30-day Cigarette Use Research Articles

N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study

IntroductionN-Acetylcysteine (NAC) may have efficacy in treating tobacco use disorder (TUD) by reducing craving and smoking reward. This study examines whether treatment with NAC may have a clinical efficacy in the treatment of TUD.MethodsA 12-week double blind randomized controlled trial was conducted to compare the clinical efficacy of NAC 3 g/day versus placebo. We recruited 34 outpatients with therapy resistant TUD concurrently treated with smoking-focused group behavioral therapy. Participants had assessments of daily cigarette use (primary outcome), exhaled carbon monoxide (COEXH) (secondary outcome), and quit rates as defined by COEXH<6 ppm. Depression was measured with the Hamilton Depression Rating Scale (HDRS). Data were analyzed using conventional and modified intention-to-treat endpoint analyses.ResultsNAC treatment significantly reduced the daily number of cigarettes used (Δ mean±SD = −10.9 ± 7.9 in the NAC-treated versus −3.2 ± 6.1 in the placebo group) and COEXH (Δ mean± SD = −10.4 ± 8.6 ppm in the NAC-treated versus −1.5 ± 4.5 ppm in the placebo group); 47.1% of those treated with NAC versus 21.4% of placebo-treated patients were able to quit smoking as defined by COEXH<6 ppm. NAC treatment significantly reduced the HDRS score in patients with tobacco use disorder.ConclusionsThese data show that treatment with NAC may have a clinical efficacy in TUD. NAC combined with appropriate psychotherapy appears to be an efficient treatment option for TUD.

Tobacco Use and Clinical Symptoms in a Sample of Outpatients Diagnosed with Schizophrenia

Introduction The self-medication hypothesis suggests that patients diagnosed with schizophrenia might smoke as an attempt to self-medicate theirsymptoms. As a consequence, smoking cessation could worsen their clinical status. Objectives To assess the clinical changes associated with tobacco cessation in a sample of smoking outpatients with schizophrenia. Methods Sample: 63 smoking outpatients with DSM-IV Schizophrenia from three Mental Health Centers located in Northern Spain [77.0% males; mean age (SD) = 43.90 (8.72); average daily cigarette use (SD) = 27.99 (12.55)]. Instruments: (1) Clinical symptoms: Positive and Negative Symptoms Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI). (2) Pattern of tobacco use: n° cigarettes/day; Expired carbon monoxide (CO ppm). Design: A quasi-experimental design with two groups was implemented: control group (GC − 18 patients not willing to stop smoking), and treatment group [TG − 45 patients in smoking cessation supported by nicotine patches or vareniclina (12 weeks)]. Patients were evaluated at baseline and at week 11 (end of program). Paired sample t-test was used to detect changes in clinical symptoms from baseline to follow-up. Results 23.1% stopped smoking (from TG). No significant differences were found between baseline and follow-up scores (p>.05) among smokers and abstinent in PANSS subscales, HDRS and CGI. Conclusions Tobacco cessation did not have a significant effect on the clinical symptoms of this group of patients. Further studies should analyze the stability of these outcomes at longer follow-ups to confirm our results.

The Metacognitions about Smoking Questionnaire: Development and psychometric properties

ObjectivesRecent research has suggested that metacognitions may play a role in smoking. The goal of the current set of studies was to develop the first self-report instrument of metacognitions about smoking. MethodWe conducted three studies with samples of smokers (n=222, n=143, n=25) to test the structure and psychometric properties of the Metacognitions about Smoking Questionnaire and examined its capacity to predict smoking behaviour. ResultsExploratory and confirmatory factor analyses supported a four-factor solution: positive metacognitions about cognitive regulation, positive metacognitions about emotional regulation, negative metacognitions about uncontrollability, and negative metacognitions about cognitive interference. Internal consistency, predictive and divergent validity, and temporal stability were acceptable. The metacognition factors correlated positively with daily cigarette use and levels of nicotine dependence, and contributed to the prediction of these outcomes over and above smoking outcome expectancies. ConclusionsThe Metacognitions about Smoking Questionnaire was shown to possess good psychometric properties, as well as predictive and divergent validity within the populations that were tested. The metacognition factors explained incremental variance in smoking behaviour above smoking outcome expectancies.

