Association of post-treatment smoking change with future smoking and cessation efforts among adolescents with psychiatric comorbidity

Abstract

Little is known about how initial change following a smoking intervention relates to longer-term smoking outcomes among adolescent smokers with psychiatric comorbidity. The present study investigated this relationship among psychiatrically hospitalized adolescents (N=183) who participated in a controlled trial comparing motivational interviewing to brief advice. Quit attempters (n=37), reducers (n=45), and maintainers (n=101) were assembled based on, respectively, having made a quit attempt, having reduced smoking by at least 50%, and having reduced smoking by less than 50% in the first week after hospital discharge. Hierarchical linear models and generalized estimating equations were conducted to test group differences in average number of cigarettes per smoking day and odds of making a quit attempt during subsequent weeks of a 12-month continuous follow-up, and in cotinine-verified abstinence rates at 1, 6, and 12 months posthospitalization. Baseline smoking levels and presence of a substance use disorder or anxiety disorder were predictive of outcomes. After controlling for covariates, we found that quit attempters smoked less during follow-up than did the other change groups and that reducers smoked less than maintainers. Quit attempters evidenced a higher percentage of quit attempts during follow-up than did the other change groups. Reducers had a greater average percentage of quit attempts during follow-up than did maintainers. However, groups did not differ on cotinine-verified abstinence rates across the followup period. Findings have implications for initial post-treatment change as it relates to subsequent smoking and cessation outcomes among adolescent smokers at especially high risk for smoking persistence.

Psychological, peer, and family influences on smoking among an adolescent psychiatric sample

“…Psychiatric hospitalization represents a window of opportunity to implement cessation and prevention efforts among this high risk population. In one of the only studies to examine the process of quitting among adolescents following psychiatric hospitalization, MacPherson and colleagues (2007) found that adolescents who attempted to quit in the first week following hospitalization demonstrated less average smoking over a 12 month follow-up period compared to adolescent smokers who did not make an attempt during this period. However, adolescents who attempted to quit immediately following hospitalization demonstrated a marked increase in smoking within the first few months following treatment (MacPherson et al, 2007).…”

“…In one of the only studies to examine the process of quitting among adolescents following psychiatric hospitalization, MacPherson and colleagues (2007) found that adolescents who attempted to quit in the first week following hospitalization demonstrated less average smoking over a 12 month follow-up period compared to adolescent smokers who did not make an attempt during this period. However, adolescents who attempted to quit immediately following hospitalization demonstrated a marked increase in smoking within the first few months following treatment (MacPherson et al, 2007). This finding suggests that the time period during and immediately following hospitalization represents an important window for cessation efforts and that a greater intensity or duration of treatment may be necessary for this high risk group (Brown et al, 2003).…”

Tobacco use in youth with mental illnesses

“…A study conducted with 120 children and adolescent psychiatric inpatients ages 8-18 years old found that 39.4% were current smokers (Upadhyaya et al, 2003). A more recent study by MacPherson et al (2007) included 183 adolescent psychiatric inpatients and found that 58.5% were regular smokers. In terms of the public mental health system, a study conducted by Morris et al (2006) found that approximately 20% of adolescents being served by community mental health centers across the state of Colorado reported current tobacco use.…”

Integration of the brief behavioral activation treatment for depression (BATD) into a college orientation program: Depression and alcohol outcomes.

“…Evaluation of main effects was followed by models that included interactions of treatment condition with both the linear time and the quadratic time effects in the final block. Estimates of significant Treatment Group × Linear Time interactions are reported using models after removing any nonsignificant quadratic time interactions (e.g., MacPherson et al, 2007). …”