Self-Efficacy Mediates Treatment Outcome in a Smoking Cesstion Program for Adolescent Smokers

Background: Initiating cigarette use in adolescence is associated with continued smoking in adulthood and increased risk for chronic health conditions. As such, preventing the escalation of adolescent cigarette use to more chronic levels may have significant public health benefits. Given that cognitive behavioral therapy (CBT) has long been the standard intervention for adolescent smoking cessation, the current study sought to examine whether there are additional benefits to combining abstinence-contingent incentives (CM) with CBT.   Specifically, we examined whether self-efficacy to resist smoking mediated the effect of CM and CM + CBT on smoking cessation.  

Methods: Participants were 82 predominantly White (93%), adolescent smokers (54% female, 46% male) randomized to one of three 4-week interventions:  CM (n = 25), CBT (n = 26) or CM + CBT (n =31). At baseline and at the end of treatment, adolescents reported on their self-efficacy to resist smoking when emotionally stressed, self-efficacy to resist smoking during recreational activities, and self-efficacy to resist smoking in the presence of peer and social influences. The primary outcome for smoking was self-reported number of days of cigarette use during the last 7 days of treatment.  

Results:  Using regression analyses, we controlled for baseline levels of self-efficacy and found that self-efficacy to resist smoking when emotionally stressed (assessed at the end of treatment) mediated the effect of CM + CBT on abstinence over the course of treatment (indirect effect = -.24, p= .02, 95% CI = -.29 to -.05).  In particular, relative to participants in the CBT condition, participants in the CM + CBT condition experienced higher levels of self-efficacy to resist smoking while emotionally stressed (B = .34, p = .01) which, in turn, was associated with fewer number of days smoking during the last week of treatment (B =-.75 , p < .001).  We did not find evidence to suggest that the CM or CBT conditions significantly differed in their influence on self-efficacy.

Conclusions:  Adolescents who participated in CM + CBT had greater self-efficacy to resist smoking when emotionally stressed.  CM, by helping adolescents achieve abstinence early in treatment, may enhance their ability to focus on learning and applying CBT skills.