Brin, 17, started smoking when she was 15 years old. It was a habit she picked up after being around friends and family members who also smoked.

STORIES OF COURAGE: Brin's story
The decision to quit smoking

Brin, 17, started smoking when she was 15 years old. It was a habit she picked up after being around friends and family members who also smoked.

More than a year after her first cigarette, though, a shopping trip changed her outlook on smoking and tobacco. While shopping, she was approached and recruited to take part in an adolescent smoking cessation program called Not-On-Tobacco (N-O-T), the official teen smoking cessation program of the American Lung Association. The program, initiated at Nationwide Children's Hospital in 2006, is one of the first smoking cessation programs for adolescents in central Ohio.

Once a week for 10 weeks, Brin attended a smoking cessation class held at Nationwide Children's. During the first half of the program, she learned some of the common myths of smoking, as well as information about the impact smoking has on overall health. "I already knew a lot of the information, but we were given real-life examples, which made it much more intense," said Brin.

During the fifth class, Brin committed to try to quit smoking, and the remaining group sessions helped support her as she dealt with the standard withdrawal and lifestyle changes associated with quitting. She hasn't quit smoking completely, but she's down to about one cigarette a week, which she usually saves for the weekend when she's around friends who smoke.

"Usually when I'm around it, I don't want one. It makes me not want one more, because it smells," said Brin. "But sometimes it does make me want one. If they would quit, it would be easier [for me] to quit."

Of the more than 80 participants who have joined in the N-O-T program at Nationwide Children's, more than 20 percent have either quit smoking or reduced their smoking by at least 50 percent. Brin is still taking each day at a time, but she has some advice for other teens who are thinking about quitting. "You think you need one, but your body doesn't really need one," she said. "You have to have willpower." She also added that it's easier to quit when you have the structure and support of a class setting, such as the N-O-T program.



PEDIATRIC ADVANCEMENTS: So, why do adolescents smoke?
It's a simple question with no easy answer. No single factor causes someone to smoke. In an effort to better understand some of the motivating forces behind behaviors such as smoking, researchers at Nationwide Children's Hospital are studying not only the smoking habits of teens, but their approach to money.

Brady Reynolds, Ph.D., is a principal investigator with the Center for Biobehavioral Health at the Research Institute at Nationwide Children's Hospital. Reynolds has focused much of his research on the connection between smoking and impulsivity, or more specifically, delayed discounting. Delayed discounting describes a person's preference for a smaller, immediate reward over a larger reward that is delayed for a period of time.

To clarify the relationship behind delayed discounting and a person's success with smoking cessation, Reynolds developed the Experiential Discounting Task (EDT) -a computer-based program that measures delayed discounting. To complete the EDT, the participant views a computer screen that displays two monetary amounts: one that offers a smaller immediate reward and another that offers the possibility of a larger reward at a delayed time. For example, do you want 15 cents now, or the possibility of 30 cents 28 seconds from now? A specialized change machine then dispenses the correct amount, based on the patient's choice.

To determine how delayed discounting relates to cigarette smoking behavior, Reynolds is comparing the results of this task with the results of the N-O-T smoking cessation program offered at Nationwide Children's. He found that adolescents who opt for the lesser, more immediate reward more often are less likely to quit smoking, even after participating in the program aimed at helping them quit. Reynolds' study could have significant implications for designing effective smoking cessation programs. "To reach an adolescent smoker who discounts a great deal, you need to make the benefits of quitting smoking more immediate," said Reynolds. "Programs that stress the long-term effects of smoking are going to be less effective for these adolescents."


FAST FACTS: Preventing your child from picking up the habit:

Start talking about the dangers of tobacco when kids are young and continue the conversation over the years. Establish good communication and discuss topics openly; try to avoid judging. Encourage your child to get involved with activities that prohibit smoking, such as sports. Talk to your child about what he or she sees in movies and on TV and how it compares with reality. Discuss ways to respond to peer pressure to smoke. Encourage your child to walk away from friends who don't recognize or respect his or her reasons for not smoking. Explain the ramifications of smoking and its effect on friendships, health, and your teen's spending money. Establish firm rules and explain the reasons behind them.
For more information about the Not-On-Tobacco smoking cessation program at Nationwide Children's Hospital, call (614) 355-3445, or click on Education Classes at NationwideChildrens.org.