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 Platts; Farzana 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

doi:10.1093/ntr/ntw080

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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Abstract

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 language	English
Pages (from-to)	1952-1959
Number of pages	8
Journal	Nicotine & Tobacco Research
Volume	18
Issue number	10
Early online date	31 Mar 2016
DOIs	https://doi.org/10.1093/ntr/ntw080
Publication status	Published - 1 Oct 2016

ASJC Scopus subject areas

Public Health, Environmental and Occupational Health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1093/ntr/ntw080Licence: CC BY-NC-ND

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© The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected].
Final published version, 178 KBLicence: CC BY-NC-ND

Cite this

Vaz, L. R., Aveyard, P., Cooper, S., Leonardi-Bee, J., Coleman, T., Watts, K., Thornton, J., Lewis, S., Britton, J., Coughtrie, M., Godfrey, C., Mannion, C., Marlow, N., Brown, J., Davis, Y., Dickinson, A., Dixon, C., Holloway, F., Lakin, J., ... Sharp, S. (2016). The association between treatment adherence to nicotine patches and smoking cessation in pregnancy: A secondary analysis of a randomized controlled trial. Nicotine & Tobacco Research, 18(10), 1952-1959. https://doi.org/10.1093/ntr/ntw080

@article{a1bdfca59bc447238baadb18c534f80b,

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

abstract = "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.",

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

note = "No funding.",

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doi = "10.1093/ntr/ntw080",

language = "English",

volume = "18",

pages = "1952--1959",

journal = "Nicotine & Tobacco Research",

issn = "1462-2203",

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Vaz, LR, Aveyard, P, Cooper, S, Leonardi-Bee, J, Coleman, T, Watts, K, Thornton, J, Lewis, S, Britton, J, Coughtrie, M, Godfrey, C, Mannion, C, Marlow, N, Brown, J, Davis, Y, Dickinson, A, Dixon, C, Holloway, F, Lakin, J, Platts, J, Rashid, F, Redford, A, Taylor, C, Allsop, J, Cunningham, S, Glass, K, Hall, V, Ismail, K, Ramsay, M, Appleby, S, Bailey, D, Gustard, L, Haworth, E, Hopps, G, Lindley, A, Kettle, C, Pearce, C, Sexton-Bradshaw, D, Savage, J, Smith, S, Taylor, S, Witham, A, Brady, B, Battlemuch, M, Dudley, W, Edwards, R, Frith, L, Hari, I, Holden, C, Hoskyns, L, Jackson, P, Rajaratnam, G, Richardson, D, Wade, L, Whittaker, M, Cook, B, Hodgson, S, Humphries, L, Sanders, B, Simpkins, D & Sharp, S 2016, 'The association between treatment adherence to nicotine patches and smoking cessation in pregnancy: A secondary analysis of a randomized controlled trial', Nicotine & Tobacco Research, vol. 18, no. 10, pp. 1952-1959. https://doi.org/10.1093/ntr/ntw080

TY - JOUR

T1 - The association between treatment adherence to nicotine patches and smoking cessation in pregnancy

T2 - A secondary analysis of a randomized controlled trial

AU - Vaz, Luis R.

AU - Aveyard, Paul

AU - Cooper, Sue

AU - Leonardi-Bee, Jo

AU - Coleman, Tim

AU - Watts, Kim

AU - Thornton, Jim

AU - Lewis, Sarah

AU - Britton, John

AU - Coughtrie, Michael

AU - Godfrey, Christine

AU - Mannion, Clare

AU - Marlow, Neil

AU - Brown, Janet

AU - Davis, Yvette

AU - Dickinson, Anne

AU - Dixon, Caroline

AU - Holloway, Fiona

AU - Lakin, Joanne

AU - Platts, Jayne

AU - Rashid, Farzana

AU - Redford, Amanda

AU - Taylor, Cara

AU - Allsop, Jonathan

AU - Cunningham, Simon

AU - Glass, Karen

AU - Hall, Vince

AU - Ismail, Khaled

AU - Ramsay, Margaret

AU - Appleby, Sheena

AU - Bailey, Denise

AU - Gustard, Linda

AU - Haworth, Emma

AU - Hopps, Grace

AU - Lindley, Amanda

AU - Kettle, Chris

AU - Pearce, Colleen

AU - Sexton-Bradshaw, Dymphna

AU - Savage, Julia

AU - Smith, Sandra

AU - Taylor, Sheila

AU - Witham, Alison

AU - Brady, Barbara

AU - Battlemuch, Michelle

AU - Dudley, Wendy

AU - Edwards, Rochelle

AU - Frith, Lorraine

AU - Hari, Indu

AU - Holden, Catriona

AU - Hoskyns, Linda

AU - Jackson, Paul

AU - Rajaratnam, Giri

AU - Richardson, Deborah

AU - Wade, Lucy

AU - Whittaker, Maureen

AU - Cook, Bernie

AU - Hodgson, Sheila

AU - Humphries, Lisa

AU - Sanders, Bernie

AU - Simpkins, Dan

AU - Sharp, Sheila

N1 - No funding.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - 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.

AB - 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.

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U2 - 10.1093/ntr/ntw080

DO - 10.1093/ntr/ntw080

M3 - Article

C2 - 27611311

AN - SCOPUS:84995633265

SN - 1462-2203

VL - 18

SP - 1952

EP - 1959

JO - Nicotine & Tobacco Research

JF - Nicotine & Tobacco Research

IS - 10

ER -

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

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