Combined Pharmaco/Behavior Therapy in Adolescent Smokers

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DESCRIPTION (provided by applicant): Although cigarette smoking has recently declined in adolescents, it remains a major health concern because adolescence is a critical period for smoking initiation. Most adult smokers (80%) initiate smoking prior to age 18. Cigarette smoking not only causes significant morbidity and mortality, but also leads to a significant economic burden. Fifty percent of all smokers die due to smoking related illnesses. Even though adolescence is a crucial period for initiation of smoking and progression to regular smoking, there is a lack of evidence for effective treatments for adolescent smokers. Several approaches have been tried with equivocal results. Buproprion SR is efficacious in promoting smoking cessation in adult smokers. Our pilot data suggests that buproprion may ALSO be efficacious in adolescents. Contingency management (CM) has been shown to be efficacious in the treatment of a number of substance use disorders in adults, including smoking cessation. CM has also been shown to be efficacious for increasing retention of subjects in treatment trials. The use of CM in adolescents is under explored. The objective of this proposal is to examine the relative efficacy of medication (buproprion SR), CM and medication + CM for smoking cessation and treatment retention for smoking cessation in adolescents. The specific aims of the proposed project are: 1) to examine the efficacy of treatment with buproprion SR in adolescents with nicotine dependence. 2) To examine the efficacy of contingency management (CM) + buproprion SR for improving retention and smoking cessation outcomes as compared to buproprion SR treatment alone, in adolescent smokers. 3) To examine the efficacy of treatment with CM in adolescent smokers. The proposed design is a 2x2 balanced factorial design with four treatment groups: 1) buproprion SR only, 2) buproprion SR + CM, 3) CM + placebo, 4) placebo only. Two hundred and sixteen participants will be urn randomized to one of the four conditions. Primary dependent variable will be continuous abstinence and salivary cotinine levels. The total duration of the study will be 12 weeks (1-week medication titration, 4 weeks of active intervention and a 12-week follow-up. Results of the study will help improve the current state of knowledge for smoking cessation in adolescent smokers.