Mediators of the effect of nicotine pre-treatment on quitting smoking
<h4>Background and aims</h4> <p>Using smoking cessation medications for several weeks prior to quitting smoking facilitates quitting success, but how it does so is not clear. Candidate theories are that pre-cessation medication enhances self-efficacy, facilitates medication adhere...
| Main Authors: | , , , , , |
|---|---|
| Format: | Journal article |
| Published: |
Wiley
2018
|
| _version_ | 1797099201860993024 |
|---|---|
| author | Hajek, P Lewis, S Munafo, M Lindson, N Coleman, T Aveyard, P |
| author_facet | Hajek, P Lewis, S Munafo, M Lindson, N Coleman, T Aveyard, P |
| author_sort | Hajek, P |
| collection | OXFORD |
| description | <h4>Background and aims</h4> <p>Using smoking cessation medications for several weeks prior to quitting smoking facilitates quitting success, but how it does so is not clear. Candidate theories are that pre-cessation medication enhances self-efficacy, facilitates medication adherence post-quit, induces aversion to smoking, reduces reward from smoking, or reduces the drive to smoke. We investigated these pathways using data from a large trial of nicotine preloading, using mediation analysis. </p> <h4>Design</h4> <p>Randomised controlled trial of nicotine preloading. Potential mediators were assessed at baseline and one week into the pre-loading (three weeks prior to quitting). In addition to this, urges to smoke in abstainers were assessed one week after the target quit date.</p> <h4>Setting</h4> <p>England</p> <h4>Participants</h4> <p>1792 smokers who wanted to quit attending specialist smoking cessation services in England were enrolled between 13/08/2012 and 10/03/2015.</p> <p>Intervention and comparator: Participants were randomised to either standard smoking cessation medications accompanied by behavioural support or the same treatment supplemented by nicotine ‘preloading’, i.e. four weeks of 21mg nicotine patch use prior to quitting. </p> <h4>Measurements</h4> <p>The primary outcome, selected for its proximity in time to potential mediators, was biochemically validated abstinence from smoking at four weeks post target quit date. Potential mediators included Modified Cigarette Evaluation Questionnaire with subscales assessing satisfaction, reward, craving and aversion; ratings of strength and frequency of urges to smoke; Mood and Physical Symptoms Scale assessing cigarette withdrawal symptoms; two items from Nicotine Dependence Syndrome Scale assessing smoking stereotypy; self-reported reduction in cigarettes per day and in CO reading; post-TQD medication adherence; self-efficacy; nausea.</p> <h4>Findings</h4> <p>Preloading reduced urges to smoke at three weeks pre-quit (p<0.001) and exhaled CO concentrations (p<0.001), and also urges to smoke post-quit in abstainers (p=0.001). At three weeks pre-quit, it also reduced cigarette consumption, enjoyment of and satisfaction from smoking and smoking reward and increased nausea, aversion (all p<0.001) and smoking stereotypy (p=0.003). Only the first three variables however (reduced smoke intake and reduced urges to smoke pre- and post-quit) mediated abstinence from smoking at 4 weeks and only the latter two mediated abstinence at six months (indirect mediating effects p<0.05).</p> <h4>Conclusions</h4> <p>Nicotine preloading appears to facilitate smoking abstinence by reducing urges to smoke and smoke intake before quitting and urges to smoke after quitting.</p> |
| first_indexed | 2024-03-07T05:20:21Z |
| format | Journal article |
| id | oxford-uuid:deaab8e8-ac43-436a-ac89-fe9f55249cc5 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T05:20:21Z |