Disparities in tobacco use by sexual orientation among high school students

ObjectiveThis study examined whether cigarette use is associated with sexual orientation among high school students. MethodsData were from a 2012 cross-sectional survey of 5994 students in grades 9, 10 and 12 attending public schools in Atlantic Canada. Multilevel logistic regression analysis was used to examine differences in cigarette use by sexual orientation. ResultsLesbian, gay and bisexual adolescents (LGB) reported higher prevalence (22%) of daily cigarette use compared with heterosexuals (11%). Multilevel logistic regression analysis, controlling for standard covariates, found that LGB adolescents were more likely to be daily smokers than non-LGB adolescents (odds ratio 2.00, 95% confidence interval 1.50–2.68). Bisexual adolescents were at least twice more likely to be a smoker compared with heterosexual adolescents. ConclusionsPrevalence of cigarette use was significantly higher among LGB adolescent students. Our results join a growing body of evidence indicating that sexual minorities are at heightened risk of tobacco use. Smoking cessation measures that specifically target this group may be beneficial given that there is no one size fits all approach.

A longitudinal study of electronic cigarette use among a population-based sample of adult smokers: association with smoking cessation and motivation to quit.

Increasingly popular electronic cigarettes (e-cigarettes) may be the most promising development yet to end cigarette smoking. However, there is sparse evidence that their use promotes cessation. We investigated whether e-cigarette use increases smoking cessation and/or has a deleterious effect on quitting smoking and motivation to quit. Representative samples of adults in 2 US metropolitan areas were surveyed in 2011/2012 about their use of novel tobacco products. In 2014, follow-up interviews were conducted with 695 of the 1,374 baseline cigarette smokers who had agreed to be re-contacted (retention rate: 51%). The follow-up interview assessed their smoking status and history of electronic cigarette usage. Respondents were categorized as intensive users (used e-cigarettes daily for at least 1 month), intermittent users (used regularly, but not daily for more than 1 month), and non-users/triers (used e-cigarettes at most once or twice). At follow-up, 23% were intensive users, 29% intermittent users, 18% had used once or twice, and 30% had not tried e-cigarettes. Logistic regression controlling for demographics and tobacco dependence indicated that intensive users of e-cigarettes were 6 times more likely than non-users/triers to report that they quit smoking (OR: 6.07, 95% CI = 1.11, 33.2). No such relationship was seen for intermittent users. There was a negative association between intermittent e-cigarette use and 1 of 2 indicators of motivation to quit at follow-up. Daily use of electronic cigarettes for at least 1 month is strongly associated with quitting smoking at follow-up. Further investigation of the underlying reasons for intensive versus intermittent use will help shed light on the mechanisms underlying the associations between e-cigarette use, motivation to quit, and smoking cessation.

Gender, Depressive Symptoms, and Daily Cigarette Use

Objective: It is widely known that cigarette use and depressive symptoms co-occur during adolescence and young adulthood and that there are gender differences in smoking initiation, progression, and co-occurrence with other drug use. Given that females have an earlier onset of depressive symptoms while males have an earlier onset of cigarette use, this study explored the possible bidirectional development of cigarette use and depressive symptoms by gender across the transition from adolescence to young adulthood. Gender differences in the stability and crossed effects of depressive symptoms and cigarette smoking during the transition to young adulthood, controlling for other known risk factors, were examined using a nationally representative longitudinal sample. Methods: A bivariate autoregressive multi-group structural equation model examined the longitudinal stability and crossed relationships between a latent construct of depressive symptoms and cigarette smoking over four waves of data. Data for this study came from four waves of participants (N = 6,501) from the National Longitudinal Survey of Adolescent Health. At each of four waves, participants completed a battery of measures including questions on depressive symptoms and an ordinal measure of number of cigarettes smoked per day. Results: The best-fitting bivariate autoregressive models were gender-specific, included both crossed and parallel associations between depressive symptoms and cigarette use during the transition to adulthood, and controlled for wave-specific parental smoking, alcohol use, and number of friends who smoke. For females, greater depressive symptoms at each wave, except the first one, were associated with greater subsequent cigarette use. There were bidirectional associations between depressive symptoms and cigarette use only for females during young adulthood, but not for males. Conclusions: The development of depressive symptoms and cigarette use from adolescence and into young adulthood follows similar patterns for males and females. Controlling for the correlation and stability between initial levels of depressive symptoms and cigarette use from adolescence into young adulthood, there remains a crossed association between cigarette use and depressive symptoms specific to females during young adulthood. The findings suggest that prevention interventions focused on mental health should include warnings that cigarette use may exacerbate depressive symptoms.

Symptoms of tobacco dependence among middle and high school tobacco users: results from the 2012 National Youth Tobacco Survey.

