Nicotine patches work for adult smokers who want to quit but not for teen-agers, researchers at the Mayo Clinic in Rochester, Minn., have found.

The discovery means that programs for teen-agers must be tailored to their needs, not just adapted from adult programs, said Dr. Richard Hurt, the lead investigator of the study and director of the Mayo Clinic's Nicotine Dependence Center. Teen-age smoking is a critical health issue. Studies show that more than 40 percent of Minnesota 12th-graders smoke, up from about 30 percent in 1992. But most smoking cessation studies exclude participants under age 18 because of a presumption that teen-age smokers do not want to quit, Hurt said. ``A large number of teen-age smokers are interested in stopping. We just haven't figured out how to do it yet,'' Hurt explained. In a study published in the latest edition of the Archives of Pediatric and Adolescent Medicine, Hurt and his colleagues discovered that only about 5 percent of teen-age smokers who wore nicotine patches were nonsmokers after six months. That compares to about 25 percent of adults who quit after using the patches. While the final results were discouraging, Hurt found some bright spots. First, the myth that teens don't want to quit was shattered when far more teens applied than could be enrolled in the study. Second, ``they showed up, wore their patches and did everything we asked,'' Hurt said. Finally, while few quit, teens significantly reduced their smoking, from an average of 18 cigarettes a day to less than three a day. Dorothy Hatsukami, a noted nicotine dependency expert and professor in the University of Minnesota psychiatry department, was not surprised. ``Teen-age smokers are one of the most difficult groups to reach,'' she said. However, just because patches do not work alone does not mean they won't work if combined with some form of behavior counseling, Hatsukami said. Many teens are dealing with a number of issues, including self-image, various stresses, depression, attention deficit hyperactivity disorder and other drugs, such as alcohol. ``Adolescence is not a simple stage of development,'' she said. ``There is a lot of complexity involved in treatment. Sometimes you just can't deal with the teens alone. You must provide information they can share with their parents. At this point in time, we just don't know what works in teens.'' Emily Nelson, 20, of Plymouth began smoking in the ninth grade. She tried to quit several times but failed. Finally, at 19, rising cigarette prices and the impact that tobacco was having on her running convinced her to try to quit again. This time, she enrolled in one of Hatsukami's smoking cessation studies. Some participants received nicotine patches and counseling, while others received placebo patches and counseling. Although Nelson doesn't know whether she got the real or the fake patches, she does know that quitting was extremely difficult. ``It was hard because all my friends smoked,'' she said. ``The first two weeks, I had to stay home and sleep it off. I was very crabby. Now a lot of people ask me for help. And I got some of my friends to quit, too. That really made me feel good.'' Even though Nelson will mark the first anniversary of the day she quit on Feb. 16, she still craves cigarettes. ``I know if I smoked just one, I'd start again,'' she said. ``My secret is that I don't take the first one.'' Hurt said this study was prompted by results of an earlier one -- the first of its kind -- that he and his colleagues conducted about four years ago. In that study, they found that nicotine patches are safe for teen-age smokers. Once the safety question was answered, the Mayo researchers wanted to see how effective they were. They recruited 101 smokers age 13 to 17. About half were from Rochester, and the rest were from La Crosse, Wis. They had been smoking an average of four years, and the nicotine content of their blood and their nicotine tolerance levels resembled those of adult smokers, Hurt said. The teen-agers wore the nicotine patches for six weeks. They were not counseled, because data from previous studies showed the patches work in adults without counseling, and the researchers wanted to test the theory in teens. The participants also were quizzed about the support they received at home. At the end of the treatment, only 11 of the participants had quit. And six months later, six of those 11 were smoking again. Researchers don't know why the patches were so ineffective, or what impact peer pressure may have had on the outcome. But they did discover that 75 percent of the teens lived in homes with other smokers. ``These kids live in high-risk situations,'' Hurt said. ``This is not true in adults.'' The participants were asked what the adults in their homes could have done to help them stop smoking. The teens said the adults should not have smoked around them and should not have bought or provided cigarettes for them. ``We learned a lot that hopefully will set the stage for more novel and effective programs that we're going to test in the near future,'' Hurt said. For instance, in a month or so, Hurt and his colleagues will begin testing the smoking-cessation drug Zyban on teens. Some of the participants will have a support person helping them, while the others will just take the drug. Hurt also will begin a study that uses an Internet program to help teens quit smoking. ``It will be interactive and use chat rooms and that sort of stuff,'' he said. ``You have to get outside the box to do things that are innovative and creative, because teen smokers are a real challenge. But it's encouraging, because a lot of them want to quit.''

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