Predicting Initiation of Smoking Cessation Treatment and Outcome Among Adolescents Using Stressful Life Events and Coping Style

ABSTRACT

Background: Adolescent smoking is a major public health concern, and current treatments are only somewhat effective in promoting abstinence. One way to improve treatments is to identify psychosocial characteristics that impede cessation, allowing development of targeted treatments. This study examined the influence of 2 such characteristics, life event stressors and coping, on initiation of cessation treatment and end-of-treatment abstinence status. Methods: One hundred five adolescent smokers were eligible to participate in a validated contingency management (CM) and cognitive-behavioral (CBT) cessation treatment; of those, 72 completed at least 1 treatment session. Data included sociodemographic characteristics, questionnaires assessing past-year life events and coping behavior use, and abstinence status at the end of the 4-week treatment. Logistic regression was used to predict treatment initiation and abstinence status, with life event stressor number, coping, or their interaction as predictors. Results: Higher levels of cognitive and peer support coping predicted treatment initiation, whereas life events were unrelated. End-of-treatment abstinence was predicted by higher numbers of life events and greater use of avoidant coping. The interaction of helpless coping and life events also predicted abstinence, with greater increases in helpless coping as total life events rose in abstinent but not nonabstinent participants. Finally, greater use of behavioral coping predicted abstinence in participants exposed to only CM treatment, whereas lesser use of behavioral coping predicted abstinence in participants receiving combined CM/CBT treatment. Conclusions: Exposure to life event stressors may promote cessation by forcing use of self-control resources prior to the quit attempt, which may strengthen such resources. Techniques that improve self-control resources may improve cessation outcome, and prevention programs may want to emphasize behavioral coping to improve rates of treatment initiation.

Keywords:

• Adolescent
• coping
• smoking cessation
• stress

AUTHOR CONTRIBUTIONS

This paper was derived from a parent study designed by S.K.S. and D.A.C., with conception and design of this particular investigation by T.S.S. T.S.S., D.A.C., G.K., T.L., and A.L. participated in the data collection for this study. All analyses were performed by T.S.S., and T.S.S. was also the primary author of the manuscript. All authors participated in the editing process for the manuscript, and all authors approved of its final submission.

Funding

Preparation of this paper was supported by National Institutes of Health (NIH) grant P50 DA009421. NIH (National Institute on Drug Abuse) had no further role in study design, the collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the paper for publication. The authors declare that they have no conflicts of interest.