A growing body of evidence suggests that tobacco dependence symptoms can occur soon after smoking onset and with low levels of use. However, limited data are available nationally and among non-cigarette tobacco users. To examine the prevalence and determinants of tobacco dependence symptoms among adolescent tobacco users in the 2012 National Youth Tobacco Survey, a nationally representative, school-based survey of U.S. middle and high school students. Multivariate logistic regression was used to identify independent predictors of dependence symptoms among current users (i.e., past 30-day use) of cigarettes, cigars, or smokeless tobacco. Analyses were conducted in 2013 using SAS-callable SUDAAN, version 11 to account for the complex survey design. Prevalence of tobacco dependence symptoms ranged from 20.8% (95% CI=18.6, 23.1) of current tobacco users reporting wanting to use tobacco within 30 minutes of waking to 41.9% (95% CI=39.3, 44.5) reporting recent strong cravings. Reporting of dependence symptoms was most consistently associated with polytobacco use, higher frequency of use, earlier initiation age, and female gender. A 2-4-fold increase in the odds of symptom reporting was found in adolescents using tobacco products on as few as 3-5 days compared to those who only used it for 1-2 of the past 30 days. A substantial proportion of U.S. adolescent tobacco users, including those with low levels of use, report symptoms of tobacco dependence. These findings demonstrate the need for full implementation of evidence-based strategies to prevent both experimentation and progression to regular tobacco use among youth.

Trajectories of daily cigarette use from mid-adolescence to young adulthood: The role of depressive symptoms

Trajectories of daily cigarette use from mid-adolescence to young adulthood: The role of depressive symptoms

Tobacco use among Norwegian adolescents: from cigarettes to snus

AimsTo: (i) investigate the development of smoking and snus use among Norwegian adolescents, and (ii) describe the users in each group.DesignTwo population-based surveys with identical procedures in 2002 (response rate 91.0%) and 2010 (response rate 84.3%).SettingNorway.ParticipantsA total of 6217 respondents, aged 16–17 years.MeasurementsData were collected on smoking and snus use, socio-demographic factors, school adjustment, social network, sport activities, alcohol and cannabis use and depression symptoms.FindingsPrevalence of daily smoking fell from 23.6% in 2002 to 6.8% in 2010 (P < 0.001), while the prevalence of daily snus use increased from 4.3 to 11.9% (P < 0.001). Dual daily use of cigarettes and snus remained at 1%. The relative proportion of non-daily smokers using snus increased steeply. Both snus users and smokers reported more adverse socio-economic backgrounds, less favourable school adjustment and higher levels of alcohol intoxication and cannabis use than non-users of tobacco. However, snus users were better adjusted to school and used cannabis less often than smokers.ConclusionsAdolescent smoking prevalence has fallen dramatically in Norway, accompanied by a smaller increase in snus use. Young snus users in Norway have many of the same risk factors as smokers, but to a lesser degree.

Reliability of the Timeline Followback for cocaine, cannabis, and cigarette use.

The Timeline Followback (TLFB), a retrospective calendar-based measure of daily substance use, was initially developed to obtain self-reports of alcohol use. Since its inception it has undergone extensive evaluation across diverse populations and is considered the most psychometrically sound self-report measure of drinking. Although the TLFB has been extended to other behaviors, its psychometric evaluation with other addictive behaviors has not been as extensive as for alcohol use. The present study evaluated the test-retest reliability of the TLFB for cocaine, cannabis, and cigarette use for participants recruited from outpatient alcohol and drug treatment programs and the general community across intervals ranging from 30 to 360 days prior to the interview. The dependent measure for cigarette smokers and cannabis users was daily use of cigarettes and joints, respectively, and for cocaine users it was a "Yes" or "No" regarding cocaine use for each day. The TLFB was administered in different formats for different drug types. Different interviewers conducted the two interviews. The TLFB collected highly reliable information about participants' daily use of cocaine, cannabis, and cigarettes from 30, 90, to 360 days prior to the interview. Findings from this study not only suggest that shorter time intervals (e.g., 90 days) can be used with little loss of accuracy, but also add to the growing literature that the TLFB can be used with confidence to collect psychometrically sound information about substance use (i.e., cocaine, cannabis, cigarettes) other than alcohol in treatment- and nontreatment-seeking populations for intervals from ranging up to 12 months prior to the interview.

