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Efficacy, Withdrawal Symptom Relief, and Carbon Monoxide and Plasma Cotinine Levels

Richard D. Hurt, MD; Gary A. Croghan, PhD, MD; Scott D. Beede, MD; Troy D. Wolter, MS; Ivana T. Croghan, PhD; Christi A. Patten, PhD

Arch Pediatr Adolesc Med. 2000;154:31-37.

Objectives  To determine the efficacy of nicotine patch therapy in adolescents who want to stop smoking and to assess biochemical markers of smoking and 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 least 10 cigarettes per day (cpd).

Intervention  Six weeks of nicotine patch therapy and follow-up visits at 12 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). Biochemically confirmed point prevalence smoking abstinence was 10.9% (11/101) at 6 weeks and 5.0% (5/101) at 6 months. The mean (± SD) plasma cotinine level at baseline was 1510.9 ± 732.7 nmol/L; for nonsmoking subjects at 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) and with mean cigarettes smoked per day during weeks 3 (r = 0.24; P = .04) and 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 does not appear to be effective for treatment of adolescent smokers. Plasma cotinine and CO levels appear to be valid measures of smoking rates during the cessation process, but not at baseline. Smoking rates were reduced throughout the study. Additional pharmacological and behavioral treatments should be considered in adolescent smokers.

From the the Nicotine Dependence Center (Drs Hurt, G. Croghan, I. Croghan, and Patten), Division of Community Internal Medicine (Dr Hurt), Division of General Internal Medicine (Dr G. Croghan), and Section of Biostatistics (Mr Wolter), Mayo Clinic, Rochester, Minn; and the Division of General Internal Medicine, Franciscan Skemp Healthcare, La Crosse, Wis (Dr Beede).

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