title: Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy.
abstract: BACKGROUND
  Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward.
  
  
  METHODS
  We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence.
  
  
  RESULTS
  CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation.
  
  
  CONCLUSIONS
  CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers.
authors.affiliation: Department of Psychology, Oberlin College, 120 West Lorain Street, Oberlin, OH 44074, United States; Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, United States. Electronic address: meghan.morean@gmail.com.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Morean
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Grace
authors.initials: G
authors.lastname: Kong
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, 1 Long Wharf, New Haven, CT 06519, United States.
authors.forename: Deepa R
authors.initials: DR
authors.lastname: Camenga
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Dana A
authors.initials: DA
authors.lastname: Cavallo
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, MIRECC 151D, West Haven, CT 06516, United States.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Pittman
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Krishnan-Sarin
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome
keywords: Adolescent; Cognitive behavioral therapy; Contingency management; Impulsivity; Smoking cessation