| publishDate | 2018 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:deaab8e8-ac43-436a-ac89-fe9f55249cc52022-03-27T09:33:56ZMediators of the effect of nicotine pre-treatment on quitting smokingJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:deaab8e8-ac43-436a-ac89-fe9f55249cc5Symplectic Elements at OxfordWiley2018Hajek, PLewis, SMunafo, MLindson, NColeman, TAveyard, P <h4>Background and aims</h4> <p>Using smoking cessation medications for several weeks prior to quitting smoking facilitates quitting success, but how it does so is not clear. Candidate theories are that pre-cessation medication enhances self-efficacy, facilitates medication adherence post-quit, induces aversion to smoking, reduces reward from smoking, or reduces the drive to smoke. We investigated these pathways using data from a large trial of nicotine preloading, using mediation analysis. </p> <h4>Design</h4> <p>Randomised controlled trial of nicotine preloading. Potential mediators were assessed at baseline and one week into the pre-loading (three weeks prior to quitting). In addition to this, urges to smoke in abstainers were assessed one week after the target quit date.</p> <h4>Setting</h4> <p>England</p> <h4>Participants</h4> <p>1792 smokers who wanted to quit attending specialist smoking cessation services in England were enrolled between 13/08/2012 and 10/03/2015.</p> <p>Intervention and comparator: Participants were randomised to either standard smoking cessation medications accompanied by behavioural support or the same treatment supplemented by nicotine ‘preloading’, i.e. four weeks of 21mg nicotine patch use prior to quitting. </p> <h4>Measurements</h4> <p>The primary outcome, selected for its proximity in time to potential mediators, was biochemically validated abstinence from smoking at four weeks post target quit date. Potential mediators included Modified Cigarette Evaluation Questionnaire with subscales assessing satisfaction, reward, craving and aversion; ratings of strength and frequency of urges to smoke; Mood and Physical Symptoms Scale assessing cigarette withdrawal symptoms; two items from Nicotine Dependence Syndrome Scale assessing smoking stereotypy; self-reported reduction in cigarettes per day and in CO reading; post-TQD medication adherence; self-efficacy; nausea.</p> <h4>Findings</h4> <p>Preloading reduced urges to smoke at three weeks pre-quit (p<0.001) and exhaled CO concentrations (p<0.001), and also urges to smoke post-quit in abstainers (p=0.001). At three weeks pre-quit, it also reduced cigarette consumption, enjoyment of and satisfaction from smoking and smoking reward and increased nausea, aversion (all p<0.001) and smoking stereotypy (p=0.003). Only the first three variables however (reduced smoke intake and reduced urges to smoke pre- and post-quit) mediated abstinence from smoking at 4 weeks and only the latter two mediated abstinence at six months (indirect mediating effects p<0.05).</p> <h4>Conclusions</h4> <p>Nicotine preloading appears to facilitate smoking abstinence by reducing urges to smoke and smoke intake before quitting and urges to smoke after quitting.</p> |
| spellingShingle | Hajek, P Lewis, S Munafo, M Lindson, N Coleman, T Aveyard, P Mediators of the effect of nicotine pre-treatment on quitting smoking |
| title | Mediators of the effect of nicotine pre-treatment on quitting smoking |
| title_full | Mediators of the effect of nicotine pre-treatment on quitting smoking |
| title_fullStr | Mediators of the effect of nicotine pre-treatment on quitting smoking |
| title_full_unstemmed | Mediators of the effect of nicotine pre-treatment on quitting smoking |
| title_short | Mediators of the effect of nicotine pre-treatment on quitting smoking |
| title_sort | mediators of the effect of nicotine pre treatment on quitting smoking |
| work_keys_str_mv | AT hajekp mediatorsoftheeffectofnicotinepretreatmentonquittingsmoking AT lewiss mediatorsoftheeffectofnicotinepretreatmentonquittingsmoking AT munafom mediatorsoftheeffectofnicotinepretreatmentonquittingsmoking AT lindsonn mediatorsoftheeffectofnicotinepretreatmentonquittingsmoking AT colemant mediatorsoftheeffectofnicotinepretreatmentonquittingsmoking AT aveyardp mediatorsoftheeffectofnicotinepretreatmentonquittingsmoking |