title: Gender differences in a randomized controlled trial treating tobacco use among adolescents and young adults with mental health concerns.
abstract: BACKGROUND
  Treatment of tobacco use in mental health settings is rare despite high rates of comorbidity. With a focus on early intervention, we evaluated a tobacco treatment intervention among adolescents and young adults recruited from outpatient, school-based, and residential mental health settings and tested for gender differences.
  
  
  METHODS
  Intervention participants received computerized motivational feedback at baseline, 3 months, and 6 months and were offered 12 weeks of cessation counseling and nicotine patches. Usual care participants received a self-help guide and brief cessation advice. We examined 7-day point prevalence abstinence with biochemical confirmation at 3, 6, and 12 months; smoking reduction; and 24-hr quit attempts.
  
  
  RESULTS
  At baseline, the sample (N = 60, 52% female, mean age = 19.5±2.9 years, 40% non-Hispanic Caucasian) averaged 7±6 cigarettes/day, 62% smoked daily, 38% smoked ≤ 30 min of waking, 12% intended to quit in the next month, 47% had a parent who smoked, and 3 of 5 of participants' closest friends smoked on average. During the 12-month study, 47% of the sample reduced their smoking, 80% quit for 24 hr, and 11%, 13%, and 17% confirmed 7-day point prevalence abstinence at 3-, 6-, and 12-month follow-up, respectively, with no differences by treatment condition (ps > .400). Over time, abstinence was greater among girls (adjusted odds ratio [AOR] = 8.9) than among boys, and abstinence was greater for lighter smokers than heavier smokers (AOR = 4.5) (p < .05). No mental health or other measured variables predicted abstinence.
  
  
  CONCLUSIONS
  Adolescent and young adult smokers with mental health concerns are a challenging group to engage and to effectively treat for tobacco addiction, particularly heavier smokers and boys. Innovative approaches are needed.
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA; jpro@stanford.edu.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Prochaska
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA;
authors.forename: Sebastien C
authors.initials: SC
authors.lastname: Fromont
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA;
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Ramo
authors.affiliation: Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA;
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Young-Wolff
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA;
authors.forename: Kevin
authors.initials: K
authors.lastname: Delucchi
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Brown
authors.affiliation: Department of Psychiatry, University of California, San Francisco, San Francisco, CA;
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D005260:Female; D005783:Gender Identity; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008605:Mental Health Services; D009538:Nicotine / Q000008:administration & dosage*; D012495:San Francisco; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D057968:Transdermal Patch; D055815:Young Adult
chemical_list: D009538:Nicotine