The effectiveness of text support for stopping smoking in pregnancy (MiQuit): multi-trial pooled analysis investigating effect moderators and mechanisms of action

Emery, Joanne; Leonardi-Bee, Jo; Coleman, Tim; McDaid, Lisa; Naughton, Felix

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.

Citation

Emery, J., Leonardi-Bee, J., Coleman, T., McDaid, L., & Naughton, F. (2024). The effectiveness of text support for stopping smoking in pregnancy (MiQuit): multi-trial pooled analysis investigating effect moderators and mechanisms of action. Nicotine & Tobacco Research, Article ntae026. https://doi.org/10.1093/ntr/ntae026

• Journal Article Type: Article
• Acceptance Date: Feb 4, 2024
• Online Publication Date: Feb 14, 2024
• Publication Date: Feb 14, 2024
• Deposit Date: Feb 16, 2024
• Publicly Available Date: Feb 16, 2024
• Journal: Nicotine & Tobacco Research
• Print ISSN: 1462-2203
• Electronic ISSN: 1469-994X
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: ntae026
• DOI: https://doi.org/10.1093/ntr/ntae026
• Keywords: Nicotine dependence; pregnancy; smoking; smoking cessation; follow-up; infant; motivation; self efficacy; arm; pharmacokinetics; prenatal care; late stage of pregnancy; smoking in pregnancy; text messaging; prevention; self-report; smokers; data analysis
• Public URL: https://nottingham-repository.worktribe.com/output/31159697
• Publisher URL: https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntae026/7607909