Review article
Research on tobacco use among teenagers: ethical challenges1

https://doi.org/10.1016/S1054-139X(02)00365-8Get rights and content

Abstract

Recent increases in adolescent smoking portend upcoming public health challenges as the majority of smokers initiate long-term addiction during youth, but experience major health consequences later in life. To effectively address this important teenage and adult health issue, critical research information and early interventions are needed, yet conducting tobacco research with teen smokers poses substantial challenges, including several ethical dilemmas. This paper reviews some of the ethical issues presented in etiologic and clinical treatment research addressing adolescent smoking. Common problems and possible solutions are presented. Issues of parent/guardian involvement, decision-making ability of teens, the need to maintain confidentiality are discussed, along with the specific problems of recruitment, compensation, and ethical challenges that arise in group treatment settings. Context-specific ethical adjustments and alternative perspectives are likely to be needed if we are to overcome procedural difficulties in conducting teen smoking studies.

Section snippets

General considerations

Ethical aspects of research on teen smoking fall within the broader context of research ethics and are based on the principles of respect for autonomy of subjects, beneficence, and justice, as described in previous documents, such as the 1979 Belmont Report [15] and the 1964 Declaration of Helsinki [16]. The challenge remains how to apply them to the practical conduct of research with teenagers, considering that adolescence constitutes a transitional phase of life when issues and concerns

The consent process

A key aspect of obtaining informed consent is ensuring that participants understand the procedures involved, the potential risks as well as benefits from participating in the research, and the alternatives to participation. Several studies have reported on aspects of the decision-making capacity of children to participate in research [19]. Our focus in this paper is on adolescent minors, among whom there is considerable variation in cognitive abilities. Researchers need to carefully consider

Risks and benefits

The principle of beneficence mandates an appropriate risk-benefit ratio for any research study. Federal guidelines require that research risks are justified and reasonable with respect to the anticipated benefits for the research participants and society [21]. As teenagers could be exposed to experiences that result in harm that is minor or serious and transient or permanent, consideration of several categories of risk is important. Ascribing a risk category to a research project is the

Confidentiality

The issue of confidentiality is particularly important in research on adolescent tobacco use. Because it is illegal to sell cigarettes to a minor or, in many states, for a minor to possess cigarettes, cigarette smoking by teens may constitute a form of illegal substance use or a punishable behavior. A teenager may thus not readily disclose smoking status to parents or to other authorities, and it is incumbent on research teams to protect the adolescent’s confidentiality, which may also affect

Recruitment and retention

Researchers generally agree that recruitment can be the most challenging aspect of conducting research with teens [35]. The setting (i.e., school, laboratory, clinic, or other), type of study, and other variables will likely shape the strategies for recruitment of adolescents of various age groups, genders, and ethnicities into smoking studies. One crucial question to address is how researchers can ethically recruit teenagers.

Ensuring confidentiality is critical when the research concerns a

Compensation

Questions of timing, beneficiary, and amount of compensation arise commonly when seeking to improve recruitment and retention of participants. Remuneration of teenage research participants may be justified to reimburse them for expenses incurred (e.g., transportation), reduce their personal financial sacrifice (if they are using work time), and to compensate for time and effort. Compensation, however, should not be described as a benefit of participation in a research study. Participant payment

Etiologic/epidemiologic studies involving families

There are several ethical and logistical dilemmas that arise in conducting family studies related to adolescent tobacco use. For example, genetic analyses are important for helping to answer questions about the heritability of tobacco use and nicotine dependence, and studies of family environment or mediating factors might help explain the link between parent and child smoking. Concerns have been expressed that genetic information may be used to stigmatize or discriminate against individuals in

Summary and conclusions

It has become increasingly clear that more research on teenage smoking is needed. Careful attention to the specific ethical issues that affect adolescent tobacco use research should help to increase the field’s ability to move forward on challenging research studies involving youth. From a practical standpoint, certain developmental and sociolegal features of adolescence should prompt adjustments geared to address the challenges and potential barriers that researchers may encounter. For

Acknowledgments

We are grateful to Drs. David Gorelick and Thiri Aung, as well as the staff of the Teen Tobacco Addiction Treatment Research Clinic for their contributions to this manuscript.

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