在一项戒烟治疗的随机试验中，时间变动对吸烟的影响
2014/06/17
摘要
背景：越来越多的研究者开始搜集关于吸烟生态瞬时评估(EMA)的数据，急需新的统计方法来完全解析这些数据里的信息。在这篇文章中，我们采用了新的技术，逻辑时变效应模型(逻辑TVEM)，来检测戒烟两周后的吸烟几率。
方法：本研究数据来自一项药物戒烟疗法的随机、安慰剂对照试验，选取达到初始戒烟的亚组人群(N = 1,106, 58% 为女性) 。在戒烟治疗结束后的2周，受试者每天完成4次EMA评估。预测因素包括：基线尼古丁依赖程度，EMA测得的吸烟欲望和消极情绪的数据，以及受试者的分组情况（安慰剂组、单药治疗组或联合治疗组）。采用逻辑TVEM对这些预测因素的时变效应进行评估。
结果:吸烟欲望是戒烟2周后开始吸烟的一个重要预测因素。到第二周时，基线尼古丁依赖程度的影响开始无显著效应，但消极情绪的影响随时间不断增加。在戒烟后的第一周，与安慰剂组相比，单药治疗和联合治疗组吸烟率显著降低，但这些差异在第二周无显著性。
结论：我们的研究表明戒烟较早期，药物疗法比安慰剂组疗效更好。此时基线尼古丁依赖程度对吸烟的影响较强，但吸烟欲望和消极情绪的影响随时间增加。通过在戒烟的第二周后给予其他支持可能能使未来的戒烟治疗更成功。
（刘国梁 审校）
Nicotine Tob Res. 2014 May;16 Suppl 2:S135-43. doi: 10.1093/ntr/ntt185.
Time-varying processes involved in smoking lapse in a randomized trial of smoking cessation therapies.
Vasilenko SA1, Piper ME, Lanza ST, Liu X, Yang J, Li R.
ABSTRACT
INTRODUCTION: Researchers have increasingly begun to gather ecological momentary assessment (EMA) data on smoking, but new statistical methods are necessary to fully unlock information from such data. In this paper, we use a new technique, the logistic time-varying effect model (logistic TVEM), to examine the odds of smoking in the 2 weeks after a quit attempt.
METHODS: Data are from a subsample of participants from a randomized, placebo-controlled trial of smoking cessation pharmacotherapies who achieved initial abstinence (N = 1,106, 58% female). Participants completed up to 4 EMA assessments per day during the 2 weeks after their quit day. Predictors include baseline nicotine dependence, EMA measures of craving and negative affect, and whether an individual was assigned to a placebo, monotherapy, or combination therapy condition. Time-varying effects of these predictors were estimated using logistic TVEM.
RESULTS: Cravings were a significant predictor of smoking throughout the entire 2 weeks postquit, whereas the effect of baseline dependence became nonsignificant by the second week, and the effect of negative affect increased over time. Individuals in the monotherapy and combination therapy conditions had decreased odds of smoking compared with placebo in the first week postquit, but these differences were nonsignificant in the second week.
CONCLUSIONS: Findings suggest that pharmacotherapies are more effective compared with placebo earlier in a quit attempt, when the effect of baseline nicotine dependence on smoking is stronger, whereas the effect of craving and negative affect increased over time. Future cessation therapies may be more successful by providing additional support in the second week after quit attempt.
Nicotine Tob Res. 2014 May;16 Suppl 2:S135-43. doi: 10.1093/ntr/ntt185.