Evaluation of a community-based tobacco control intervention in five remote north Queensland Indigenous communities

This study aimed to assess the impact of a complex community-based tobacco control program in eight remote north Queensland Indigenous communities with high rates of tobacco use. A community-based tobacco intervention trial was conducted over one year in five intervention sites and three control sites in far north Queensland with predominantly Aboriginal and Torres Strait Islander populations. The intervention was composed of six components: a school-based education program ‘Smokin’ No Way’, ‘SmokeCheck’ tobacco brief intervention training for health workers, assistance to develop workplace smoke-free policies, an Event Support Program, ‘Smoke Rings’ support group and enforcement of tobacco sales legislation. Household surveys of self-reported tobacco use were conducted at baseline and one year after the interventions, along with interviews with key individuals and organisations, to assess intervention implementation. It was found that there was a modest effect on self-reported daily tobacco use and mean number of cigarettes smoked weekly after 12 months in intervention communities. There were non-significant declines in self-reported smoking and mean cigarettes smoked per week in aggregated control communities. Independent evaluation of fidelity of implementation found major shortcomings in actual program delivery. To enhance success of future interventions, fidelity of implementation should be ensured and a longer implementation period utilised.

Energy Drinks, Soft Drinks, and Substance Use Among United States Secondary School Students

Examine energy drink/shot and regular and diet soft drink use among United States secondary school students in 2010-2011, and associations between such use and substance use. We used self-reported data from cross-sectional surveys of nationally representative samples of 8th-, 10th-, and 12th-grade students and conducted multivariate analyses examining associations between beverage and substance use, controlling for individual and school characteristics. Approximately 30% of students reported consuming energy drinks or shots; more than 40% reported daily regular soft drink use, and about 20% reported daily diet soft drink use. Beverage consumption was strongly and positively associated with past 30-day alcohol, cigarette, and illicit drug use. The observed associations between energy drinks and substance use were significantly stronger than those between regular or diet soft drinks and substance use. This correlational study indicates that adolescent consumption of energy drinks/shots is widespread and that energy drink users report heightened risk for substance use. This study does not establish causation between the behaviors. Education for parents and prevention efforts among adolescents should include education on the masking effects of caffeine in energy drinks on alcohol- and other substance-related impairments, and recognition that some groups (such as high sensation-seeking youth) may be particularly likely to consume energy drinks and to be substance users.

Examining the stability of young-adult alcohol and tobacco co-use: A latent transition analysis

Although use of both alcohol and tobacco is common among college-attending young adults, little is known about the stability of co-use over time. Difficulties in studying change in these behaviors may reflect inconsistencies in how smoking in particular is categorized. This study used longitudinal data, gathered at three time points three months apart, to examine cigarette and alcohol use profiles and the stability of profile structure and membership. Undergraduate student smokers’ (N = 320) past 30-day alcohol and cigarette use was assessed using the timeline followback procedure. Smoking (number of cigarettes and number of smoking days) and drinking (number of drinks and number of binges) were entered into a latent transition analysis (LTA) to identify the latent taxonomic structure within the sample, and determine the probability of movement between groups over time. A three-profile solution emerged at each time point. The LTA probabilities highlighted both progression and reduction in the lower-use groups. Overall, findings revealed notable changes in tobacco and alcohol use behaviors over the span of six months, affecting both profile structures and individual membership status. This suggests that among young adults both tobacco and alcohol use are temporally unstable behaviors, particularly among those using at lower levels.

Systematic review with meta‐analysis: race‐specific effects of alcohol and tobacco on the risk of oesophageal squamous cell carcinoma

Oesophageal squamous cell carcinoma (OSCC) is associated with alcohol use, tobacco use and African or Asian descent. However, little is known about how racial background modifies the effects of alcohol or tobacco. To investigate how racial and geographical background modifies the effect of alcohol and tobacco on OSCC via a systematic review and meta-analysis of published literature. We performed a literature search in multiple online databases regardless of language. Eligible studies were population-based assessments of the effect of tobacco and/or alcohol on the risk of OSCC allowing stratification by race. The quality of studies was assessed by the Newcastle-Ottawa Scale. Meta-analyses were performed to estimate summary effects using random effect models. Systematic review identified 9668 unique citations of which 34 were eligible. The majority were of high quality. The effect of current smoking vs. never-smoking was weaker among Asians than among Europeans [European: odds ratio (OR)=4.21, 95% confidence interval (CI) 3.13, 5.66; Asian: OR=2.31, 95% CI 1.78, 2.99], with the 95% CIs not crossing, indicating statistical significance. Asians also trended towards weaker effects of long-duration cigarette use and of heavy daily cigarette use. There was no difference in the effect of alcohol on OSCC risk by race. Contrary to our hypothesis, a weaker effect of tobacco for OSCC was observed among Asians than among Europeans. Differences in other factors must explain the higher incidence of OSCC among Asians. More studies are needed to understand the cause of the disparate incidence of OSCC between races.

