孕期尼古丁贴片治疗依从性与戒烟之间的关联：一项随机对照试验的二次分析
The Association Between Treatment Adherence to Nicotine Patches and Smoking Cessation in Pregnancy: A Secondary Analysis of a Randomized Controlled Trial.
作者信息
Vaz Luis R, Aveyard Paul, Cooper Sue, Leonardi-Bee Jo, Coleman Tim
机构信息
UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK;
UK Centre for Tobacco and Alcohol Studies, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK;
出版信息
Nicotine Tob Res. 2016 Oct;18(10):1952-9. doi: 10.1093/ntr/ntw080. Epub 2016 Mar 31.
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.
引言
在非孕期的“戒烟者”中，坚持使用尼古丁替代疗法（NRT）可提高戒烟成功率。我们研究了孕期使用安慰剂或NRT贴片的依从性与戒烟之间的关系，包括对反向因果关系的评估，以及使用尼古丁或安慰剂贴片时，依从性与戒烟之间的关系是否受到调节。
方法
利用1050名孕期试验参与者的数据，通过回归模型研究母亲特征、依从性与戒烟之间的关联。
结果
第一个月的依从性与较低的基线可替宁浓度相关（β=-0.08，95%置信区间[CI]=-0.15至-0.01），且与随机分配至NRT组相关（β=2.59，95%CI=1.50至3.68）。两个治疗月的依从性与随机分配至NRT组相关（β=0.51，95%CI=0.29至0.72），与较高的尼古丁依赖性呈负相关。使用NRT或安慰剂的依从性与1个月时戒烟（优势比[OR]=1.11，95%CI=1.08至1.13）及分娩时戒烟（OR=1.06，95%CI=1.03至1.09）相关，但在不可能存在反向因果关系的亚组中未观察到这种关联。在所有女性中，更高的尼古丁贴片依从性与戒烟增加相关（OR=2.47，95%CI=1.32至4.63），但更高的安慰剂依从性则不然（OR=0.98，95%CI=0.44至2.18）。
结论
更坚持使用NRT的女性更有可能实现戒烟；尼古丁依赖性更强的女性对NRT的依从性可能较低，因为她们更容易更快复吸。含尼古丁贴片与戒烟依从性之间的相互作用表明，尼古丁贴片依从性与戒烟之间的关联可能部分存在因果关系。
启示
本研究利用安慰剂随机对照试验数据，调查了女性特征与NRT贴片治疗依从性之间的关联，以及孕期戒烟者中NRT贴片治疗依从性与戒烟几率之间的关系。NRT贴片的依从性更高，且更高的NRT贴片依从性增加了戒烟几率。对这些发现的一个可能解释是，NRT贴片如果充分使用，可能对至少一些试图戒烟的孕妇有效。建议进行试验，测试鼓励女性坚持使用更高剂量NRT的干预措施。
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