Nicotine patch therapy in 101 adolescent smokers - Efficacy, withdrawal symptom relief, and carbon monoxide and plasma cotinine levels

Objectives: To determine the efficacy of nicotine patch therapy in adolesce nts who want to stop smoking and to assess biochemical markers of smoking a nd nicotine intake. Design: Nonrandomized, open-label trial using a 15 mg/16 h patch. Setting: Two midwestern cities. Subjects: One hundred one adolescents aged 13 through 17 years smoking at l east 10 cigarettes per day (cpd). Intervention: Six weeks of nicotine patch therapy and follow-up visits at 1 2 weeks and 6 months. Main Outcome Measures: Self-reported smoking abstinence verified by expired -air carbon monoxide (CO) level of no more than 8 ppm, nicotine withdrawal symptoms, and plasma cotinine level. Results: Forty-one participants were female (mean [+/- SD] age, 16.5 [+/- 1 .1] years). Median baseline smoking rate was 20.0 cpd (range, 10-40 cpd). B iochemically confirmed point prevalence smoking abstinence was 10.9% (11/10 1) at 6 weeks and 5.0% (5/101) at 6 months. The mean (+/- SD) plasma cotini ne level at baseline was 1510.9 +/- 732.7 nmol/L; for nonsmoking subjects a t weeks 3 and 6, 607.8 +/- 386.2 and 710.0 +/- 772.5 nmol/L, respectively. Plasma cotinine levels were correlated with CO levels at baseline (r = 0.27 ; P = .006), week 3 (r = 0.34; P = .004), and week 6 (r = 0.26; P = .03) an d with mean cigarettes smoked per day during weeks 3 (r = 0.24; P = .04) an d 6 (r = 0.30; P = .02). Mean smoking rates decreased significantly during the study, an effect that lessened at 12 weeks and 6 months. Conclusions: Nicotine patch therapy plus minimal behavioral intervention do es not appear to be effective for treatment of adolescent smokers. Plasma c otinine and CO levels appear to be valid measures of smoking rates during t he cessation process, but not at baseline. Smoking rates were reduced throu ghout the study. Additional pharmacological and behavioral treatments shoul d be considered in adolescent smokers.