Historically, almost all adult smokers begin smoking as adolescents,5
but smoking becomes more entrenched during young adulthood (i.e., ages 18–24 years),6–8
and initiation into smoking is also not uncommon during this developmental period. This combination of initiation and escalation of smoking produces smoking prevalence equivalent to that of older age groups; in 2009, 21.8% of those aged 18–24 years in the U.S. were current smokers.1
Despite the increasing prevalence of smoking from adolescence into young adulthood, young adult smokers are interested in stopping smoking, and young adults are more likely to make a quit attempt than are older adults.1
In 2007, slightly more than half of current everyday smokers attempted to quit in the past 12 months.2
Yet young adults appear to differ in their methods of quitting smoking compared to older adults. For example, Solberg et al.9
found that young adults (aged 18–24 years) were less likely than older adults (aged 25–65 years) to use medication or to receive help from medical sources during the quit attempts, even in a sample that had access to assistance and medication. Curry et al. 10
similarly found in a national sample that young adults underutilized smoking-cessation treatments and rarely received advice from health providers concerning how to quit. What is unknown, however, is whether evidence-based treatments that benefit the general population are helpful for young adults also.
The DHHS Clinical Practice Guidelines for Treating Tobacco Use and Dependence3
identified multiple effective methods for smoking cessation among adults. The guidelines did not, however, specifically address the special population of young adults. Young adults' smoking patterns differ substantially from those of older adults.8
For example, young adults are more likely to be nondaily smokers and lighter smokers than are older adults.9,11
Among young adult smokers, Fagan et al.11
found that factors associated with quit attempts vary for daily and nondaily smokers, such that nicotine dependence may be more of a factor among daily smokers and sociodemographic factors may be more important among nondaily smokers. These different patterns of smoking as well as different factors associated with attempts at quitting bring into question whether cessation methods that are effective for adults in general will be equally effective for young adult smokers.
Villanti, et al.12
conducted a systematic qualitative review of smoking-cessation interventions for young adults (aged 18–24 years) in the U.S. They identified 12 RCCTs and two nonrandomized studies for review. Their analysis focused exclusively on interventions designed to meet the needs of young adults in the U.S., and not ones geared toward the general adult smoking population. All of the interventions included in the review focused on individual-level strategies for behavior change; there were no studies included of pharmacologic interventions in young adults. Of the 14 studies included, only two had significant results beyond 6 months follow-up. These authors conclude that there is limited evidence to date for the efficacy of smoking-cessation interventions for young adults in the U.S., but also note that the evidence base is limited by the methodologic variability in the studies, the lack of consistency of standard measures of smoking for this age group, and the limited diversity of smokers included in their sample of studies.
The overall goal of the current paper was to conduct a meta-analysis examining the efficacy of general adult smoking-cessation interventions in young adults. Smoking-cessation trials have generally not focused on young adults. When they are included in intervention trials, their outcomes typically are pooled with older or younger participants, making it difficult to assess whether particular interventions are effective for those aged 18–24 years.
The present meta-analysis differs from the Villanti et al.12
review in several ways. First, the present meta-analysis did not focus on interventions specifically designed for young adults, but rather, addressed the question of whether smoking-cessation interventions found effective for all adults would be effective for young adult smokers. Second, in addition to behavioral counseling studies, the present review included studies with a variety of pharmacotherapies as well as interventions found effective in special populations (e.g., pregnant women, hospitalized smokers). Finally, the analytic approaches were somewhat different, with the present study conducting a more formal meta-analysis. Only one study included in the previous review12
overlaps with the current study's meta-analysis.13
Thus, the present study complements the review of Villanti et al. and by more specifically addressing the question: Do smoking-cessation interventions geared for the general adult population show efficacy specifically for young adults?