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Abstract
In 2008–2009, we conducted a 6-week, open-label trial of transdermal nicotine replacement therapy and practical counseling for 34 adolescents seeking smoking cessation in Los Angeles. Dependent outcomes were study retention, use of the patch, and 7-day quit status at the end-of-study and at follow-up visits. Predictors of outcomes included cigarette dependence, withdrawal symptoms, demographic and psychiatric measures, and other substance use. Variables significant in bivariate analysis (p < .10) were retained in a multivariate model. Subjects had significant pre-to-post reductions in quit rates, dependence, and withdrawal symptoms. Subjects also reported a high number of comorbidities. Implications for clinicians are discussed.
RÉSUMÉ
Parti en fumée? Étude préliminaire pour une thérapie de substitution de nicotine et pour une thérapie de cognitive comportementale et motivationnelle visant l'arrêt de la cigarette chez des jeunes de Los Angeles
En 2008–2009, nous avons conduit un essai pour une thérapie transdermique de substitution de nicotine et de conseil pratique sur 34 adolescents de Los Angeles cherchant à arrêter de fumer. Les résultats dépendants étaient la le maintien dans l’étude, l'utilisation de patch, l'abstinence au terme de l’étude et le suivi. Les indices incluaient la dépendance à la cigarette, les symptômes de manque, des mesures démographiques et psychiatriques et l'utilisation d'autres substances. Les données significatives en analyse bivariables ont été conservées dans un modèle multivariables. Les participants ont montré pré/post réductions en termes de symptômes de manque, de dépendance et d'abstinence. Les participants ont montré un grand nombre de comorbidités psychiatriques. Les implications pour les cliniciens sont discutées. Soutien: Philip Morris USA, Pike Chair in Addiction Studies et Marjorie M. Greene Trust.
RESUMEN
¿En Humo? Un Estudio Preliminar de Etiqueta Abierta Ensayo de Terapia de Reemplazo de Nicotina y Cognitivo Aumento de la Motivación Conductual de Dejar de Fumar Entre Los Jóvenes en los Angeles
En 2008–2009, nosotros conducimos una prueba de 6-semanas de etiqueta medica abierta de terapia de reemplazo de nicotina transdérmica y consejeria práctica para 34 adolescentes que buscan dejar de fumar en Los Angeles. Resultados dependientes fueron retención del estudio, el uso de el parche, y abstinencia al final de el estudio y en la visita de continuación. Predictores incluido fue dependencia del cigarrillo, los síntomas de abstinencia, medidas demográficas y psiquiátricas, y el uso de otras sustancias. Las variables significativas en el análisis bivariado fueron retenidos en un modelo multivariado. Los sujetos tenían respuestas significante antes y despues de reducciones en los síntomas de retracción, dependencia y abstinencia. Los sujetos se presentaron un elevado número de comorbilidades. Implicaciones para los clínicos se discuten. Soporte: Philip Morris USA, Pike Chair in Addiction Studies, y Marjorie M. Greene Trust.
THE AUTHORS
Aimee-Noelle Swanson, PhD, is an Assistant Research Sociologist and the Clinical Research Director of the Center for Behavioral & Addiction Medicine (CBAM) in the UCLA David Geffen School of Medicine. Dr. Swanson earned her PhD degree in sociology from Stanford University and has focused on HIV and substance abuse during her tenure at UCLA since 2002. Dr. Swanson is interested in issues of measurement and research design of clinical trials as well as pharmacotherapies for methamphetamine dependence.
THE AUTHORS
Steven Shoptaw, PhD, is a Professor and the Executive Director of the Center for Behavioral & Addiction Medicine (CBAM), which works to advance the prevention and treatment of chronic illnesses, especially in communities with health disparities. He is a clinical psychologist and a Professor in both Departments of Family Medicine and Psychiatry and Biobehavioral Sciences in UCLA. Dr. Shoptaw has led more than two dozen clinical trials of medical and behavioral treatments, primarily for stimulant dependence. He serves as Site P.I. and a member of the protocol development team for the HIV Prevention Trials Network (HPTN) study 073, “Pre Exposure Prophylaxis (PrEP) Uptake and Adherence Among Black Men Who Have Sex With Men.” He also serves as cochair of the HPTN's Substance Use Scientific Committee. In addition, as Co-Director of the Combination Prevention Core of the UCLA Center for HIV Identification and Prevention and Treatment Services, Dr. Shoptaw evaluates the efficacy of antiretroviral medications when combined with behavioral therapies for HIV prevention. He directs a T-32 training grant in the Department of Family Medicine, training the next generation of clinical researchers on addiction medicine in primary care, and he volunteers as the Executive Director for Safe House, a 26-bed facility that provides high-tolerance-based housing to homeless persons living with HIV/AIDS who have concomitant mental illnesses and chemical dependency.
