Medication plus counseling may help teens kick the smoking habit

November 05, 2007

The medication bupropion plus counseling appears to help adolescents quit cigarette smoking in the short term, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Almost one-fourth of U.S. high school students currently smoke cigarettes, according to background information in the article. Many teen smokers want to quit, but studies estimate that only about 4 percent of those who try are successful each year. The antidepressant bupropion has been shown to help adults quit smoking and also is used to treat attention deficit disorders in children.

Myra L. Muramoto, M.D., M.P.H., Scott J. Leischow, Ph.D., and colleagues at the University of Arizona, Tucson, conducted a clinical trial of 312 adolescents age 14 to 17 who smoked six or more cigarettes per day and had tried to quit at least twice before. They were randomly assigned to receive 150 milligrams (105 teens) or 300 milligrams (104 teens) of bupropion per day, or placebo (103 teens). Participants visited the clinic weekly for seven weeks--six weeks of treatment plus one week post-treatment--and received 10- to 20-minute individual cessation counseling sessions. They were interviewed by phone after 12 weeks and in person after 26 weeks.

During treatment, quit rates were higher for the 300-milligram group than for placebo every week except the fourth week. After six weeks, 5.6 percent of those in the placebo group, 10.7 percent of those in the 150-milligram bupropion group and 14.5 percent of those in the 300-milligram group had quit smoking. At the 26-week follow-up, 10.3 percent of those who took placebo, 3.1 percent of those who took 150 milligrams of bupropion and 13.9 percent of those who took 300 milligrams were still abstaining from cigarettes. The teens' reported quit rates were verified by checking the level of cotinine, a byproduct of nicotine processing, in the urine.

Though the results suggest that 300 milligrams of bupropion plus brief counseling sessions may help teens quit smoking over the short term, abstinence rates at the end of the treatment period were lower than those seen in adults taking the same medication, the authors note. In addition, the high rate of relapse after stopping medication suggests that a longer treatment period--such as the 12 weeks recommended for adult smokers--may be needed.

"Nonetheless, this study provides hope for helping a generation of smokers quit before they become adults," the authors conclude. "These results are critically important because few effective treatment options are available for adolescent smokers who want to quit."
-end-
(Arch Pediatr Adolesc Med. 2007;161(11):1068-1074. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by a National Cancer Institute grant, The Robert Wood Johnson Foundation (financial support for all aspects of the study) and GlaxoSmithKline (provided study medication and placebo, financial support for cotinine analyses, subject screening, data cleaning and review of the draft manuscript; all data were maintained by the University of Arizona). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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