Validity of urges to smoke measures in predicting smoking relapse during treatment in primary care

Daniel Kotz,Wolfgang Viechtbauer,Onno C P Van Schayck,Mark Spigt,Carolien Van Rossem

doi:10.1038/s41533-021-00259-3

Abstract

In the context of smoking cessation treatment in primary care, identifying patients at the highest risk of relapse is relevant. We explored data from a primary care trial to assess the validity of two simple urges to smoke questions in predicting long-term relapse and their diagnostic value. Of 295 patients who received behavioural support and varenicline, 180 were abstinent at week 9. In this subgroup, we measured time spent with urges to smoke (TSU) and strength of urges to smoke (SUT; both scales 1 to 6 = highest). We used separate regression models with TSU or SUT as predictor and relapse from week 9–26 or week 9–52 as an outcome. We also calculated the sensitivity (SP), specificity and positive predictive values (PPV) of TSU and SUT in correctly identifying patients who relapsed at follow-up. The adjusted odds ratios (aOR) for predicting relapse from week 9–26 were 1.74 per point increase (95% CI = 1.05–2.89) for TSU and 1.59 (95% CI = 1.11–2.28) for SUT. The aORs for predicting relapse from week 9–52 were 2.41 (95% CI = 1.33–4.37) and 1.71 (95% CI = 1.14–2.56), respectively. Applying a cut-point of ≥3 on TSU resulted in SP = 97.1 and PPV = 70.0 in week 9–26, and SP = 98.8 and PPV = 90.0 in week 9–52. Applying a cut-point of ≥4 on SUT resulted in SP = 99.0 and PPV = 85.7 in week 9–26, and SP = 98.8 and PPV = 85.7 in week 9–52. Both TSU and SUT were valid predictors of long-term relapse in patients under smoking cessation treatment in primary care. These simple questions may be useful to implement in primary care.Trial registration: Dutch Trial Register (NTR3067).

Highlights

Tobacco smoking is a major risk factor for a range of highly prevalent diseases treated in primary care, including cardiovascular and respiratory disease[1]
In the context of primary care, where many smokers are treated for tobacco addiction, it would be very relevant to identify patients at high risk of relapse in order to target relapse prevention interventions efficiently, such as adding or extending pharmacological treatment[4]
TSU time spent with urges (1–6 = all of the time), SUT strength of urges to smoke (1–6 = extremely strong), CPD cigarettes per day (31), TTFC time to first cigarette, HSI Heaviness of Smoking Index (0–6 = highest level of tobacco dependence), adjusted odds ratios (aOR) odds ratio adjusted for the treatment group, health care centre, age, gender, education, income, level of self-efficacy, duration of a longest previous quit attempt, level of depression, level of anxiety, number of smokers in the social environment and alcohol misuse

Summary

Introduction

Tobacco smoking is a major risk factor for a range of highly prevalent diseases treated in primary care, including cardiovascular and respiratory disease[1]. We explored data from a randomised controlled smoking cessation trial in primary care[9] to assess the validity of these two urges to smoke measures in predicting long-term relapse in patients who were abstinent from smoking for several weeks.

Results

Conclusion