Tobacco Use by Sexual Identity Among Young Adults in the United States

National surveillance data are needed for the lesbian, gay, bisexual, and transgender population, a group which has been shown to have unique health needs. This study uses data from Legacy's Young Adult Cohort Study, a nationally representative sample collected in the summer of 2011 to examine patterns of tobacco use by sexual identity. Homosexual and bisexual past 30-day cigarette use (35% and 27%, respectively) was higher than heterosexual past 30-day cigarette use (18%; p = .004). The prevalence of any current tobacco use among heterosexuals was 22% compared with 35% in homosexuals and 31% in bisexuals (p = .04). Prevalence of dual use was 30% among heterosexuals, 43% among homosexuals, and 35% among bisexuals. High school education (OR = 4.27), current alcohol use (OR = 12.64), and current other drug use (OR = 9.67) were significant predictors of current cigarette use among lesbian, gay, and bisexual respondents. Strong predictors of other tobacco product use were Black race (OR = 6.95), current alcohol use (OR = 11.70), and current other drug use (OR = 7.42). Prevalence estimates for tobacco use were higher among young adults who self-identify as sexual minorities compared with those who identify as heterosexuals. Tobacco use is strongly associated with alcohol and other drug use in this population. This study highlights the significant disparities in tobacco use behaviors among sexual minority populations and the critical need to conduct surveillance among these groups.

Understanding Physical Activity Outcomes as a Function of Teen Smoking Cessation

Recent evidence suggests physical activity may be protective against smoking initiation and increased smoking among youth. The present study explored the effects of a teen smoking cessation intervention supplemented with a physical activity module on participants' physical activity outcomes. A secondary aim examined the relationship between participants' physical activity outcomes and postprogram smoking intensity. The study reports primary data from a 3-arm randomized group trial consistent with CONSORT guidelines (Registry # NCT01242657). Public high schools (N = 19) in West Virginia. Teens aged 14-19 years (N = 233) who reported current smoking, ≥1 cigarette in the past 30 days. High schools were randomly selected, then randomly assigned to Brief Intervention (standard of care), Not-On-Tobacco (N-O-T, teen cessation program), or N-O-T plus a physical activity module (N-O-T+FIT). Standardized instruments at baseline and end of treatment/3-months postbaseline measured physical activity outcomes. The study assessed smoking intensity using cigarettes smoked per day. We conducted ANCOVA controlling for school-level variance to measure physical activity changes. Multiple linear and logistic regression analyses explored favorable change influence of physical activity on smoking cessation outcomes, controlling for potential clustering. Teens who increased the number of days on which they received at least 20 minutes of exercise were significantly more likely to reduce their daily cigarette use, with those in the N-O-T+FIT condition having the highest likelihood of reducing smoking. Teens in the N-O-T+FIT condition who increased the number of days on which they received at least 30 minutes of exercise were significantly more likely than those in other groups to quit smoking. Findings suggest that it is possible to alter simultaneously more than one health behavior among teens-favorable changes in physical activity and smoking cessation may be particularly compatible targets for dual behavior change.

Depressive symptoms, religious coping, and cigarette smoking among post-secondary vocational students.

Depressive symptoms are associated with increased levels of cigarette smoking, yet not every individual experiencing depressive symptoms smokes. This study examined whether religious coping moderated the impact of depressive symptoms on past 30-day cigarette use among a racially/ethnically diverse sample of 963 postsecondary vocational students (46.8% women; mean age = 25 years). Results from negative binomial regression analyses indicated that depressive symptoms increased the likelihood of cigarette smoking (quantity-frequency measure of cigarette use) for female students, whereas positive religious coping decreased the likelihood of smoking for female students. Consistent with religious coping theory and as expected, negative religious coping moderated the depressive symptoms-smoking relationship such that negative religious coping exacerbated the impact of depressive symptoms on cigarette smoking among females. Positive religious coping also moderated the depressive symptoms-cigarette smoking relationship for females. However, contrary to expectations, high levels of positive religious coping exacerbated the likelihood of cigarette smoking among females with high levels of depressive symptoms. Surprisingly, neither depressive symptoms nor positive or negative religious coping contributed to the likelihood of males' smoking. Study limitations and suggestions for directions in future research are discussed.

