Currently, more than 4 million adolescents in the United States smoke cigarettes. Although few of these smokers believe they will smoke long-term, 75 percent are still smoking five to seven years later. Various issues affect adolescents who smoke cigarettes, including nicotine addiction, stress reduction, and coping skills. While nicotine addiction does occur in this population, studies have shown minimal benefit to treating this addiction with medication. New strategies in smoking cessation using the Transtheoretical Model of Change (TMC) state that physicians should tailor their smoking cessation strategies to individual patients based on where they are in this model. No studies exist that evaluate this model's ability to change adolescent behavior. Siqueira and colleagues compared perceived reasons for continued smoking, attempts to quit, and withdrawal symptoms between current smokers and subjects who successfully quit. In addition, they compared the relationship between nicotine dependence, stress, and coping methods with the outcome of being a smoker or a quitter.

The study included 354 patients between the ages of 12 and 21 who reported past or current smoking. The participants completed a questionnaire that measured basic demographic information, smoking status, perceived reasons to continue smoking, attempts to quit, and withdrawal symptoms. In addition, each subject completed standardized measures of nicotine dependence, perceived stress, negative life measures, coping methods, and a self-reporting of what stage of change they were currently in: precontemplation, contemplation, preparation, action, or maintenance.

The most common reason adolescents gave for continuing to smoke was that it “relaxes me.” A significant number of current smokers had attempted to quit for 24 hours or more within the past six months. Subjects who failed in these attempts were much more likely to resume the habit for reasons related to cigarette craving and stress. Subjects in the precontemplation and contemplation stages of change were more likely to have lower scores on coping methods than subjects in the other stages of change. Subjects who had stopped smoking were far less likely to report nicotine addiction than subjects who were still smoking.

The authors conclude that adolescent smoking cessation strategies should be based on the level of nicotine addiction, levels of perceived stress, and decreased coping methods. This basis provides a better model for smoking cessation than the TMC in adolescents. In addition, the authors noted that only one third of the adolescents reported being asked by their physician to quit smoking. The latter deficiency should be corrected to ensure that adolescents are given the skills necessary to stop smoking cigarettes.

editor's note: In the past, smoking cessation programs used the same strategies regardless of the patient's interest or motivation to change behavior. The TMC provides a basis for tailoring the smoking cessation message to the patient's stage of change. This model may work for adults, but adolescents present physicians with different challenges. In adolescents, the message must concentrate on the addiction level, stress levels, and coping methods. Adolescents who are only given information concerning health issues and smoking are unlikely to stop smoking. However, by providing alternative strategies for stress reduction and assisting in improving coping skills, physicians can improve their patients chances for success. This study demonstrates that one single smoking cessation message will not work for the spectrum of patients and that physicians need to provide an individualized approach to changing patients' smoking habits.—k.e.m.