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Tob Control. 2003 December; 12(Suppl 4): iv3–iv10.
PMCID: PMC1766133

Effects of motivational interviewing on smoking cessation in adolescents with psychiatric disorders


Objective:To test the hypothesis that among adolescent smokers hospitalised for psychiatric and substance use disorders, motivational interviewing (MI) would lead to more and longer quit attempts, reduced smoking, and more abstinence from smoking over a 12 month follow up.

Design:Randomised control trial of MI versus brief advice (BA) for smoking cessation, with pre- and post-intervention assessment of self efficacy and intentions to change, and smoking outcome variables assessed at one, three, six, nine, and 12 month follow ups.

Setting:A private, university affiliated psychiatric hospital in Providence, Rhode Island, USA.

Patients or other participants:Consecutive sample (n = 191) of 13–17 year olds, admitted for psychiatric hospitalisation, who smoked at least one cigarette per week for the past four weeks, had access to a telephone, and did not meet DSM-IV criteria for current psychotic disorder.

Interventions:MI versus BA. MI consisted of two, 45 minute individual sessions, while BA consisted of 5–10 minutes of advice and information on how to quit smoking. Eligible participants in both conditions were offered an eight week regimen of transdermal nicotine patch upon hospital discharge.

Main outcome measures:Point prevalence abstinence, quit attempts, changes in smoking rate and longest quit attempt. Proximal outcomes included intent to change smoking behaviour (upon hospital discharge), and self efficacy for smoking cessation.

Results:MI did not lead to better smoking outcomes compared to BA. MI was more effective than BA for increasing self efficacy regarding ability to quit smoking. A significant interaction of treatment with baseline intention to quit smoking was also found. MI was more effective than BA for adolescents with little or no intention to change their smoking, but was actually less effective for adolescents with pre-existing intention to cut down or quit smoking. However, the effects on these variables were relatively modest and only moderately related to outcome. Adolescents with comorbid substance use disorders smoked more during follow up while those with anxiety disorders smoked less and were more likely to be abstinent.

Conclusions:The positive effect of MI on self efficacy for quitting and the increase in intention to change in those with initially low levels of intentions suggest the benefits of such an intervention. However, the effects on these variables were relatively modest and only moderately related to outcome. The lack of overall effect of MI on smoking cessation outcomes suggests the need to further enhance and intensify this type of treatment approach for adolescent smokers with psychiatric comorbidity.

