The efficacy of nicotine patches to help adolescents quit smoking

Abstract

Although the percentage adolescent smokers in the Netherlands has gradually decreased over the past years, the number of daily smokers is still increasing rapidly, from 12% of 16-year-olds to 27% of 19-year-olds. Adolescents often make quit attempts within a very short period after taking up smoking. However, many adolescents fail in their quit attempts, because nicotine dependence is a major barrier to successful smoking cessation. To assist adolescents in their quit attempts, nicotine replacement therapy (NRT) was expected to be an effective intervention. Nicotine replacement therapy aims to reduce relapse by reducing withdrawal symptoms and craving and allows individuals to achieve (more) sustainable abstinence.Although NRT has been proven effective among adults by almost doubling the chance of quitting, to date, healthcare professionals do not advise that adolescents use NRT because of limited evidence for the efficacy of NRT among this age group. This study tested the efficacy of NRT among a large sample of Dutch adolescents. For the intervention, 265 adolescents aged 13-18, were placed in a double-blind randomized trial to either a nicotine patch or placebo patch group. We found that two weeks after the quit date, significantly more participants had quit smoking in the nicotine patch group (31.9%), compared to those in the placebo patch group (21.3%); however, no significant effects were found at the end of NRT treatment after 6 or 9 weeks (14.8% achieved abstinence in the nicotine patch group compared to 13.1% in the placebo patch group), and at 6- and 12-month follow-ups (percentages of quitters ranged from 5.7% to 8.2%). At end-of-treatment, the effect of NRT on smoking cessation was moderated by the level of NRT compliance, which indicates a greater likelihood to achieve abstinence in the nicotine patch group for those participants who reported higher compliance. Furthermore, three different compliance trajectories were found, all starting with high compliance levels at the beginning of the treatment, but differences in the extent of decline during treatment and characterized by different features. Compared to the compliers, the moderate decreasers were less conscientious and less educated. The strong decreasers were less conscientious and agreeable, and more extravert than were adolescents in the compliers trajectory. These findings imply that providing adolescents with NRT is not nearly as effective as it is for adults; that compliance levels appear to affect abstinences rates; and that personality tailored treatments might enhance compliance levels. We also found that positive effects of the nicotine patches (i.e., reductions in craving) were shown mainly on the quit day and seemed to disappear over time, and that the effect of nicotine patches on end-of-treatment smoking abstinence was not mediated by the course of craving or withdrawal symptoms. These findings imply that nicotine patches do not act exactly as they are supposed to act for adolescent smokers. Finally, we tested the effects of several non-smoking related protective and risk factors on smoking (re)lapse, but most potential predictors were not statistically related to smoking (re)lapse. Thus, little is known about the contextual predictors of (re)lapse among youngsters.