Racial Differences in the Effect of Alcohol and Tobacco on the Risk of Esophageal Squamous Cell Carcinoma

Purpose: Within the U.S., African and Asian Americans have higher incidences of esophageal squamous cell carcinoma (ESCC) than whites. Alcohol and tobacco use are well-established risk factors for ESCC. We hypothesized that the effects of these exposures are stronger among individuals of Asian or African descent than among those of European descent. Methods: We performed a systematic literature review in electronic databases regardless of language. Eligible studies were population-based assessments of the effect of tobacco and/or alcohol on the risk of ESCC, and allowed for stratification by race. Quality of studies was assessed by the Newcastle-Ottawa Scale. Meta-analyses were performed to identify summary estimates using random effect models. Heterogeneity was defined by Cochrane's Q p<0.20 and the inconsistency index (I2, < 25% low, > 75% high). Results: Systematic review identified 4,951 unique citations, of which 39 were eligible. 30 were case-control and 9 were cohort studies; the majority was high quality. 16 studies provided data on individuals of European, 16 of Asian, 6 of South American, and 2 of African descent. In analyses pooling all races, there were dose-response relationships with alcohol and tobacco use, but with substantial heterogeneity (Table). The effect of current smoking vs. never was weaker among Asians than Europeans (European: OR 4.59, 95% CI 3.46-6.10; Asian: OR 2.59, 95% CI 1.99-3.37), with the 95% CI of the estimates not crossing each other's boundaries, indicating statistical significance. Asians also trended toward having weaker effects of long duration cigarette use (>20 years vs never, European: OR 5.00, 95% CI 3.51-7.12; Asian: OR 3.39, 95% CI 1.66-6.94), and of heavy daily cigarette use (>20 per day vs. none, European: OR 4.65, 95% CI 3.12-6.92; Asian: OR 2.70, 95% CI 1.69-4.30). There was no difference of the effect of alcohol on the risk of ESCC by race.Table: Maximally adjusted summary odds ratios: all studiesConclusion: The estimated effects of alcohol and tobacco use on the risk of ESCC from population-based studies are heterogeneous. Contrary to our hypothesis, a weaker effect of tobacco for ESCC was observed among Asians than among Europeans. Differences in the effects of other factors or in the prevalence of tobacco and alcohol use must explain the higher incidence of ESCC among Asians. The study was limited by the small number of studies among individuals of African descent. More studies are needed to understand the cause of the higher incidence of ESCC among African and Asian Americans.

The Relative Risk to Health From Snus and Cigarettes: Response to Grimsrud et al.'s Commentary on "Perceptions of the Relative Harmfulness of Snus Among Norwegian General Practitioners and Their Effect on the Tendency to Recommend Snus in Smoking Cessation"

The Relative Risk to Health From Snus and Cigarettes: Response to Grimsrud et al.'s Commentary on "Perceptions of the Relative Harmfulness of Snus Among Norwegian General Practitioners and Their Effect on the Tendency to Recommend Snus in Smoking Cessation"

One-year outcomes of a drug abuse prevention program for older teens and emerging adults: Evaluating a motivational interviewing booster component.

The present study tested the efficacy of motivational interviewing-based booster sessions for Project Toward No Drug Abuse (TND), a 12-session school-based curriculum targeting youth at risk for drug abuse. In addition, generalization of effects to risky sexual behavior was assessed. The 1-year outcomes evaluation of the project is presented. A total of 24 schools were randomized to one of three conditions: standard care control (SCC), TND classroom program only (TND-only), and TND plus motivational interviewing booster (TND + MI). A total of 1186 participants completed baseline and 1-year follow-up surveys. Following the classroom program, youth in the TND + MI condition received up to 3 sessions of MI in person or by telephone. Effects were examined on 30-day cigarette, alcohol, marijuana, and hard drug use, as well as measures of risky sexual behavior (number of sex partners, condom use, having sex while using drugs or alcohol). Collapsed across the 2 program conditions, results showed significant reductions in alcohol use, hard drug use, and cigarette smoking relative to controls. These effects held for an overall substance use index. The MI booster component failed to achieve significant incremental effects above and beyond the TND classroom program. No effects were found on risky sexual behavior. While the program effects of previous studies were replicated, the study failed to demonstrate that an adequately implemented MI booster was of incremental value at 1-year follow-up.