Smoking cessation behaviours in a cohort of newly initiated Montreal-area adolescent cigarette smokers

Introduction. After several years of decline, the prevalence of smoking among Canadian adolescents has stabilized at 18%. A lack of knowledge about the process of smoking cessation among adolescents, about how cessation behaviours should be measured, and about the environmental and social factors that influence cessation, has impeded research that would support the development of cessation programs targeted specifically to adolescent smokers that could further reduce the prevalence of smoking. The objectives of this dissertation were to investigate newly initiated adolescent smokers: (i) to identify measures of cessation relevant to the early stages of smoking onset and nicotine dependence; (ii) to estimate the incidence of first cessation attempts and the risk of subsequent relapse; and (iii) to estimate the effect of social influences (friend, sibling and parental smoking) on the occurrence of first cessation attempts and on subsequent relapse. Method. A cohort of 283 newly initiated adolescent smokers was followed from 1999 to 2005. Results. First cessation attempts occurred soon after initiation (median 2.5 months), and were more often reports of having "tried smoking but... [have] now stopped completely and (probably) forever" (i.e., labelled the no longer trying smoking indicator in this dissertation) than of having "seriously... [tried] to quit smoking completely and forever" (i.e., labelled the quit indicator in this dissertation). The incidence of no longer trying smoking was higher among triers compared to those at more advanced stages of smoking onset; and among those who had never experienced symptoms of nicotine dependence or more advanced smoking milestones (e.g., those who had never smoked 100 cigarettes in their lifetime) compared to those who had. The incidence of having quit did not differ across these characteristics. The risk of relapse both after no longer trying smoking and after having quit was high (cumulative incidence, 95% confidence interval [CI] at 6 months 0.56, 95% CI: 0.48, 0.65 and 0.67, 95% CI: 0.56, 0.78, respectively). Compared to adolescents with no friends who smoke, adolescents with a few friends who smoke (Hazard Ratio [HR]: 0.9, 95% CI: 0.6, 1.2) or with half or more friends who smoke (HR: 0.7, 95% CI: 0.5, 1.0) were at lower risk of attempting cessation. Compared to subjects with siblings who do not smoke, subjects with siblings who smoke were more likely to attempt cessation (HR: 1.4, 95% CI: 1.0, 1.9), whereas subjects who did not have siblings were more likely to relapse (HR: 1.8, 95% CI: 0.9, 3.6). Neither friend nor parental smoking had a strong or significant effect on risk of relapse. Conclusions. The immediacy with which newly initiated adolescent smokers first attempt cessation and then relapse suggests that surveillance and research on cessation in adolescents should include smokers in the earliest stages of smoking onset and nicotine dependence. The earliest cessation attempts should be assessed both as no longer trying smoking and as having quit. Among newly initiated adolescent smokers, both friend smoking and siblings may influence cessation behaviours. Cessation programs targeted to newly initiated adolescent smokers may need to incorporate components that take social influences into account. In addition, such programming may need to incorporate a relapse-prevention component.

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