New Techniques Needed to Measure Teens' Smoking Patterns - and Attempts to Quit

Developing Youth Tobacco Cessation Treatment Outcome Measures

In 1999, the Society for Research on Nicotine and Tobacco (Society), Middleton, Wis., integrated research issues on tobacco treatment for adolescents into a conference addressing methodological issues in tobacco treatment outcomes research.

The Society is an interdisciplinary organization for research, practice, and policy leadership concerning the prevention and treatment of nicotine addiction.

Existing studies indicate that tobacco cessation techniques developed for adults are less effective with adolescents. The portion of the conference on tobacco treatment assessed approaches to measuring adolescent tobacco cessation.

For a year before the conference, a working group (see the Appendix):

  • Conducted a literature review on the natural history of adolescent smoking cessation (e.g., the patterns, timing, and rate of cessation among adolescents without intervention).
  • Reviewed treatment outcomes from published studies of adolescent smoking cessation.
  • Analyzed unpublished data on the validity of self-reports and biochemical verification.

Key Results

  • The conference — entitled the "Tobacco Treatment Methodology Expert Panel Conference" — was held in Washington, on November 8–9, 1999. It was sponsored by the Society for Research on Nicotine and Tobacco.

    At the conference, the findings of the working group were presented and discussed with an audience that included:
    • Selected members of the working group.
    • Society for Research on Nicotine and Tobacco members with treatment outcome measurement expertise.
    • Representatives of the National Cancer Institute, National Institute on Drug Abuse, the Centers for Disease Control and Prevention, the Food and Drug Administration, and the Robert Wood Johnson Foundation (RWJF).

    Among the working group's recommendations were that studies of adolescent tobacco cessation treatment outcomes should do the following:
    • Pay more attention to baseline measurement of smoking. The patterning and variability of youth smoking needs to be captured. Use multiple measures and a minimum 30-day period to establish a baseline measurement of youth smoking.
    • Report recruitment inclusion criteria and detailed descriptions of actual samples, recruitment methods and success rates, complete retention data, and patterns of relapse.
    • Include adolescents' self-perception of their smoking status, labels, and intentions ("quitting" vs. "stopping").
    • Consider that adolescents' self-reports reflect both under- and over-reporting and work to minimize potential biases.
    • Consider using biochemical verification to minimize potential biases in adolescents' self-reports.
    • Use a variety of outcome measures; consider intermediate outcomes (quit attempts). Recommended 30 days as a criterion for abstinence.
    • Use multiple time points (three, six, nine, and 12 months) for follow-up data collection and extend follow-up into adulthood, if possible. Also, the length of follow-ups may be dictated by treatment goals.
    • Consider longitudinal patterns and trajectories of use as outcome variables.
    • Consider the range of tobacco products used.
    • Consider overall study designs, particularly the use of appropriate control groups.

    Researchers also recommended that potential opportunities for research into adolescent tobacco cessation treatment lay in the following areas:
    • Studies of unassisted quit efforts and intervention by "former smokers."
    • Factors that influence self-reports.
    • Intermediate outcomes and their relationship with future nonsmoking as an adult.
    • Comparison of self-report methods and time frames.
    • Relapse studies.
    • Identifying new methods of external validation.
  • A summary of the Expert Panel Conference was presented at three other conferences, including a pre-conference of the Society for Research on Nicotine and Tobacco's annual meeting on February 17, 2000, in Arlington, Va.

    An article based on the findings of the working group will be published in the Society's journal, Nicotine & Tobacco Research.

    According to the program officer at RWJF, the recommendations are expected to have a significant impact on how tobacco researchers conduct and analyze the data from future clinical trials involving adolescent smokers.

Funding

RWJF helped support the conference with a grant of $20,000 between November 1999 and January 2000.

Other funders of the conference included:

  • U.S. Centers for Disease Control and Prevention ($30,000)
  • National Institute on Drug Abuse ($10,000)
  • National Cancer Institute ($15,000)
  • SmithKline Beecham ($20,000)
  • Glaxo Wellcome ($10,000) (SmithKline Beecham and Glaxo Wellcome combined in 2000 to form GlaxoSmithKline).