Paper in JAMA Peds Highlights Challenges of Helping Youth Quit Smoking

Teen smoking
While an intensive in-person treatment including varenicline and counseling didn’t work with youth, an innovative texting program to get teens off nicotine has shown promise. 

Helping teens quit smoking is daunting, but more research could reveal innovative ways to help, according to an editorial in JAMA Pediatrics by UW-CTRI Associate Research Director Dr. Megan Piper, Dr. Robin Mermelstein of the University of Illinois-Chicago, and UW-CTRI Director of Research Dr. Timothy Baker.

The editorial was a response to the JAMA Pediatrics study by Dr. Kevin Gray and colleagues at the Medical University of South Carolina-Charleston. The study offered intensive counseling plus varenicline to teens and young adults who smoke. They found that the intervention was largely ineffective (8.9% abstinence in both the active and placebo conditions at the end of treatment), predominantly because the 12 in-person sessions were sparsely attended.

“This tells me that craving suppression in adolescents is insufficient to help them quit smoking,” Piper said, referring to how varenicline is intended to block both cravings for nicotine as well as the dopamine rush that comes with its use. The state-of-the-science treatment for adults had failed with teens.

Why didn’t they engage with an opportunity that could dramatically improve their health? Possibilities include:

  • Dual dependence. They had very high dual dependence; 59 percent of participants tested positive for marijuana, 68 percent admitted to using an illicit substance and nearly 80 percent said they drank alcohol in the past 30 days. So, for the 8 percent of high schoolers who smoke, it may be that they need interventions that focus on dual addictions, the authors wrote. The Wisconsin Nicotine Treatment Integration Project (WiNTiP), led by UW-CTRI Researcher Dr. Bruce Christiansen and Managing Consultant David “Mac” Macmaster, are working to ensure behavioral health providers throughout Wisconsin do just that. This includes support from the UW-CTRI Outreach team and state tobacco control coalitions.
  • Motives. They have more secondary or instrumental motives (such as smoking for the “high” or because their friends are doing it) than primary motives (automatic smoking, loss of control, craving, or tolerance). They don’t perceive they need to quit, or that they need help to do so.
  • Adverse childhood events. More research could be done on how adverse childhood events (e.g., abuse, homelessness, divorce) factor into varying dependence levels and motivations to self-medicate or quit, and how to help with it. While these also influence adults, adolescents are still learning to regulate emotions and these events make emotion regulation even more difficult.
  • Logistics. This study asked teens to take time to go somewhere and talk with grownups. This may not be the ideal treatment approach for this population who tend to prefer digital interactions.

The authors propose further research on youth nicotine dependence to better understand why they smoke, what their environment is like, and whether they would engage in technological assistance, such as help to quit via a social media app like TikTok or Snapchat, or simple texting.

For example, one text program to help kids quit vaping developed by the TRUTH Initiative, “This Is Quitting,” has shown promising engagement, with 27,000 youth signing up for the program in the first two months of 2019, and 100 to 150 a day thereafter. According to a paper in Nicotine and Tobacco Research, a majority of enrollees set a quit date (teens 69%; young adults 74%). At 14 days, 60.8 percent of respondents indicated they had reduced (teens 46.5%; YA 46.5%) or stopped (teen 12.3%; YA 16%) using e-cigarettes altogether. These results, of course, are for vaping only and further research would need to be done to see if they could be replicated for youth who smoke.

Piper said some of the youth who did engage with the Gray et al study did have success (40 percent quit for at least 7 days vs. 30 percent with placebo), but those appeared to be a handful of highly motivated participants.