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Emery, Joanne 
ORCID: https://orcid.org/0000-0002-8915-7033, Leonardi-Bee, Jo, Coleman, Tim, McDaid, Lisa ORCID: https://orcid.org/0000-0001-5032-2380 and Naughton, Felix
(2024)
The effectiveness of text support for stopping smoking in pregnancy (MiQuit): Multi-trial pooled analysis investigating effect moderators and mechanisms of action.
Nicotine and Tobacco Research.
ISSN 1462-2203
Abstract
Introduction: Digital cessation support appeals to pregnant smokers. In two pooled RCTs, MiQuit, a pregnancy-specific tailored text messaging intervention, did not show effectiveness for validated prolonged abstinence. However, secondary outcomes and potential moderators and mediators have not been investigated. We aimed to determine, using pooled RCT data: 1) MiQuit effectiveness for a range of smoking outcomes; 2) whether baseline tobacco dependence or quit motivation moderate effectiveness; 3) whether hypothesized mechanisms of action (quitting determination, self-efficacy, baby harm beliefs, lapse prevention strategies) mediate effectiveness. Methods: Pooled data analysis from two procedurally identical RCTs comparing MiQuit (N=704) to usual care (N=705). Participants were smokers, <25 weeks pregnant, recruited from 40 English antenatal clinics. Outcomes included self-reported seven-day abstinence at four weeks post-baseline and late pregnancy, and prolonged abstinence. Late pregnancy outcomes were also biochemically validated. We used hierarchical regression and Structural Equation Modelling. Results: MiQuit increased self-reported, seven-day abstinence at four weeks (OR=1.73 [95% CI 1.10-2.74]) and was borderline significant at late pregnancy (OR=1.34 [0.99-1.82]) but not for prolonged or validated outcomes. Effectiveness was not moderated by baseline dependence (Heaviness of Smoking "low" versus "moderate-high") or motivation (planning to quit ≤30 days [high] versus >30days [low]), but effects on self-reported outcomes were larger for the high motivation sub-group. MiQuit had a small effect on mean lapse prevention strategies (MiQuit 8.6 [SE 0.17], UC 8.1 [SE 0.17]; P=0.030) but not other mechanisms. Conclusions: MiQuit increased short-term but not prolonged or validated abstinence and may be most effective for those motivated to quit sooner. Implications: Digital cessation support appeals to pregnant smokers. MiQuit, a tailored, theory-guided text messaging program for quitting smoking in pregnancy, has not shown effectiveness for validated prolonged abstinence in two previous RCTs but its impact on other smoking outcomes and potential mechanisms of action are unknown. When pooling trial data, MiQuit increased self-reported short-term abstinence, including making a quit attempt and abstinence at four-week follow-up, but not late pregnancy, sustained or validated abstinence. MiQuit appeared effective at late pregnancy for participants with high quitting motivation, but its mechanisms of action remain uncertain. Additional support components are likely required to enhance effectiveness.
| Item Type: | Article |
|---|---|
| Additional Information: | Data Availability: Anonymized data is available upon reasonable request. Funding information: This research was funded by the National Institute for Health Research (NIHR), Programme Development Grant NIHR203305. TC is an NIHR Senior Investigator. The views expressed in this manuscript are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. |
| Faculty \ School: | Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Behavioural and Implementation Science Faculty of Medicine and Health Sciences > Research Groups > Health Promotion Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health |
| Depositing User: | LivePure Connector |
| Date Deposited: | 03 Apr 2024 11:32 |
| Last Modified: | 03 Apr 2024 11:32 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/94795 |
| DOI: | 10.1093/ntr/ntae026 |
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