The Journal of Pediatrics
Volume 152, Issue 5 , Pages 738-739, May 2008

Bupropion assists with tobacco cessation in adolescents but relapse is high

Children's National Medical Center, Washington, DC

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Muramoto ML, Leischow SJ, Sherrill D, Matthews E, Strayer LJ. Randomized, double-blind, placebo-controlled trial of 2 dosages of sustained-release bupropion for adolescent smoking cessation. Arch Pediatr Adolesc Med 2007;161:1068-74 

Question 

Among adolescent smokers, does sustained-release bupropion hydrochloride improve cessation rates compared with placebo?

Design 

Prospective, randomized, placebo-controlled trial.

Setting 

Metropolitan areas of Tucson and Phoenix, Arizona.

Participants 

312 adolescents, aged 14 to 17 years, who smoked 6 or more cigarettes per day, had an exhaled carbon monoxide level of 10 ppm or greater, had at least 2 previous quit attempts, and had no other current major psychiatric diagnosis.

Intervention 

Sustained-release bupropion hydrochloride, 150 mg/d (n = 105) or 300 mg/d (n = 104), or placebo (n = 103) for 6 weeks, plus weekly brief individual counseling. Subjects were followed up at 12 weeks (by telephone call) and 26 weeks.

Outcomes 

Confirmed 7-day point prevalence abstinence at 6 weeks and 30-day prolonged abstinence (carbon monoxide level < 10 ppm at each visit; urinary cotinine level ≤ 50 μg/L at weeks 2 and 6).

Main results 

Cotinine-confirmed 7-day point prevalence abstinence rates at 6 weeks were as follows: placebo, 5.6%; 150 mg, 10.7%; and 300 mg, 14.5% (P = .03, 300 mg vs placebo, number needed to treat [NNT] = 12). At 26 weeks, confirmed point prevalence abstinence rates were as follows: placebo, 10.3%; 150 mg, 3.1%; and 300 mg, 13.9% (P = .049). During treatment, confirmed point prevalence rates were significantly higher for 300 mg than placebo at every week except week 4.

Conclusions 

Sustained-release bupropion hydrochloride, 300 mg/d, plus brief counseling demonstrated short-term efficacy for adolescent smoking cessation. Abstinence rates were lower than those reported for adults, with rapid relapse after medication discontinuation.

Comment 

This well-designed and -described study of bupropion for adolescent smoking cessation is an important but discouraging piece of the puzzle of adolescent smoking. Once again, a cessation treatment successful in the adult population has been shown to be less effective when used to treat adolescents. The recent report of DiFranza et al,1 also published in the Archives, of loss of autonomy over tobacco in adolescents before development of daily smoking, is another piece of the same puzzle. Will we ever figure out adolescent smoking and tobacco use? Perhaps not, at least to the same extent that we understand adult tobacco use. As the authors of this study found, there are many barriers to studies of adolescents who use tobacco—recruitment, protocol compliance, parental permission, etc. The more important question may be: when will we seriously begin to prevent tobacco use? We know many of the influences that promote smoking, including depiction of smoking in movies and other media,2 targeting of children and adolescents by tobacco advertising,3 and the influence of peers and family members.4 We also know how to reduce and eliminate tobacco use: higher prices for tobacco products, effective clean indoor air rules and regulations, mass media anti-tobacco education, and changing the social norm around tobacco use.5 These influences and treatments have been known for years; and although many communities deserve credit for implementing many of the parts, as a society we are guilty of ignoring the need for comprehensive tobacco control. Tobacco use is a pediatric disease. The deaths and diseases caused by tobacco use are completely preventable. Is 2008 the year we get serious?

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References 

  1. DiFranza JR, Savageau JA, Fletcher K, O'Loughlin J, Pbert L, Ockene JK, et al. Symptoms of tobacco dependence after brief intermittent use: the development and assessment of nicotine dependence in youth-2 study. Arch Pediatr Adolesc Med. 2007;161:704–710
  2. Dalton MA, Sargent JD, Beach ML, Titus-Ernstoff L, Gibson JJ, Ahrens MB, et al. Effect of viewing smoking in movies on adolescent smoking initiation: a cohort study. Lancet. 2003;362:281–285
  3. Lovato C, Linn G, Stead LF, Best A. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database Syst Rev. 2003;4:CD003439
  4. van den Bree MB, Whitmer MD, Pickworth WB. Predictors of smoking development in a population-based sample of adolescents: a prospective study. J Adolesc Health. 2004;35:172–181
  5. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs—2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2007;October

PII: S0022-3476(08)00127-3

doi:10.1016/j.jpeds.2008.02.021

The Journal of Pediatrics
Volume 152, Issue 5 , Pages 738-739, May 2008

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