fect of the information and nurse contact
control condition. Unfortunately,
we do not know if the high rates of
abstinence achieved at 12-month
follow-up in both conditions reflect a
secular trend because we did not have
a no-contact control. Therefore, although
promising, these findings indicate
the need to explore strengthening
the counseling intervention to enhance
its effect on abstinence and long-term
maintenance and the need to include a
no-contact control condition in the
study design. A number of intervention
effects on potential mediators of quitting
were identified. First, adolescents’
confidence in their ability to quit improved
more from baseline to 3
months in intervention compared with
control schools, although not at 12
months. It is possible that the initial
success in quitting during and soon after
the intervention boosted confidence,
but with relapse back to smoking,
their confidence eroded. Second,
adolescents in the counseling condition
had made more than twice as
many quit attempts by 3 months compared
with the controls and were able
to refrain for a greater number of days
at both 3 and 12 months. This suggests
the counseling intervention stimulated
more attempts to quit in the shortterm
and enhanced the ability to quit
over a longer time-period during each
attempt.
Consistent with many previous studies
demonstrating dependence and
failed cessation in nondaily smokers
of all ages,31–33 we note that although
38.2% of our subjects were nondaily
smokers, the overall abstinence rate
at 3 months was only 11%. Our analysis
of predictors of cessation outcomes is
the subject of a separate report, but it
is obvious that the majority of nondaily
smokers failed to maintain abstinence.
We conclude that nondaily smokers
are in need of assistance in quitting.
Use of pharmacologic adjuncts for
quitting was relatively low in this
study, comparable with lifetime use of
buproprion (7%) and nicotine gum
(17%) and nicotine patch (16%) in surveys
of youth who have attempted to
quit.34 Nicotine replacement therapy
use was somewhat higher in control
compared with intervention schools at