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Selected References

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  • Moolchan ET, Ernst M, Henningfield JE. A review of tobacco smoking in adolescents: treatment implications. J Am Acad Child Adolesc Psychiatry. 2000 Jun;39(6):682–693. [PubMed]
  • Sussman S, Lichtman K, Ritt A, Pallonen UE. Effects of thirty-four adolescent tobacco use cessation and prevention trials on regular users of tobacco products. Subst Use Misuse. 1999 Sep;34(11):1469–1503. [PubMed]
  • Houston T, Kolbe LJ, Eriksen MP. Tobacco-use cessation in the '90s--not "adults only" anymore. Prev Med. 1998 Sep-Oct;27(5 Pt 3):A1–A2. [PubMed]
  • McDonald CA, Roberts S, Descheemaeker N. Intentions to quit smoking in substance-abusing teens exposed to a tobacco program. J Subst Abuse Treat. 2000 Apr;18(3):291–308. [PubMed]
  • Sussman S, Dent CW, Lichtman KL. Project EX: outcomes of a teen smoking cessation program. Addict Behav. 2001 May-Jun;26(3):425–438. [PubMed]
  • Engels RC, Knibbe RA, de Vries H, Drop MJ. Antecedents of smoking cessation among adolescents: who is motivated to change? Prev Med. 1998 May-Jun;27(3):348–357. [PubMed]
  • Sussman S, Dent CW, Severson H, Burton D, Flay BR. Self-initiated quitting among adolescent smokers. Prev Med. 1998 Sep-Oct;27(5 Pt 3):A19–A28. [PubMed]
  • Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977 Mar;84(2):191–215. [PubMed]
  • Velicer WF, DiClemente CC, Prochaska JO, Brandenburg N. Decisional balance measure for assessing and predicting smoking status. J Pers Soc Psychol. 1985 May;48(5):1279–1289. [PubMed]
  • Dunn C, Deroo L, Rivara FP. The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review. Addiction. 2001 Dec;96(12):1725–1742. [PubMed]
  • Monti PM, Colby SM, Barnett NP, Spirito A, Rohsenow DJ, Myers M, Woolard R, Lewander W. Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. J Consult Clin Psychol. 1999 Dec;67(6):989–994. [PubMed]
  • Lawendowski LA. A motivational intervention for adolescent smokers. Prev Med. 1998 Sep-Oct;27(5 Pt 3):A39–A46. [PubMed]
  • Peltier B, Telch MJ, Coates TJ. Smoking cessation with adolescents: a comparison of recruitment strategies. Addict Behav. 1982;7(1):71–73. [PubMed]
  • Colby SM, Monti PM, Barnett NP, Rohsenow DJ, Weissman K, Spirito A, Woolard RH, Lewander WJ. Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. J Consult Clin Psychol. 1998 Jun;66(3):574–578. [PubMed]
  • Brown RA, Lewinsohn PM, Seeley JR, Wagner EF. Cigarette smoking, major depression, and other psychiatric disorders among adolescents. J Am Acad Child Adolesc Psychiatry. 1996 Dec;35(12):1602–1610. [PubMed]
  • Biener L, Abrams DB. The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol. 1991;10(5):360–365. [PubMed]
  • Pohl JM, Martinelli A, Antonakos C. Predictors of participation in a smoking cessation intervention group among low-income women. Addict Behav. 1998 Sep-Oct;23(5):699–704. [PubMed]
  • Coleman-Wallace D, Lee JW, Montgomery S, Blix G, Wang DT. Evaluation of developmentally appropriate programs for adolescent tobacco cessation. J Sch Health. 1999 Oct;69(8):314–319. [PubMed]
  • Ockene JK, Emmons KM, Mermelstein RJ, Perkins KA, Bonollo DS, Voorhees CC, Hollis JF. Relapse and maintenance issues for smoking cessation. Health Psychol. 2000 Jan;19(1 Suppl):17–31. [PubMed]
  • Sciamanna CN, Hoch JS, Duke GC, Fogle MN, Ford DE. Comparison of five measures of motivation to quit smoking among a sample of hospitalized smokers. J Gen Intern Med. 2000 Jan;15(1):16–23. [PMC free article] [PubMed]
  • Mermelstein Robin, Colby Suzanne M, Patten Christi, Prokhorov Alexander, Brown Richard, Myers Mark, Adelman William, Hudmon Karen, McDonald Paul. Methodological issues in measuring treatment outcome in adolescent smoking cessation studies. Nicotine Tob Res. 2002 Nov;4(4):395–403. [PubMed]
  • Weinstein SR, Noam GG, Grimes K, Stone K, Schwab-Stone M. Convergence of DSM-III diagnoses and self-reported symptoms in child and adolescent inpatients. J Am Acad Child Adolesc Psychiatry. 1990 Jul;29(4):627–634. [PubMed]
  • Velicer WF, Diclemente CC, Rossi JS, Prochaska JO. Relapse situations and self-efficacy: an integrative model. Addict Behav. 1990;15(3):271–283. [PubMed]
  • Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986 Mar;42(1):121–130. [PubMed]
  • Heather N, Rollnick S, Bell A, Richmond R. Effects of brief counselling among male heavy drinkers identified on general hospital wards. Drug Alcohol Rev. 1996 Mar;15(1):29–38. [PubMed]
  • Butler Christopher C, Rollnick Stephen, Cohen David, Bachmann Max, Russell Ian, Stott Nigel. Motivational consulting versus brief advice for smokers in general practice: a randomized trial. Br J Gen Pract. 1999 Aug;49(445):611–616. [PMC free article]

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