A new instrument to predict smoking cessation among patients with chronic obstructive pulmonary disease: an observational longitudinal study of the Trying To Quit smoking questionnaire.

Lena Lundh,Hans Gilljam,Lena Törnkvist,Hassan Alinaghizadeh,Maria Rosaria Galanti

doi:10.1038/npjpcrm.2016.13

Lena Lundh, Hans Gilljam + Show 3 more

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https://doi.org/10.1038/npjpcrm.2016.13

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Journal: npj Primary Care Respiratory Medicine	Publication Date: Apr 14, 2016
Citations: 1	License type: CC BY 4.0

Affiliation: Karolinska Institutet

Abstract

The Trying To Quit smoking questionnaire (TTQ), was developed to measure pressure-filled mental states, use of destructive pressure-relief strategies and ambivalent thoughts about quitting smoking among patients with COPD. The aim of this study was to evaluate whether the TTQ (available in an extended and in a reduced version) can be used to predict smoking cessation outcomes in smokers with COPD. As higher TTQ scores indicate higher degree of psychological distress, we hypothesised that TTQ scores at baseline would be negatively correlated with the probability of making a quit attempt, reducing the intensity of smoking and achieving complete abstinence during the 3 months. Smokers with COPD were recruited during planned or unplanned visits to primary healthcare centres, and 109 completed the TTQ at baseline and 85% participated in the follow-up after 3 months. Logistic regression was used to measure the association between the original (19 items) and the brief (14 item) version of TTQ scores and three outcomes: making at least one quit attempt, reducing the intensity of smoking and achieving complete abstinence. In a primary analysis among all the participants higher total score in the original version of TTQ was significantly associated with a lower probability of quit attempts. In a secondary analysis of subgroups of patients classified according to their readiness to quit, high TTQ scores at baseline were associated with lower probability of complete abstinence among patients not ready to quit (adjusted odds ratio (OR)=0.72; 95% confidence interval (CI)=0.53–0.99). Among patients ready to quit, high score on pressure-filled mental states was associated with lower probability of quit attempts (OR=0.78; 95% CI=0.66–0.94) but with higher probability of reduced smoking (OR=1.32; 95% CI=1.05–1.66). Ambivalent thoughts were associated with lower probability of all outcomes, but estimates were not statistically significant. Destructive coping strategies were inconsistently associated with the outcomes. TTQ in its original version and two of its subscales predicted smoking cessation outcomes in the anticipated direction. Therefore, this instrument may be useful in tailoring smoking cessation counselling for patients with COPD.

Highlights

Cigarette smoking is the primary cause of chronic obstructive pulmonary disease (COPD) and its progression
As higher To Quit smoking questionnaire (TTQ) scores indicate higher degrees of psychological distress, we hypothesised that TTQ scores at baseline would be negatively correlated with the probability of three outcomes related to smoking cessation: making a quit attempt, reducing the intensity of smoking and achieving complete abstinence for 3 months
The total TTQ score based on the 14 items was not significantly associated with the probability of quit attempts, 50% reduction in the intensity of smoking or achieving complete abstinence

Summary

INTRODUCTION

Cigarette smoking is the primary cause of chronic obstructive pulmonary disease (COPD) and its progression. Most smoking cessation programs for patients with COPD do not differ from those developed for other smokers[3] despite indications that a diagnosis of COPD prompts massive cessation support.[4,5] The large-scale Lung Health Study, in which such intensive support was provided, showed that about one-third of the COPD patients could reach sustained abstinence. The Trying To Quit smoking questionnaire (TTQ)[9] was developed to facilitate individualised cessation support for smokers with COPD.[10] The questionnaire assesses difficulties and mental processes that people with COPD may experience, and coping strategies that they may use during the process of smoking cessation.[10] The factors of importance in the success or failure of a quit attempt included pressure-filled mental states, ambivalent. There were no statistically significant differences at baseline between the

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