Level 2: Mid-level evidence
Some counseling interventions have been shown to have moderate success in reducing smoking rates in teenagers (Cochrane Database Syst Rev. 2010;1:CD003289). A recent cluster randomized trial evaluated the efficacy of adding physical activity to counseling for teenagers trying to quit smoking (Pediatrics. 2011;128:e801-e811).
High schools in West Virginia were randomly assigned to provide one of three smoking cessation programs to students aged 14 to 19 years who smoked on at least one day in the last 30 days:
- A brief intervention with a single 10-15 minute group meeting conducted by a trained facilitator
- Not on Tobacco (N-O-T), a program from the American Lung Association that includes group counseling and advice on healthy behaviors, stress management and life skills, once weekly for 10 weeks
- Or a combination of N-O-T plus a pedometer-based physical activity intervention
Students in the combined group were given pedometers and logs to record steps and daily minutes of other physical activity, and they had additional time in group sessions devoted to encouragement and instruction.
A total of 233 teenagers from 19 schools participated in the trial (54% girls, 96% daily smokers, mean smoking rates 10.1-14.5 cigarettes/day). Follow-up rates were 75% at three months and 63% at six months, but all participants were included in intention-to-treat analyses.
At six-month follow-up, the combination group had the highest quit rate (31.3%), followed by the N-O-T group (21.1%; P=0.066 vs. combination) and the brief intervention group (15.9%; P=0.013 vs. combination). In subgroup analyses by gender, the combination group had significantly increased quit rates compared to the N-O-T program alone in boys (36.8% vs. 18.4%; P=0.033, NNT 6), but not in girls (26.2% vs. 21.1%). The pattern of results was similar at three months.
Alan Ehrlich, MD, is a deputy editor for DynaMed, a database that provides evidence-based information on more than 3,000 clinical topics and is updated daily through systematic surveillance covering more than 500 journals. He is also an assistant clinical professor in Family Medicine at the University of Massachusetts Medical School in Worcester.