The association between treatment adherence to nicotine patches and smoking cessation in pregnancy: A secondary analysis of a randomized controlled trial

Luis R. Vaz, Paul Aveyard, Sue Cooper, Jo Leonardi-Bee, Tim Coleman, Kim Watts, Jim Thornton, Sarah Lewis, John Britton, Michael Coughtrie, Christine Godfrey, Clare Mannion, Neil Marlow, Janet Brown, Yvette Davis, Anne Dickinson, Caroline Dixon, Fiona Holloway, Joanne Lakin, Jayne PlattsFarzana Rashid, Amanda Redford, Cara Taylor, Jonathan Allsop, Simon Cunningham, Karen Glass, Vince Hall, Khaled Ismail, Margaret Ramsay, Sheena Appleby, Denise Bailey, Linda Gustard, Emma Haworth, Grace Hopps, Amanda Lindley, Chris Kettle, Colleen Pearce, Dymphna Sexton-Bradshaw, Julia Savage, Sandra Smith, Sheila Taylor, Alison Witham, Barbara Brady, Michelle Battlemuch, Wendy Dudley, Rochelle Edwards, Lorraine Frith, Indu Hari, Catriona Holden, Linda Hoskyns, Paul Jackson, Giri Rajaratnam, Deborah Richardson, Lucy Wade, Maureen Whittaker, Bernie Cook, Sheila Hodgson, Lisa Humphries, Bernie Sanders, Dan Simpkins, Sheila Sharp

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    18 Citations (Scopus)
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    Introduction: In nonpregnant "quitters," adherence to nicotine replacement therapy (NRT) increases smoking cessation. We investigated relationships between adherence to placebo or NRT patches and cessation in pregnancy, including an assessment of reverse causation and whether any adherence: cessation relationship is moderated when using nicotine or placebo patches.

    Methods: Using data from 1050 pregnant trial participants, regression models investigated associations between maternal characteristics, adherence and smoking cessation.

    Results: Adherence during the first month was associated with lower baseline cotinine concentrations (β -0.08, 95% confidence interval [CI] -0.15 to -0.01) and randomization to NRT (β 2.59, 95% CI 1.50 to 3.68). Adherence during both treatment months was associated with being randomized to NRT (β 0.51, 95% CI 0.29 to 0.72) and inversely associated with higher nicotine dependence. Adherence with either NRT or placebo was associated with cessation at 1 month (odds ratio [OR] 1.11, 95% CI 1.08 to 1.13) and delivery (OR 1.06, 95% CI 1.03 to 1.09), but no such association was observed in the subgroup where reverse causation was not possible. Amongst all women, greater adherence to nicotine patches was associated with increased cessation (OR 2.47, 95% CI 1.32 to 4.63) but greater adherence to placebo was not (OR 0.98, 95% CI: 0.44 to 2.18). 

    Conclusion: Women who were more adherent to NRT were more likely to achieve abstinence; more nicotine dependent women probably showed lower adherence to NRT because they relapsed to smoking more quickly. The interaction between nicotine-containing patches and adherence for cessation suggests that the association between adherence with nicotine patches and cessation may be partly causal. 

    Implications: This study used placebo randomized controlled trial data to investigate both associations between women's characteristics and adherence to NRT patch treatment, and the relationship between adherence to NRT patch treatment and odds of cessation in pregnant quitters. Greater adherence was seen with NRT patches, and greater adherence with NRT patches increased the odds of smoking cessation. A likely explanation for findings is that NRT patches, if used sufficiently, may be effective for at least some pregnant women who try to stop smoking. Trials testing interventions which encourage women's adherence to higher dose NRT are indicated.

    Original languageEnglish
    Pages (from-to)1952-1959
    Number of pages8
    JournalNicotine & Tobacco Research
    Issue number10
    Early online date31 Mar 2016
    Publication statusPublished - 1 Oct 2016

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health


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