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MUSC helps teens kick smoking habit by Jill Coley Of The Post and Courier Brittany Ray started smoking when she was 13, a habit she effortlessly picked up from older friends. “I didn’t cough. It didn’t make me sick,” she said.   Five years later, the Wando High School senior wants to toss her Newport 100’s, but she finds herself at the mercy of nicotine—a drug some researchers believe is as addictive as heroin.   Through the high school, Ray enrolled in an adolescent smoking cessation study sponsored by MUSC. The 14-week study, funded by the National Institutes of Health, is part of a multi-year trial on the use of the prescription Zyban and behavior therapy to help teenagers quit smoking.   Currently, no medication to help quit smoking is approved for teenagers, said Himanshu Upadhyaya, M.D., an MUSC psychiatry professor and principal investigator.   Yet adolescence is a pivotal period for smokers: 90 percent take their first puff before age 21. Cigarette use among South Carolina high school students is declining, as is the rate nationally among adolescents. About 74 percent of teenagers in the state reported taking at least one drag in 1991, according to the National Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention. That percentage dropped to 63 percent by 2005, the most recent data available.   But the downward trend seems to have plateaued, with little change in survey results after 2003.   Ray sat across from Upadhyaya in a school administrator’s office and answered a litany of questions on possible side effects: Do you have a sore throat? Dry mouth? Heartburn?   The teenager answered quickly, “No. No. No.”   She had doubts about the lumpy, green pills, coated to prevent identification. “I’m guessing ‘placebo’ because, in my mind, it hasn’t changed anything at all,” she said after a week of taking the pills.   Bupropion hydrochloride, which is sold as Zyban, was first used to treat depression. When those taking the medicine found quitting smoking easier, researchers took note. The Food and Drug Administration approved the drug in 1997 to help adults quit.   Ray is one of six Wando students enrolled in the study this fall. Researchers are starting up at West Ashley High School, too, and are seeing youths on an ongoing basis at MUSC. The study will include 216 adolescents.   But getting face time with busy administrators can be hard, Upadhyaya said. Wando Principal Lucy Beckham said that she jumped at the chance to give students a chance to break a habit that only gets harder to kick. “We want our students to make good choices,” she said.   The study is double-blind, so neither Upadhyaya nor Ray know whether Ray is receiving Zyban or a placebo. She does know that she’s part of the behavior therapy group and will receive increasing monetary rewards for continuously not smoking. Researchers will test urine samples for cotinine, a metabolic by-product of nicotine, to make sure students have quit.   Teenagers know smoking is bad for you, Upadhyaya said, but they see the health effects as an adult problem. Short-term effects of smoking include reduced lung function, higher resting heart rates and early signs of heart disease.   Tobacco addiction also can indicate a nexus of psychiatric issues. An October report by Columbia University’s National Center on Addiction and Substance Abuse found that teen smokers are twice as likely as their nonsmoking peers to suffer symptoms of depression.   The Columbia study also reported that 12- to 17-year-olds who smoke are more than five times likelier to drink and 13 times likelier to use marijuana.   The paradigm of tobacco as a “gateway drug” is shifting, however. Scientists are more likely to describe those who are addicted to any drug as having a “common vulnerability,” Upadhyaya said. Some go straight to marijuana, he said.   The two most common reasons teens tell Upadhyaya they smoke is to calm down and to relax. “It’s stressful in high school,” he said.   Ray feels the pressure of getting into college, where she hopes to study graphic design, and of looking for an apartment. But her favorite release valve is about to be snuffed.   “I want to quit either way, if it’s the placebo or the medicine,” she said. To participate in smoking cessation study Enrollment is ongoing for the MUSC adolescent smoking cessation study. Participants younger than age 18 need parental or guardian consent. To learn more about eligibility, call 792-2388. Smoking statistics --One-third of all smokers had their first cigarette by age 14. --90 percent of all smokers begin before the age of 21. --Each day, 6,000 children younger than 18 smoke their first cigarette. --6.4 million smokers who started as children eventually will die prematurely from smoking-related disease. Editor’s note: The article ran Nov. 5 in The Post and Courier and is reprinted with permission.     Friday, Nov. 9, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.