Abstract
AimsTo examine the ability of different common measures of cigarette dependence to predict smoking cessation during pregnancy.DesignSecondary analysis of data from a parallel‐group randomized controlled trial of physical activity for smoking cessation. The outcomes were biochemically validated smoking abstinence at 4 weeks post‐quit and end‐of‐pregnancy.SettingWomen identified as smokers in antenatal clinics in 13 hospital trusts predominantly in southern England, who were recruited to a smoking cessation trial.ParticipantsOf 789 pregnant smokers recruited, 784 were included in the analysis.MeasurementsUsing random‐effect logistic regression models, we analysed the effects of baseline measures of cigarette dependence, including numbers of cigarettes smoked daily, Fagerström Test of Cigarette Dependence (FTCD) score, the two FTCD subscales 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 receiver operating characteristic (ROC) curve was used to determine the predictive ability of the model for each measure of dependence.FindingsAll the dependence variables predicted abstinence at 4 weeks and end‐of‐pregnancy. At 4 weeks, the adjusted odds ratio (OR) (95% confidence interval) 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.ConclusionsFour common measures of dependence, including number of cigarettes smoked per day, scores for Fagerström 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.
Highlights
Smoking in pregnancy is the main preventable cause of poor birth outcomes, including miscarriage, stillbirth, prematurity and low birth weight [1,2,3,4,5,6]
The following demographic, psychological and smoking characteristics available at baseline were considered for assessment as potential predictors of smoking cessation: age, ethnicity, body mass index (BMI), marital status, parity, gestational age, gestational interval between baseline and end of pregnancy, study centre, randomization groups, alcohol consumption [44], self-reports of moderate–vigorous-intensity physical activity (MVPA) in the previous week [45], age at full-time education, occupation, Edinburgh postnatal depression scale (EPDS) [46] score, partner smoking status, number of cigarettes smoked per day before pregnancy, number of cigarettes smoked per day at baseline, smoking status in previous pregnancy, Fagerström Test of Cigarette Dependence (FTCD) score [30], expired
We conducted analysis adjusted for the random effect of study centre to explore the associations between cigarette dependence baseline variables and the smoking cessation outcomes
Summary
Smoking in pregnancy is the main preventable cause of poor birth outcomes, including miscarriage, stillbirth, prematurity and low birth weight [1,2,3,4,5,6]. It has been shown that smoking cessation during pregnancy improves maternal and fetal health and birth outcomes [14]. To target interventions for maternal smoking cessation appropriately, there is a need to identify which. Sociodemographic factors that have been shown to predict cessation significantly during pregnancy include maternal age, being married or living with partner, primiparity and higher socio-economic status (income, education, housing, employment). Psychological variables that have been shown to predict cessation in pregnancy include lower levels of depression, stress and anxiety [17,18]. Other predictors of cessation include higher self-efficacy for quitting, exposure to environmental tobacco smoke, exposure to patient education methods, greater perceived social support, stressful life events in early pregnancy, ethnicity, family history of diabetes and no use of marijuana before the pregnancy [19,20,21,22]
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