Factors Associated With Smoking Cessation in Early and Late Pregnancy in the Smoking, Nicotine, and Pregnancy Trial: A Trial of Nicotine Replacement Therapy

L R Vaz,S Cooper,M Grainge,T Coleman,P Aveyard,J Leonardi-Bee

doi:10.1093/ntr/ntt156

Abstract

Introduction:Previous studies have found partners’ smoking status, multiparity, and nicotine dependence to be associated with smoking cessation in pregnancy. However, no studies have investigated influences on cessation among women using nicotine replacement therapy (NRT). We analyzed data from a trial of NRT in pregnancy to determine factors associated with shorter- and longer-term cessation.Methods:Data were collected at baseline, 1 month, and delivery from 1,050 pregnant women. Two multivariable logistic models for validated cessation at 1 month and delivery were created with a systematic strategy for selection of included factors.Results:All findings are from multivariable analyses. At 1 month, odds of cessation were greater among those who completed full time education at >16 years of age (odds ratio [OR] = 1.82, 95% confidence interval CI = 1.24–2.67, p = .002) but they were lower in women with higher baseline cotinine levels (OR = 0.93, 95% CI = 0.90–0.95, p < .001). At delivery, the odds of cessation were greater among those who completed full time education at >16 years of age (OR = 1.89, 95% CI = 1.16–3.07, p = 0.010) but were inversely associated with higher baseline cotinine levels (OR = 0.96, 95% CI = 0.92–0.99, p = .010).Conclusions:Women who are better educated and have lower pretreatment cotinine concentrations had higher odds of stopping smoking and factors associated with shorter and longer term cessation were similar.

Highlights

Previous studies have found partners’ smoking status, multiparity, and nicotine dependence to be associated with smoking cessation in pregnancy
Imputation for the continuous variable “baseline cotinine level” was not carried out due to data being missing for only 80 participants (7.6%)
Among participants in a trial of transdermal nicotine patches in pregnancy, smoking cessation of 1-month duration and until delivery were positively associated with finishing full time education beyond the compulsory age of 16 years and negatively associated with baseline cotinine levels

Summary

Introduction

Previous studies have found partners’ smoking status, multiparity, and nicotine dependence to be associated with smoking cessation in pregnancy. A recent systematic review found that having a partner who smoked, multiparity and increasing nicotine dependence had, in many studies, been found inversely associated with likelihood of achieving cessation (Schneider, Huy, Schutz, & Diehl, 2010) Socioeconomic factors such as increased income and educational levels of the mother and partner have been shown to be associated with cessation in pregnancy (Ebert & Fahy, 2007; Mohsin & Bauman, 2005; Schneider et al, 2010), but these associations may be due to decline in smoking rates, which has been found to be lower in women from lower socioeconomic groups (US DHHS, 2004). Data from surveys conducted in the United Kingdom and Spain have found that pregnant women with lower educational and socioeconomic levels have lower chances of cessation, whereas women who smoked fewer cigarettes, started smoking at an older age, had a partner who did not smoke or were primiparous were more likely to quit (Torrent et al, 2004)

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