Predictors of smoking cessation in adolescents

Objective: To examine factors associated with cessation of smoking in adolescents 12 to 18 years of age who smoke cigarettes. Design and Setting: Prospective school-based cohort study of 1384 New Hampshire high school students surveyed at baseline and annually up to 3 subsequent years regarding their substance abuse behaviors, including adolescents who smoked 1 or more cigarettes within the past 30 days at baseline. Outcome Measures: Cessation behavior was defined by a subsequent response indicating nonsmoking status. We examined associations between smoking cessation and baseline measurements of the level of addiction (cigarette consumption pattern), experience with quitting, intent to quit now and in the future, opinion of adults smoking more than 1 pack of cigarettes per day, social influences to smoke, sex, and psychological attributes. Results: Of 276 adolescents who qualified as cigarette smokers at baseline, 123 (44.6%) were occasional smokers, 65 (23.6%) were daily smokers of 1 to 9 cigarettes, and 88 (31.9%) were daily smokers of 10 or more cigarettes. While 39 (14.1%) had smoked for 1 year or less, 62 (22.5%) had smoked for 6 or more years. Seventy-five (27.2%) reported failed past attempts to quit smoking, 71 (25.7%) reported wanting to quit now, and 50 (18.1%) reported definitely intending to be a nonsmoker in the future. Seventy-nine smokers (28.6%) described themselves as nonsmokers in follow-up surveys. The smoking cessation rate was 46.3% among occasional smokers, 12.3% among daily smokers of 1 to 9 cigarettes, and 6.8% among daily smokers of 10 or more cigarettes. Smoking cessation was associated with occasional smoking status (adjusted odds ratio 6.67 compared with daily smokers of 10 or more cigarettes [95% confidence intervals, 2.26-19.69]), and definite intentions to quit in the future (2.67 [95% confidence intervals, 1.2-5.7]). Most of those with definite intentions to quit in the future were occasional smokers (92.0%). Conclusions: This study documents cessation of smoking in nearly one third of the adolescent smokers. The cessation rate among daily smokers of 10 or more cigarettes per day is comparable with adult cessation rates. Adolescents who are less addicted, measured by low frequency of cigarette use, are more likely than daily users to quit. In addition, definite intent to quit in the future predicts cessation, but only among occasional smokers. In contrast with adults, experience with quitting was not associated with a higher likelihood of cessation. Pediatricians should focus on keeping occasional smokers from moving into daily smoking status, where nicotine addiction begins to play a prominent role in maintaining the behavior. Further study is needed to guide enhancement of the recruitment of adolescents into cessation, assessment of nicotine dependence in daily adolescent smokers, and appropriate use of nicotine replacement therapy in this group.