Keith Gregory Heinzerling, MD, MPH, is an Assistant Clinical Professor at the Department of Family Medicine in the David Geffen School of Medicine in UCLA. Dr. Heinzerling is board certified in Internal Medicine and Addiction Medicine. Dr. Heinzerling's current research and clinical activities are devoted to the discovery, development, and dissemination of effective medications for the treatment of addiction. Dr. Heinzerling is the Medical Director for the UCLA Center for Behavioral and Addiction Medicine and maintains a primary care-based addiction medicine practice at the UCLA Family Health Center in Santa Monica.
Adam C. Wade, Research Staff is currently a medical student at USC's Keck School of Medicine. Prior to attending USC, he was a research associate at UCLA's Center for Behavioral and Addiction Medicine, where his team carried out clinical translational research in the field of substance dependence. He also conducted basic research as an investigator of circadian rhythms and sociality at UC Berkeley's Helen Wills Neuroscience Institute for several years before beginning his work at UCLA. Today, He is interested in completing a PhD in neuroscience to complement his degree in medicine. Ultimately, he seeks a career as a medical scientist in which he can continue translational research to benefit those suffering from neurological and psychological dysfunction.
Matthew Worley, Graduate Student, MS, MPH, is a doctoral candidate in clinical psychology at the San Diego State University/University of California San Diego Joint Doctoral Program, and a current psychology intern at the Seattle Veterans Affairs Hospital. His research focuses on the effects of treatments for substance use disorders. More specifically, his work seeks to explain individual differences in treatment response by examining mediating factors that explain treatment effects and exploring personal and contextual factors that may impact an individual's response to treatment.
James McCracken, MD, is the Joseph Campbell Professor of Child Psychiatry and the Director of the Division of Child and Adolescent Psychiatry at the UCLA NPI-Semel Institute (formerly the Neuropsychiatric Institute) in Los Angeles. Dr. McCracken is the principal investigator of the National Institute of Mental Health (NIMH) Research Center, “Translational Research to Enhance Cognitive Control,” which aims to develop and test innovative treatments for cognitive defects associated with child psychiatric illness. His other current areas of research include family-genetic studies of childhood disorders and the testing of new pharmacologic treatments for a variety of neuropsychiatric disorders in children, including attention-deficit/hyperactivity disorder (ADHD), autism, obsessive-compulsive disorder, and anxiety disorders.
Sarah A. Wilson, MA, has experience as a research coordinator. Much of her work at UCLA has been in the studies of schizophrenia and of addictive disorders.
Joan Asarnow, PhD, is a Professor of psychiatry and biobehavioral sciences in the UCLA David Geffen School of Medicine and a clinical psychologist. Dr. Asarnow's current work focuses on interventions and service delivery strategies for improving health and mental health in youth, with an emphasis on suicide/suicide attempt prevention and depression. She has led efforts to disseminate evidence-based treatments for child and adolescent depression and suicide prevention, working across multiple service settings including emergency departments, primary care, mental health, and school settings.
Edythe D. London, PhD, is a Professor at the Departments of Psychiatry and Biobehavioral Sciences and Molecular and Medical Pharmacology, and a member of the Brain Research Institute in UCLA, where she holds the Thomas P. and Katherine K. Pike Chair in Addiction Studies. Dr. London's research aims to develop a better understanding of addictive disorders, using a translational approach toward rational design of therapeutics. She has been a major contributor to the literature on the biology of nicotine dependence.
Notes
1 Due to the effect of marijuana smoking on expired CO, we used urinary cotinine (NicAlert) in addition to the expired CO, the standard in smoking cessation.