Sargent J D, Mott L A, Stevens M
Department of Pediatrics, Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, NH, USA.
Arch Pediatr Adolesc Med. 1998 Apr;152(4):388-93. doi: 10.1001/archpedi.152.4.388.
To examine factors associated with cessation of smoking in adolescents 12 to 18 years of age who smoke cigarettes.
Prospective school-based cohort study of 1384 New Hampshire high school students surveyed at baseline and annually up to 3 subsequent years regarding their substance abuse behaviors, including adolescents who smoked 1 or more cigarettes within the past 30 days at baseline.
Cessation behavior was defined by a subsequent response indicating nonsmoking status. We examined associations between smoking cessation and baseline measurements of the level of addiction (cigarette consumption pattern), experience with quitting, intent to quit now and in the future, opinion of adults smoking more than 1 pack of cigarettes per day, social influences to smoke, sex, and psychological attributes.
Of 276 adolescents who qualified as cigarette smokers at baseline, 123 (44.6%) were occasional smokers, 65 (23.6%) were daily smokers of 1 to 9 cigarettes, and 88 (31.9%) were daily smokers of 10 or more cigarettes. While 39 (14.1%) had smoked for 1 year or less, 62 (22.5%) had smoked for 6 or more years. Seventy-five (27.2%) reported failed past attempts to quit smoking, 71 (25.7%) reported wanting to quit now, and 50 (18.1%) reported definitely intending to be a nonsmoker in the future. Seventy-nine smokers (28.6%) described themselves as nonsmokers in follow-up surveys. The smoking cessation rate was 46.3% among occasional smokers, 12.3% among daily smokers of 1 to 9 cigarettes, and 6.8% among daily smokers of 10 or more cigarettes. Smoking cessation was associated with occasional smoking status (adjusted odds ratio 6.67 compared with daily smokers of 10 or more cigarettes [95% confidence intervals, 2.26-19.69]), and definite intentions to quit in the future (2.67 [95% confidence intervals, 1.2-5.7]). Most of those with definite intentions to quit in the future were occasional smokers (92.0%).
This study documents cessation of smoking in nearly one third of the adolescent smokers. The cessation rate among daily smokers of 10 or more cigarettes per day is comparable with adult cessation rates. Adolescents who are less addicted, measured by low frequency of cigarette use, are more likely than daily users to quit. In addition, definite intent to quit in the future predicts cessation, but only among occasional smokers. In contrast with adults, experience with quitting was not associated with a higher likelihood of cessation. Pediatricians should focus on keeping occasional smokers from moving into daily smoking status, where nicotine addiction begins to play a prominent role in maintaining the behavior. Further study is needed to guide enhancement of the recruitment of adolescents into cessation, assessment of nicotine dependence in daily adolescent smokers, and appropriate use of nicotine replacement therapy in this group.
研究与12至18岁吸烟青少年戒烟相关的因素。
对1384名新罕布什尔州高中生进行前瞻性的基于学校的队列研究，在基线时以及随后3年每年对他们的药物滥用行为进行调查，包括在基线时过去30天内吸食过1支或更多香烟的青少年。
戒烟行为通过后续表明非吸烟状态的回答来定义。我们研究了戒烟与成瘾程度（香烟消费模式）的基线测量、戒烟经历、现在和未来的戒烟意愿、对每天吸食超过1包香烟的成年人的看法、吸烟的社会影响、性别以及心理特征之间的关联。
在基线时符合吸烟标准的276名青少年中，123名（44.6%）为偶尔吸烟者，65名（23.6%）为每天吸食1至9支香烟的吸烟者，88名（31.9%）为每天吸食10支或更多香烟的吸烟者。其中39名（14.1%）吸烟1年或更短时间，62名（22.5%）吸烟6年或更长时间。75名（27.2%）报告过去戒烟尝试失败，71名（25.7%）报告现在想戒烟，50名（18.1%）报告肯定打算未来成为非吸烟者。79名吸烟者（28.6%）在后续调查中称自己为非吸烟者。偶尔吸烟者的戒烟率为46.3%，每天吸食1至9支香烟的吸烟者为12.3%，每天吸食10支或更多香烟的吸烟者为6.8%。戒烟与偶尔吸烟状态相关（与每天吸食10支或更多香烟的吸烟者相比，调整后的优势比为6.67 [95%置信区间，2.26 - 19.69]），以及未来肯定的戒烟意愿（2.67 [95%置信区间，1.2 - 5.7]）。大多数未来肯定有戒烟意愿的是偶尔吸烟者（92.0%）。
本研究记录了近三分之一青少年吸烟者的戒烟情况。每天吸食10支或更多香烟的吸烟者的戒烟率与成年人的戒烟率相当。通过低吸烟频率衡量的成瘾程度较低的青少年比每日吸烟者更有可能戒烟。此外，未来肯定的戒烟意愿可预测戒烟，但仅在偶尔吸烟者中如此。与成年人不同，戒烟经历与更高的戒烟可能性无关。儿科医生应专注于防止偶尔吸烟者转变为每日吸烟状态，因为尼古丁成瘾在维持这种行为方面开始发挥重要作用。需要进一步研究以指导加强青少年戒烟招募、评估青少年每日吸烟者的尼古丁依赖以及该群体中尼古丁替代疗法的适当使用。
