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Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomised controlled trial

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Riaz, Muhammad 
Lewis, Sarah 
Coleman, Tim 
Aveyard, Paul 
West, Robert 

Abstract

Aims: To examine the ability of different common measures of cigarette dependence to predict smoking cessation during pregnancy. Design: Secondary analysis of data from a parallel-group randomised controlled trial of physical activity for smoking cessation. The outcomes were biochemically validated smoking abstinence at 4 weeks post-quit and end-of-pregnancy. Setting: Women identified as smokers in antenatal clinics in 13 hospital trusts predominantly in Southern England, who were recruited to a smoking cessation trial. Participants: Of 789 pregnant smokers recruited, 784 were included in the analysis. Measurements: Using random effect logistic regression models, we analysed the effects of baseline measures of cigarette dependence, including numbers of cigarettes smoked daily, Fagerstrom test of cigarette dependence (FTCD) score, the two FTCD sub-scales of heaviness of smoking index (HSI) and non-heaviness of smoking index (non-HSI), expired carbon monoxide (CO) level and urges to smoke (strength and frequency) on smoking cessation. Associations were adjusted for significant socio-demographic/health behaviour predictors and trial variables, and area under the ROC curve was used to determine the predictive ability of the model for each measure of dependence. Findings: All the dependence variables predicted abstinence at 4 weeks and end-of-pregnancy. At 4 weeks, the adjusted OR (95% CI) for a unit standard deviation increase in FTCD was 0.59 (0.47-0.74), expired CO 0.54 (0.41-0.71), number of cigarettes smoked per day 0.65 (0.51-0.84), and frequency of urges to smoke 0.79 (0.63-0.98); at end of pregnancy they were: 0.60 (0.45-0.81), 0.55 (0.37-0.80), 0.70 (0.49-0.98) and 0.69 (0.51-0.94), respectively. HSI and non-HSI exhibited similar results to the full FTCD. Conclusions: Four common measures of dependence, including number of cigarettes smoked per day, scores for Fagerstrom test of cigarette dependence and frequency of urges, and level of expired CO, all predicted smoking abstinence in the short term during pregnancy and at end-of-pregnancy with very similar predictive validity.

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This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Wiley.

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Addiction

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Wiley

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In the past three years: PA has done one day of consultancy for Pfizer concerning general smoking cessation advice; RW has undertaken research and consultancy for Pfizer and GlaxoSmithKline, that develop and manufacture smoking cessation; TC has been paid for speaking at one educational events that was part-sponsored by Pierre Fabre Laboratories, France, that manufactures nicotine replacement therapy; RW is an unpaid trustee of the stop smoking charity QUIT and an unpaid director of the National Centre for Smoking Cessation and Training. This project was funded by the National Institute for Health Research Health Technology Assessment Programme (project number 07.01.14).