An exploratory randomized controlled trial of a novel high-school-based smoking cessation intervention for adolescent smokers using abstinence-contingent incentives and cognitive behavioral therapy

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• 作者：Suchitra Krishnan-Sarin ; Dana A. Cavallo ; Judith L. Cooney ; Ty S. Schepis ; Grace Kong ; Thomas B. Liss ; Am ; a K. Liss ; Thomas J. McMahon ; Charla Nich ; Theresa Babuscio ; Bruce J. Rounsaville ; Kathleen M. Carroll
• 关键词：Adolescents ; Smoking cessation ; Tobacco ; Contingency management ; Incentives ; Cognitive behavioral therapy
• 刊名：Drug and Alcohol Dependence
• 出版年：2013
• 出版时间：1 September, 2013
• 年：2013
• 卷：132
• 期：1-2
• 页码：346-351
• 全文大小：879 K

文摘

Background

There are few effective smoking cessation interventions for adolescent smokers. We developed a novel intervention to motivate tobacco use behavior change by (1) enhancing desire to quit through the use of abstinence-contingent incentives (CM), (2) increasing cessation skills through the use of cognitive behavioral therapy (CBT), and (3) removing cessation barriers through delivery within high schools.

Methods

An exploratory four-week, randomized controlled trial was conducted in Connecticut high schools to dismantle the independent and combined effects of CM and CBT; smokers received CM alone, CBT alone, or CM + CBT. Participants included 82 adolescent smokers seeking smoking cessation treatment. The primary outcome was seven-day end-of-treatment (EOT) point prevalence (PP) abstinence, determined using self-reports confirmed using urine cotinine levels. Secondary outcomes included one-day EOT PP abstinence and cigarette use during treatment and follow up.

Results

Among participants who initiated treatment (n = 72), group differences in seven-day EOT-PP abstinence were observed (¦Ö² = 10.48, p < 0.01) with higher abstinence in the CM + CBT (36.7 % ) and CM (36.3 % ) conditions when compared with CBT (0 % ). One-day EOT-PP abstinence evidenced similar effects (¦Ö² = 10.39, p < 0.01; CM + CBT: 43 % , CM: 43 % , CBT: 4.3 % ). Survival analyses indicated differences in time to first cigarette during treatment (¦Ö² = 8.73, p = 0.003; CBT: Day 3, CM: Day 9, CM + CBT: Day 20). At one- and three-month follow ups, while no differences were observed, the CM alone group had the slowest increase in cigarette use.

Conclusions

High-school, incentive-based smoking cessation interventions produce high rates of short-term abstinence among adolescent smokers; adding cognitive behavioral therapy does not appear to further enhance outcomes.