Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
PLoS One. 2020 Mar 5;15(3):e0229637. doi: 10.1371/journal.pone.0229637. eCollection 2020.
Despite tobacco being an important preventable factor with respect to ill health and death, it is a legal substance that harms and kills many of those who use it. Text messaging smoking cessation interventions have been evaluated in a variety of contexts, and are generally considered to have a positive effect on smoking cessation success. In order for text messaging interventions to continue to be useful as prevalence of smoking decreases, it may be necessary to tailor the interventions to specific individuals. However, little is known with regard to who benefits the most and least from existing interventions.
In order to identify heterogenous treatment effects, we analyzed data from a randomized controlled trial of a text messaging smoking cessation intervention targeting university students in Sweden. We used a Bayesian hierarchical model where the outcome was modelled using logistic regression, and so-called horseshoe priors were used for coefficients. Predictive performance of the model, and heterogeneous treatment effects, were calculated using cross-validation over the trial data.
Findings from the study of heterogenous treatment effects identified less effect of the intervention among university students with stronger dependence of nicotine and students who smoke a greater quantity of cigarettes per week. No heterogeneity was found with respect to sex, number of years smoking, or the use of snuff.
Results emphasize that individuals with a more developed dependence of nicotine may have a harder time quitting smoking even with support. This questions the dissemination and development of text messaging interventions to university students in the future, as they may not be the optimal choice of intervention for those with a more developed dependence. On the other hand, text messaging interventions may be useful to disseminate among university students that are at risk of developing a strong dependence.
International Standard Randomized Controlled Trial Number (ISRCTN): 75766527; http://www.controlled-trials.com/ISRCTN75766527.
尽管烟草是导致健康不良和死亡的一个重要可预防因素，但它是一种合法的物质，会伤害和杀死许多使用者。短信戒烟干预措施已在各种情况下进行了评估，通常被认为对戒烟成功有积极影响。为了使短信干预措施在吸烟率下降的情况下继续发挥作用，可能需要根据特定个体来调整干预措施。然而，对于谁从现有的干预措施中受益最大和最小，人们知之甚少。
为了确定异质治疗效果，我们分析了针对瑞典大学生的短信戒烟干预措施的一项随机对照试验的数据。我们使用了贝叶斯层次模型，其中使用逻辑回归对结果进行建模，并且使用了所谓的马蹄形先验来对系数进行建模。通过对试验数据进行交叉验证，计算了模型的预测性能和异质治疗效果。
对异质治疗效果的研究结果发现，对于尼古丁依赖性较强的大学生和每周吸烟量较大的学生，干预的效果较弱。在性别、吸烟年限或鼻烟使用方面没有发现异质性。
研究结果强调，尼古丁依赖性较强的个体即使有支持也可能更难戒烟。这对未来在大学生中传播和开发短信干预措施提出了质疑，因为对于那些尼古丁依赖性较强的个体来说，它们可能不是最佳的干预选择。另一方面，短信干预措施可能有助于在有发展成强烈依赖性风险的大学生中传播。
国际标准随机对照试验编号（ISRCTN）：75766527；http://www.controlled-trials.com/ISRCTN75766527。
