Nicotine Replacement and Counseling In Adolescents

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DESCRIPTION (provided by applicant): Among addictive behaviors, tobacco smoking is the one most likely to become established during adolescence. Tobacco smoking is also one of the few preventable behaviors occurring during adolescence with direct results on adult morbidity and mortality. Among adolescents who smoke 10 or greater cigarettes per day, less than 20% report being successful at quitting and efforts to quit smoking are often hampered by withdrawal symptoms. The applicant is an Internist and specialist in Adolescent Medicine with expertise in the field of adolescent risk behaviors. The candidate's career objective is to both develop and implement new treatment strategies specifically for adolescents with a particular emphasis on tobacco cessation. During the training phase of the award, the applicant will have four primary development objectives: 1) to develop skills in the area of conducting clinical trails with a focus on the attainment of expertise specific to the study of adolescents; 2) to learn to recruit and follow large cohorts of adolescents; 3) to gain additional expertise in the qualitative and quantitative methodologies used for evaluating treatment outcomes and efficacy; and 4) to gain additional knowledge in the field of tobacco research and policy. These will be complimented by focused course work offered by the K30 funded Advanced Training in Clinical research Program at the UCSF. The research phase of the award will be to conduct a randomized controlled clinical trial comparing two methods of pharmacological smoking intervention among adolescents using data garnered from his preliminary studies on nicotine replacement and counseling in adolescents. This research will compare two different regimes that have been shown to be most efficacious in adults, for both adherence and efficacy in an adolescent population. The goals of this study are to: 1) determine the added benefit of nicotine replacement to that of counseling alone for smoking cessation in adolescents; 2) to determine which method of nicotine replacement (spray versus patch) may be superior with regards to quit rates and acceptability; 3) compare the level of adherence to each method; and 4) investigate correlations between pre-cessation cotinine levels and treatment outcome.