S. Department of Health and Human Services, 1988), the typical adolescent smoker will http://www.selleckchem.com/products/carfilzomib-pr-171.html smoke for 18 years if male and 22 years if female (Giovino, 1999). Smoking during adolescence is predictive of health problems at age 30, including respiratory ailments, neurobehavioral and cognitive problems, and general malaise (Brook, Brook, Zhang, & Cohen, 2004). Tobacco-related health consequences also may emerge relatively early as suggested by findings of significant respiratory problems among heavy smoking youth in addictions treatment programs (Myers & Brown, 1994). Tobacco use can complicate psychiatric treatment, increasing the metabolism of some antipsychotic and antidepressant medications (Zevin & Benowitz, 1999).

In prospective studies, tobacco use is one of the strongest predictors of suicidal behavior in youth and adults, even after controlling for depressive symptoms, other substance use, and prior suicidal behavior (Breslau, Schultz, Johnson, Peterson, & Davis, 2005; Oquendo et al., 2004). In regions where smoking is greatly restricted, heavy smokers with mental illness may find it difficult to participate socially, leading to isolation (Prochaska, Fletcher, Hall, & Hall, 2006). A Healthy People 2020 objective for the nation is to decrease the adolescent smoking rate to 16% (U.S. Department of Health and Human Services, 2010). Without intervention, few adolescent smokers stop smoking on their own (Mermelstein, 2003). Although an estimated 51% of high school smokers report a quit attempt in the past year (Centers for Disease Control and Prevention, 2010), only about 4% are successful (Zhu, Sun, Billings, Choi, & Malarcher, 1999).

One-year abstinence success rates are even lower (2%) among adolescents with co-occurring addictive disorders (Myers & MacPherson, 2004). Adolescent preventive service guidelines recommend clinicians regularly assess and treat tobacco use with their patients (American Medical Association, 1997; American Academy of Pediatrics, Committee on Substance Abuse, 2001). Yet, a minority of child and adolescent psychiatrists report consistently asking about smoking, advising their patients to quit, assessing readiness to quit, offering assistance, or arranging follow-up with cessation efforts, referred to as the 5 A��s of tobacco treatment (Price, Sidani, & Price, 2007; Upadhyaya, Brady, Wharton, & Liao, 2003).

A recent review of predictors of cessation in adolescent and young adult smokers concluded from Brefeldin_A the sparse literature that tobacco treatment interventions will remain less than optimally effective until there is a solid evidence base on which to develop interventions (Cengelli, O��Loughlin, Lauzon, & Cornuz, 2012). None of the studies reviewed focused on youth with mental health concerns. Further, the outpatient mental health setting has not been examined as a venue for treating youth tobacco dependence.