Time to first cigarette predicts cessation outcomes in adolescent smokers

Introduction: This study examined the relationship between the time to the first cigarette (TTFC) of the morning with quit status among adolescent smokers at the completion of a school-based smoking cessation program. Among those who did not quit, the relationship of TTFC with changes in cigarettes/day (CPD) was also examined. Methods: A total of 1,167 adolescent smokers (1,024 nonquitters and 143 quitters) from 4 states participating in efficacy and effectiveness studies of the Not-On-Tobacco (N-O-T) cessation program were assessed prior to entry into the program and again 3 months later at the end of treatment. Linear and logistic regression analyses determined the influence of treatment condition, age, gender, motivation to quit, confidence in quitting ability, baseline CPD, and TTFC on quit status and end-of-treatment CPD. Results: Adolescents with a TTFC of >30 min of waking were twice as likely to quit at end of treatment. Additionally, among those who did not quit at end of treatment (n = 700 for TTFC ≤30 min and n = 324 for TTFC for >30 min), those with a TTFC within 30 min of waking smoked a greater number of CPD. The relationships of TTFC with both of these outcomes remained when controlling for all other predictor variables. Conclusions: Identifying adolescent smokers who smoke their first cigarette of the day within the first 30 min of waking prior to a quit attempt may help to classify those individuals as having a greater risk for cessation failure. Thus, TTFC may be a behavioral indicator of nicotine dependence in adolescents.