Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

6. Tobacco 123The results of a small number of controlled trials of community interventionattest to their ability to have a positive effect on youth smoking behavior. Theeffectiveness of school-based interventions is enhanced when they are includedin a broad-based community effort, and the impact of community interventionsmay be enhanced if they are combined with strong advocacy, taxation, media,and policy interventions (Lantz et al., 2000).PSYCHOPHARMACOTHERAPYGeneral ConsiderationsThere are numerous approaches to smoking cessation and many comprehensivereviews of the literature (e.g., Hymowitz, 1999; Lando, 1993; Leventhal &Cleary, 1980; Schwartz, 1987). Although many approaches to smoking cessationhave been successful in the short run, few, if any, have proved satisfactoryin the long term. This is true for traditional group and individual counselingprograms, hypnosis and acupuncture, self-help stop-smoking strategies, multicomponentbehavioral interventions, and pharmacological therapies (Hunt &Bespalec, 1974; Hymowitz, 1999; Yudkin et al., 2003). The tendency of smokersto quit, relapse, and quit highlights the cyclic nature of the quitting processand serves as a reminder that as much care and effort must go into helpingsmokers remain cigarette-free as into helping them stop smoking in the firstplace.Youth Smoking CessationEfforts to help adolescents quit smoking have received relatively little attention.Studies suggest that teenagers who smoke on a daily basis; who wereunable to quit in the past for an extended period of time; who have parents whosmoke, particularly mothers, and a number of friends who smoke; who dopoorly in school and score high on a depression scale are least likely to quitsmoking (Burt & Peterson, 1998; Zhu, Sun, Billings, Choi, & Malarcher,1999). The more risk factors, the less likely adolescents are to quit (Zhu et al.,1999).Reviews of quit-smoking programs for adolescents painted a bleak picture(Burton, 1994; Digiusto, 1994; Sussman, et al., 1999). Retention and recruitmentof students were problematic, and end-of-group quit rates were modest.Many studies failed to use appropriate control groups, objective measures ofsmoking status, and long-term follow-up of graduates (Sussman et al., 1999).Teenage focus groups have provided insight into the nature of smoking cessationprograms that appeal to youth (Balch, 1998). Some suggestions were to (1)highlight the seriousness of quitting smoking before becoming an adult; (2)include mood control and stress management; (3) help teen smokers deal with