Rutger de Graaf - "Innovative Concepts for Flood Resilience"
Charlotte Scherphof* Regina van den Eijnden* Wilma Vollebergh* Rutger Engels^
description
Transcript of Charlotte Scherphof* Regina van den Eijnden* Wilma Vollebergh* Rutger Engels^
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Short-term efficacy of nicotine replacement therapy (NRT)
for smoking cessation among adolescents
and the role of compliance
Charlotte Scherphof*
Regina van den Eijnden*Wilma Vollebergh*Rutger Engels^
* Utrecht University, The Netherlands^ Radboud University Nijmegen, The Netherlands
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Introduction• Nicotine dependence symptoms:
– 60.9% of adolescents who ever smoked cigarettes daily had tried to quit smoking, but…
• only 12.2% were successful.
• Nicotine Replacement Therapy (NRT) as smoking cessation intervention
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Introduction
• Meta-analysis (2011): – 6 RCTs
• Review (2012): – 9 RCTs, 1 lab-based study, 3 open-label studies
• Results:– Short-term (end-of-treatment): /– Mid-term (3-6 months):
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Introduction
• Flaws– Small sample sizes (9 of 11: N < 135)– High drop-out
– Low compliance (8-67%)• no moderation effects
condition smoking cessation
compliance
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(1) efficacy of NRT (nicotine patch) on short-term smoking cessation?
(2) is the effect of NRT on smoking cessation moderated by patch use compliance?
– 2a) can different trajectories of compliance be distinguished?– 2b) which factors predict different trajectories?
(3) are there any (serious) adverse effects?
Our study – Randomized Controlled Trial
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MethodAdolescents: N = 257, mean age 16.7 years, 53% female Information meeting 6/9 week treatment
6 online
questionnaires
1) Age 12 -18 years2) No major physical health problems 3) ≥ 7 cigarettes per day 4) Parents aware of kids smoking behaviour5) Motivated to quit smoking
€ 90
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Outcome measures
• Smoking cessation (intent-to-treat)
– abstinence after two weeks / end-of-treatment abstinence (prolonged abstinence)
• Compliance– number of days participants used the patches
• Adverse events– complaints concerning health / patch use
Treatment period
T5T4 T6T1-T3Abstinence after 2 weeks
Week 1 Week 2 Week 3-6
End-of-treatment abstinence
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• Abstinence after two weeks
• End-of-treatment abstinence
Results – Main effect + Moderation
condition abstinence after 2 weeks
compliance
OR = 1.80*/2.02*
OR = 1.12/1.12
conditionOR = 0.83/0.79
abstinence at end of treatment
compliance
OR = 1.07†/1.09*
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Results – Percentages quitters Abstinence after 2 weeks End-of-treatment abstinence
Placebo patch group 21.3% 13.1%Nicotine patch group 31.9% 14.8%
7 59 15
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Compliance
Time
Com
plia
nce
Predictors
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Results – Compliance trajectories (LCGA)
Predictors- Age- Gender- Education- #CigPerDay- Previous quit att. - Impulsivity- Conscientiousness- Openness- Extraversion- Neuroticsm- Agreeableness- Condition
Compliers: 34%Moderate decreasers: 16%Strong decreasers: 50%
23%
10%
9%
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Results – adverse events
• Most reported adverse events
• In general more complaints in nicotine patch group (but scores max 2 out of 3)
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Conclusion
(1) Nicotine patches enhance abstinence rates after two weeks.
(2) Nicotine patches enhance abstinence rates at end-of-treatment, but only among high-compliant adolescents.
(2a,b) Higher number of previous quit attempts, higher level of conscientiousness and lower levels of extraversion were associated with higher levels of compliance.
(3) No serious adverse events.Bgjsbel
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Discussion
• Decline in compliance rates and abstinence rates from 2 weeks to end-of-treatment
– Clinical relevance?
• Comparison with previous studies (our study: 14.8% abstinence at end-treatment)– 18% (PA, 2-week grace period, 12 weeks of treatment)– 28% (7-day PP, 8 weeks of treatment)– 28% (7-day PP, 10 weeks of treatment)
• Time-varying predictors for compliance trajectories
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Implications• So far, no convincing evidence of efficacy NRT for adolescents
• Interventions to enhance compliance
• Influence of (smoking) peers
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“Interventions aimed at quitting smoking among
adolescents are a waste of time (and money)”
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Introduction
Percentage smoking adolescents (10-19 years) 1994-2011
boysgirls mean
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Model 1 Model 2
Step 1 Step 2 Step 1 Step2
OR OR OR OR
Abstinence after 2 weeks
Condition 1.80* 0.39 2.02* 0.49
Gender 0.76 0.71 0.65 0.62
Compliance 1.35** 1.33*
Compliance x Condition 1.12 1.12
Self-efficacy 1.50* 1.37
Alcohol consumption 0.96 0.96
Drug use 0.97** 0.97**
End-of-treatment abstinence
Condition 0.83 0.13 0.79 0.08*
Gender 0.60 0.63 0.51 0.54
2-week abstinence 15.84*** 15.06*** 14.84*** 15.04***
Compliance 0.98 0.97
Compliance x Condition 1.07† 1.09*
Self-efficacy 1.86* 1.94*
Alcohol consumption 0.92† 0.91*
Drug use 1.01 1.01
Results - Short-term effects
Condition Smoking cessation
Compliance
Condition Smoking cessation
Compliance