title: A randomised clinical trial of nicotine patches for treatment of spit tobacco addiction among adolescents.
abstract: BACKGROUND
  This study tested the efficacy of nicotine patches in combination with behavioural therapy for the treatment of adolescent spit tobacco addiction. Prior interventions had resulted in mean cessation rates below 15% at one year.
  
  
  METHODS
  This study, the PATCH Project, used a three group, placebo controlled, randomised clinical trial design. The control group received a standard 3-5 minute counselling followed by a two week follow up phone call. The two intervention groups received a six week behavioural intervention; in addition, one group received active nicotine patches while the other group received placebo patches. Both groups received quarterly stage based telephone counselling.
  
  
  RESULTS
  At one year, the usual care group's spit tobacco cessation rate was 11.4% (exact 95% confidence interval (CI) 6.1% to 19.1%), placebo patch 25.0% (95% CI 16.9% to 34.7%), and the active patch 17.3% (95% CI 10.4% to 26.3%). When both patch groups were combined, the cessation rate was 21.2% (95% CI 15.7% to 27.6%). The cessation rates for active and placebo patch were not significantly different (exact two sided p = 0.22), while the combined patch groups had a significantly greater cessation rate than usual care (exact two sided p = 0.04).
  
  
  CONCLUSIONS
  The behavioural intervention proved to be about twice as successful as previous interventions, but the nicotine patch offered no improvement in cessation rates. The behavioural intervention is based on publicly available materials and can be easily adapted for widespread use, particularly in high schools.
authors.affiliation: University of Tennessee Health Science Center, Memphis, Tennessee, USA. cstotts@utmem.edu <cstotts@utmem.edu>
authors.forename: R C
authors.initials: RC
authors.lastname: Stotts
authors.forename: P K
authors.initials: PK
authors.lastname: Roberson
authors.forename: E Y
authors.initials: EY
authors.lastname: Hanna
authors.forename: S K
authors.initials: SK
authors.lastname: Jones
authors.forename: C K
authors.initials: CK
authors.lastname: Smith
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D003367:Cotinine / Q000032:analysis; D003376:Counseling / Q000379:methods; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects; D018722:Nicotinic Agonists / Q000008:administration & dosage*; D012463:Saliva / Q000737:chemistry; D014029:Tobacco Use Disorder / Q000188:drug therapy*; D014030:Tobacco, Smokeless; D016896:Treatment Outcome
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine; D003367:Cotinine