title: An exploratory randomized controlled trial of a novel high-school-based smoking cessation intervention for adolescent smokers using abstinence-contingent incentives and cognitive behavioral therapy.
abstract: BACKGROUND
  There are few effective smoking cessation interventions for adolescent smokers. We developed a novel intervention to motivate tobacco use behavior change by (1) enhancing desire to quit through the use of abstinence-contingent incentives (CM), (2) increasing cessation skills through the use of cognitive behavioral therapy (CBT), and (3) removing cessation barriers through delivery within high schools.
  
  
  METHODS
  An exploratory four-week, randomized controlled trial was conducted in Connecticut high schools to dismantle the independent and combined effects of CM and CBT; smokers received CM alone, CBT alone, or CM+CBT. Participants included 82 adolescent smokers seeking smoking cessation treatment. The primary outcome was seven-day end-of-treatment (EOT) point prevalence (PP) abstinence, determined using self-reports confirmed using urine cotinine levels. Secondary outcomes included one-day EOT PP abstinence and cigarette use during treatment and follow up.
  
  
  RESULTS
  Among participants who initiated treatment (n=72), group differences in seven-day EOT-PP abstinence were observed (χ(2)=10.48, p<0.01) with higher abstinence in the CM+CBT (36.7%) and CM (36.3%) conditions when compared with CBT (0%). One-day EOT-PP abstinence evidenced similar effects (χ(2)=10.39, p<0.01; CM+CBT: 43%, CM: 43%, CBT: 4.3%). Survival analyses indicated differences in time to first cigarette during treatment (χ(2)=8.73, p=0.003; CBT: Day 3, CM: Day 9, CM+CBT: Day 20). At one- and three-month follow ups, while no differences were observed, the CM alone group had the slowest increase in cigarette use.
  
  
  CONCLUSIONS
  High-school, incentive-based smoking cessation interventions produce high rates of short-term abstinence among adolescent smokers; adding cognitive behavioral therapy does not appear to further enhance outcomes.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, United States. suchitra.krishnan-sarin@yale.edu
authors.forename: Suchitra
authors.initials: S
authors.lastname: Krishnan-Sarin
authors.forename: Dana A
authors.initials: DA
authors.lastname: Cavallo
authors.forename: Judith L
authors.initials: JL
authors.lastname: Cooney
authors.forename: Ty S
authors.initials: TS
authors.lastname: Schepis
authors.forename: Grace
authors.initials: G
authors.lastname: Kong
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Liss
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Liss
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: McMahon
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.forename: Theresa
authors.initials: T
authors.lastname: Babuscio
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Rounsaville
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003367:Cotinine / Q000652:urine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009042:Motivation; D010349:Patient Compliance; D012044:Regression Analysis; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003367:Cotinine
keywords: Adolescents; Cognitive behavioral therapy; Contingency management; Incentives; Smoking cessation; Tobacco