; hence, training and development in this area can target possible 'gaps'. This study aimed at exploring pharmacy students' knowledge about and attitudes toward smoking cessation, as compared to practicing community pharmacists and smoking cessation educators. The overall objective was to uncover underlying 'gaps' in pharmacy-based smoking cessation practice, particularly clinical gaps. Final-year pharmacy students at the University of Sydney, practicing community pharmacists and smoking cessation educators in Australia. As no previous standard pharmacist-focused smoking cessation knowledge questionnaires exist, a review of the literature informed the development of such a questionnaire. The questionnaire was administered to a cohort of fourth-year pharmacy students at the University of Sydney, practicing pharmacists and smoking cessation educators. Data analysis was performed using Predictive Analytics SoftWare (PASW® Statistics 18). Mean total scores, independent t-tests, analysis of variances and exploratory factor analysis were performed. To determine areas of major clinical deficits about current evidence related to smoking cessation interventions at the pharmacy level. Responses from 250 students, 51 pharmacists and 20 educators were obtained. Smoking educators scored significantly higher than pharmacists and students (P < .05), while score differences in the latter two groups were not statistically significant (P > .05). All groups scored high on 'general' knowledge questions as compared to specialised pharmacologic and pharmacotherapeutic questions. All respondents demonstrated positive attitudes toward the implications of smoking cessation. Factor analysis of the 24-item knowledge section extracted 12 items loading on 5 factors accounting for 53% of the total variance. The results provide a valid indication of 'gaps' in the practice of up-to-date smoking cessation services among Australian pharmacy professionals, particularly in clinical expertise areas involving assessment of nicotine dependence and indications, dosages, adverse effects, contraindications, drug interactions and combinations of available pharmacotherapies. These gaps should be addressed, and the results should inform the design, implementation and evaluation of a pharmacy-based educational training program targeting current clinical issues in smoking cessation.
    Full-text · Article · Sep 2013 · SpringerPlus
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    • "Internet-based methodologies can also be used to increase the accessibility and feasibility of contingency management interventions for behavior other than smoking (Kosten, 2007; Carroll and Rounsaville, 2007). For example, contingency management has been used to reinforce adherence to prescription and non-prescription medication protocols, such as the complicated HIV antiretroviral protocol (Rosen, Dieckhaus, McMahon, Valdes, Petry, Cramer, Rounsaville, 2007; Sorenson, Haug, Delucchi, Gruber, Kletter, Batki, Tulskey, Barnett, Hall, 2007) and nicotine replacement therapy for smoking cessation (Hanson, Allen, Jensen, Hatsukami, 2003; Mooney, Babb, Jensen, Hatsukami, 2005). Furthermore, contingency management has also been applied to behavior associated with promoting general health, such as increasing engagement in exercise regimens (Epstein, McKenzie, Valoski, Klein, Wing, 1994; Dapcich-Miura and Hovell, 1979), facilitating adherence with prescribed diets (Epstein et al., 1994; Dapcich-Miura and Hovell, 1979), encouraging behavior necessary to control diabetes (Duvinsky, Jacobs, Foy, 1987; Lowe and Lutzker, 1979), and establishing consistent monitoring of lung capacity by asthmatic children and adolescents (Burkhart, Rayens, Oakley, Abshire, and Zhang, 2007). "
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    ABSTRACT: Information technology represents an excellent medium to deliver contingencies of reinforcement to change behavior. Recently, we have linked the Internet with a science-based, behavioral treatment for cigarette smoking: abstinence reinforcement therapy. Under abstinence reinforcement interventions, incentives are provided for objective evidence of abstinence. Several studies suggest that the intervention is effective in initiating abstinence. The intervention addresses limitations (access, cost, sustainability, and dissemination potential) inherent in traditional abstinence reinforcement delivery models. It can also be applied to vulnerable, at-risk populations, and to other behavior to promote health. Information technologies offer unprecedented and rapidly expanding opportunities to facilitate behavior change.
    Full-text · Article · Jan 2011 · Substance Use & Misuse
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    • "Additionally, our reported abstinence rates may be underestimates, as we conservatively opted to consider participants to be non-abstinent at all missed visits. Our treatment completion rate, 30% inclusive of all randomization groups, was somewhat lower than those in prior large-scale adolescent smoking cessation pharmacotherapy studies, which have ranged roughly from 40% to 60% (Hanson et al., 2003; Moolchan et al., 2005; Muramoto et al., 2007). We encountered several potential contributing factors. "
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    ABSTRACT: There is a significant need for evidence-based treatments for adolescent smoking cessation. Prior research, although limited, has suggested potential roles for bupropion sustained-release (SR) and contingency management (CM), but no previous studies have assessed their combined effect. In a double-blind, placebo-controlled design, 134 adolescent smokers were randomized to receive a 6-week course of bupropion SR + CM, bupropion SR + non-CM, placebo + CM, or placebo + non-CM, with final follow-up at 12 weeks. The primary outcome was 7-day cotinine-verified point prevalence abstinence, allowing for a 2-week grace period. Combined bupropion SR + CM treatment yielded significantly superior abstinence rates during active treatment when compared with placebo + non-CM treatment. In addition, combined treatment showed greater efficacy at multiple time points than did either bupropion SR + non-CM or placebo + CM treatment. Combined bupropion SR and CM appears efficacious, at least in the short-term, for adolescent smoking cessation and may be superior to either intervention alone.
    Full-text · Article · Oct 2010 · Journal of substance abuse treatment
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