Ojo-Fati O, Thomas J L, Vogel R I, Ogedegbe O, Jean-Louis G, Okuyemi K S
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
Program in Health Disparities Research, University Of Minnesota, Minneapolis, MN, USA.
J Fam Med. 2016;3(7). Epub 2016 Sep 6.
Adherence to smoking cessation treatment is generally low, especially among socio-economically disadvantaged groups including individuals experiencing homelessness and those with mental illnesses. Despite the high smoking rates in homeless populations (~70%) no study to date has systematically examined predictors of adherence to nicotine replacement therapy (NRT) in this population.
The aim of this secondary analysis was to identify predictors of adherence to NRT in a smoking cessation trial conducted among homeless smokers.
Secondary analysis of data from a randomized controlled trial enrolling 430 persons who were homeless and current cigarette smokers. Participants were assigned to one of the two study conditions to enhance smoking cessation: Motivational Interviewing (MI; 6 sessions of MI + 8 weeks of NRT) or Standard Care (Brief advice to quit+ 8 weeks of NRT). The primary outcome for the current analysis was adherence to NRT at end of treatment (8 weeks following randomization). Adherence was defined as a total score of zero on a modified Morisky adherence scale). Demographic and baseline psychosocial, tobacco-related, and substance abuse measures were compared between those who did and did not adhere to NRT.
After adjusting for confounders, smokers who were depressed at baseline (OR=0.58, 95% CI, 0.38-0.87, p=0.01), had lower confidence to quit (OR=1.10, 95% CI, 1.01-1.19, p=0.04), were less motivated to adhere (OR=1.04, 95% CI, 1.00-1.07, p=0.04), and were less likely to be adherent to NRT. Further, age of initial smoking was positively associated with adherence status (OR= 0.83, 95% CI, 0.69-0.99, p=0.04).
These results suggest that smoking cessation programs conducted in this population may target increased adherence to NRT by addressing both depression and motivation to quit.
clinicaltrials.gov: NCT00786149.
戒烟治疗的依从性普遍较低，尤其是在社会经济地位不利的群体中，包括无家可归者和患有精神疾病的人。尽管无家可归者中的吸烟率很高（约70%），但迄今为止尚无研究系统地调查该人群中尼古丁替代疗法（NRT）依从性的预测因素。
这项二次分析的目的是确定在无家可归吸烟者中进行的戒烟试验中NRT依从性的预测因素。
对一项随机对照试验的数据进行二次分析，该试验招募了430名无家可归的当前吸烟者。参与者被分配到两种研究条件之一以促进戒烟：动机性访谈（MI；6次MI + 8周NRT）或标准护理（简短戒烟建议 + 8周NRT）。当前分析的主要结局是治疗结束时（随机分组后8周）对NRT的依从性。依从性定义为改良的莫里西依从性量表上的总分为零。比较了依从和不依从NRT者的人口统计学和基线心理社会、烟草相关及物质滥用指标。
在调整混杂因素后，基线时抑郁的吸烟者（OR = 0.58，95% CI，0.38 - 0.87，p = 0.01）、戒烟信心较低者（OR = 1.10，95% CI，1.01 - 1.19，p = 0.04）、坚持动机较低者（OR = 1.04，95% CI，1.00 - 1.07，p = 0.04）对NRT的依从性较低。此外，首次吸烟年龄与依从状态呈正相关（OR = 0.83，95% CI，0.69 - 0.99，p = 0.04）。
这些结果表明，在该人群中开展的戒烟项目可通过解决抑郁和戒烟动机问题来提高对NRT的依从性。
clinicaltrials.gov：NCT00786149。
