Smoking cessation treatment targets adolescents

December 10, 2019

Preventable deaths are those that can be stymied by public health intervention, and deaths related to tobacco use are at the top of that list in the United States as well as globally.

And while rates of adolescent smoking have declined over the years, 4.9 million middle and high school students reported using tobacco in 2018, according to the U.S. Department of Health and Human Services.

The primary focus of smoking cessation research in the past has always been adults, but a new study in JAMA Pediatrics zeroed in on adolescents. "Too often, we make the assumption that adolescents are just little adults," said Kevin Gray, M.D., a psychiatry and behavioral sciences professor and physician at the Medical University of South Carolina. "And so, we treat them the same way as we do our adult patients. But it's much more complicated than that."

One of the key differences in treating adolescents is the pressure surrounding their smoking habit. Adolescents are more likely than adults to start using addictive substances, and they are more likely to do something risky without considering the long-term consequences. "Most people who decide it's time to quit are well into adulthood," said Gray. "Oftentimes, their health consequences are becoming quite real for them." Adolescents don't usually experience health issues related to smoking until much later.

Gray also points to peer influence. Adolescents are more likely to be influenced by and pressured by their peers, and they're more likely to try new things.

Varenicline tartrate, more commonly recognized under the brand name Chantix, is a popular pharmacotherapy for smokers looking to quit. It has proven effective in adults but has not been examined as a smoking cessation tool for adolescents. By adhering closely to the protocol used when treating adults, Gray and his research team at MUSC can compare past research to their current results.

Participants were treated with varenicline in conjunction with therapy over the course of 12 weeks to determine the drug's efficacy. But what Gray and his team found was that at the end of 12 weeks, there was no significant difference between the placebo group and the treatment group in terms of end-of-treatment smoking abstinence. A similar number of participants in the two groups had quit by the end of the trial, but when Gray looked at posttreatment abstinence -- that is, the number of participants who remained smoke-free even after treatment had ended -- he saw that those in the varenicline group were less likely to relapse.

"The group differences at the end of treatment, considered in isolation, may not always be the most important marker of efficacy," said Gray. "The nuanced piece of it is quitting smoking earlier on in treatment, which in our study occurred in the varenicline group compared to the placebo group, is a better indicator of a participant's long-term success."

This study showed that varenicline affects smoking cessation in adolescents differently than in adults and may not be an effective treatment on its own. Overall rates of quitting were lower in these trials than in previous adult varenicline trials, a common finding when comparing studies between the two age groups. Gray suggests that participant motivation plays a role. The desire to quit waxes and wanes over time, especially in adolescence. Gray compares it to a dimmer switch as opposed to an on-off switch and says that motivation can depend on timing as well as life situations. He embraces the idea that medication alone likely won't work as well for adolescents as pairing a medication like varenicline with therapy and behavioral treatments.

While this study specifically looked at adolescent smoking cessation, it is part of a larger team at the hospital. The MUSC Youth Collaborative works together to further advance the education, clinical care and research surrounding substance use treatment outcomes for both adolescents and their families through studies like this one.

Next, Gray's team will be working on "outside-the-box" treatment opportunities for their patients. Having to schedule clinic time around participants' school hours as well as factoring in transportation has inspired the team to look into mobile technology as a way of enhancing treatment options. "We want to match our treatments to the needs of adolescents," said Gray. "And part of that is truly understanding where adolescents are with smoking and designing treatments around that."

Founded in 1824 in Charleston, MUSC is the oldest medical school in the South, as well as the state's only integrated, academic health sciences center with a unique charge to serve the state through education, research and patient care. Each year, MUSC educates and trains more than 3,000 students and 700 residents in six colleges: Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy. The state's leader in obtaining biomedical research funds, in fiscal year 2018, MUSC set a new high, bringing in more than $276.5 million. For information on academic programs, visit

Medical University of South Carolina

Related Smoking Articles from Brightsurf:

Smoking rates falling in adults, but stroke survivors' smoking rates remain steady
While the rate of Americans who smoke tobacco has fallen steadily over the last two decades, the rate of stroke survivors who smoke has not changed significantly.

What is your risk from smoking? Your network knows!
A new study from researchers at Penn's Annenberg School for Communication found that most people, smokers and non-smokers alike, were nowhere near accurate in their answers to questions about smoking's health effects.

Want to quit smoking? Partner up
Kicking the habit works best in pairs. That's the main message of a study presented today at EuroPrevent 2019, a scientific congress of the European Society of Cardiology (ESC).

Smoking and mortality in Asia
In this analysis of data from 20 studies conducted in China, Japan, South Korea, Singapore, Taiwan and India with more than 1 million participants, deaths associated with smoking continued to increase among men in Asia grouped by the years in which they were born.

Predictors of successfully quitting smoking among smokers registered at the quit smoking clinic at a public hospital in northeastern Malaysia
In the current issue of Family Medicine and Community Health, Nur Izzati Mohammad et al. consider how cigarette smoking is one of the risk factors leading to noncommunicable diseases such as cardiovascular and respiratory system diseases and cancer.

Restaurant and bar smoking bans do reduce smoking, especially among the highly educated
Smoking risk drops significantly in college graduates when they live near areas that have completely banned smoking in bars and restaurants, according to a new study in the American Journal of Epidemiology.

How the UK smoking ban increased wellbeing
Married women with children reported the largest increase in well-being following the smoking bans in the UK in 2006 and 2007 but there was no comparable increase for married men with children.

Smoking study personalizes treatment
A simple blood test is allowing Vanderbilt University Medical Center (VUMC) researchers to determine which patients should be prescribed varenicline (Chantix) to stop smoking and which patients could do just as well, and avoid side effects, by using a nicotine patch.

A biophysical smoking gun
While much about Alzheimer's disease remains a mystery, scientists do know that part of the disease's progression involves a normal protein called tau, aggregating to form ropelike inclusions within brain cells that eventually strangle the neurons.

A case where smoking helped
A mutation in the hemoglobin of a young woman in Germany was found to cause her mild anemia.

Read More: Smoking News and Smoking Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to