The Level of Depression, Parental Involvement and Nicotine Dependence in Adolescent Cigarette Smokers

Purpose: Currently in the United States tobacco use is the leading cause of preventable death and disability. At present there are 4 million smokers under age 18 in the United States and approximately 3,000 who become regular smokers each day. Estimations suggest that 5 million adolescents will die prematurely from a tobacco related illness if current trends continue. This study was a secondary analysis of a smoking cessation intervention that was conducted with a group of high-school student cigarette smokers aged 15-18. The purpose of the primary study was to determine the feasibility of a school based tobacco cessation intervention including an 8-week program of nicotine replacement and bupropion SR pharmacotherapy in combination with weekly one-to-one behavioral intervention. The research questions are: 1. What is the level of self-reported depression symptoms at baseline measurement among adolescent cigarette smokers? 2. For those students with information beyond baseline, were there changes in depression symptomatology at the 8-week interval? 3. What is the teenager’s perception of parental supervision and parental attitude towards drugs at baseline? 4. What is the extent of exposure to cigarette smoking in the adolescent’s home and social settings at baseline? 5. What is the relationship between nicotine dependence and the level of depression? Research Method: Target population was students enrolled in a selected high school in central Ohio. Inclusion criteria were ages 15 through 18, status as student in high school and regular smoker for 6 months or longer. Parent informed consent and youth assent was obtained. Exclusion criteria included acute medical illness, pregnancy, regular drug use, and clinical diagnosis of depression. This was a feasibility pilot study with participation of 23 students. Baseline data collection included the following valid and reliable questionnaires: Fagerstöm Test for Nicotine Dependence, Centers for Epidemiologic Studies Depression Scale, personal smoking history, and teenager’s perception of parental involvement. These were repeated at the 8- and 12-week interval. Students were placed on the nicotine patch and/or bupropion SR if not contraindicated and weekly individual counseling was provided by an advanced practice nurse. Medications were dispensed in 2-week supply with side effects monitored. Smoking abstinence at 4-, 8-, and 12-week intervals were confirmed with carbon monoxide in exhaled air being <8 ppm. Findings: Although the instrument used is not appropriate for clinical diagnosis, the average depression findings indicated depression was above the level of concern, or in need of professional evaluation at baseline and 8-week follow-up. The parental supervision and attitude were at a moderate level at baseline. The majority of participants’ best friends (70%) and mothers (65%) smoked. The relationship between nicotine dependence and the level of depression was not significant. Implications: A holistic, integrative, approach to adolescent cessation is necessary. Cessation programs should entail assessment and treatment for depression (if not contraindicated), as well as offer smoking cessation treatment to friends and parents. More research is needed to more accurately understand the link between nicotine dependence and depression level.