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Smoking Cessation in Adolescents
The Role of Nicotine Dependence, Stress, and Coping Methods
Lorena M. Siqueira, MD;
Linda M. Rolnitzky, MS;
Vaughn I. Rickert, PsyD
Arch Pediatr Adolesc Med. 2001;155:489-495.
Objectives To compare perceived reasons for continued smoking and withdrawal symptoms
between current smokers and quitters in an inner-city adolescent population.
To examine the relationship of nicotine dependence, stress, and coping methods
between smokers and quitters and, using the Transtheoretical Model of Change,
among adjacent smoking cessation stages.
Design A cross-sectional study using a self-administered questionnaire.
Participants The study comprised 354 clinic patients between the ages of 12 and 21
years who reported past or present smoking.
Main Outcome Measures Demographic characteristics, smoking status, perceived reasons for continued
smoking, attempts to quit, and withdrawal symptoms, as well as standardized
scales assessing nicotine dependence, stress, and coping methods.
Results The overall prevalence of smoking in this population was 26%. Smokers
were significantly more likely to report smoking more cigarettes per day as
well as higher levels of physical addiction (P<.01),
greater levels of perceived stress (P<.02), and
less use of cognitive coping methods (P<.02) than
quitters (P<.005). However, comparison of consecutive
stages revealed a significant difference only between precontemplation and
contemplation in cognitive coping methods (P<.01).
Three of 20 withdrawal symptoms (cravings, difficulty dealing with stress,
and anger) were reported more frequently among current smokers who had attempted
to quit in the last 6 months than among former smokers (P<.01).
Conclusion Interventions for inner-city adolescents who smoke should be designed
to target those with the highest levels of nicotine dependence, stress, and
decreased use of cognitive coping methods because they are the least likely
to quit on their own, rather than developing stage-specific models.
From the Department of Pediatrics, Mt Sinai School of Medicine, New
York, NY.
Corresponding author: Lorena M. Siqueira, MD, Mt Sinai Adolescent
Health Center, Box 1005, 320 E 94th St, New York, NY 10128 (e-mail: Lorena_Siqueira{at}mssm.edu).
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