Researchers seek smoking cessation treatments designed for adolescents rather than adapted from adults

Preventable deaths are those that can be stymied by public health intervention, and deaths related to tobacco use are at the top of that list in the U.S. as well as globally.

And while rates of adolescent smoking have declined over the years, 4.9 million middle and high school students reported using tobacco in 2018, according to the U.S. Department of Health and Human Services.

The primary focus of smoking cessation research in the past has always been adults, but a new study in JAMA Pediatrics zeroed in on adolescents. “Too often, we make the
assumption that adolescents are just little adults,” said Kevin Gray, M.D., a psychiatry and behavioral sciences professor and physician at MUSC. “And so we treat them the same way as we do our adult patients. But it’s much more complicated than that.”

One of the key differences in treating adolescents is the pressure surrounding their smoking habit. Adolescents are more likely than adults to start using addictive substances, especially if they’re being influenced by peers. They are also more likely to do something risky without considering the long-term consequences. “Most people who decide it’s time to quit are well into adulthood,” said Gray. “Oftentimes, their health consequences are becoming quite real for them.”

Varenicline tartrate, more commonly recognized under the brand name Chantix, is a popular pharmacotherapy for smokers looking to quit. It has proven effective in adults but has not been examined as a smoking cessation tool for adolescents.

Gray and his team found that at the end of a 12-week treatment, there was no significant difference between the placebo group and the treatment group in terms of end-of-treatment smoking abstinence. But when Gray looked at posttreatment abstinence — that is, the number of participants who remained smoke-free even after treatment had ended — he saw that those in the varenicline group were less likely to relapse.

“The group differences at the end of treatment, considered in isolation, may not always be the most important marker of efficacy,” said Gray. “The nuanced piece of it is that quitting smoking earlier on in treatment, which in our study occurred in the varenicline group, is a better indicator of a participant’s long-term success.”

This study showed that varenicline affects smoking cessation in adolescents differently than in adults and may not be an effective treatment on its own. Overall rates of quitting were lower in these trials than in previous adult varenicline trials, a common finding when comparing studies between the two age groups, which may have to do with motivation and life situations. The desire to quit waxes and wanes over time, especially in adolescence. Gray compares it to a dimmer switch as opposed to an on-off switch. He embraces the idea that medication alone likely won’t work as well for adolescents as pairing a medication like varenicline with therapy and behavioral treatments, and he looks forward to improving on this treatment process.