Adolescents in smoking cessation treatment: Relationship between externalizing symptoms, smoking history and outcome

Previous research has indicated a potential bi-directional link between youth substance use and externalizing psychiatric comorbidities. We hypothesized that the degree of externalizing symptoms predicts the likelihood of successful smoking cessation (prolonged abstinence) among adolescent smokers participating in a cessation trial. We also explored the association of externalizing symptoms with age at smoking initiation. Ninety one adolescents (mean ± S.D.; age 15.1 ± 1.4 years, cigarettes per day 18.4 ± 8.1, Fagerström Test for Nicotine Dependence 7.1 ± 1.3) were included. The Child Behavior Checklist/4–18 and Youth Self-Report assessed the degree of externalizing symptoms. Regression analysis indicated that lower CBCL externalizing scores significantly predicted the likelihood of prolonged abstinence. Pearson's correlation analysis indicated a significant association of lower externalizing scores with later onset of smoking initiation. Our findings highlight the importance of addressing externalizing behaviors in adolescent smoking cessation programs.