Abstract
Significance: Little is known about the mechanisms by which medication adherence promotes smoking cessation among adults with MDD. We tested the hypothesis that early adherence promotes abstinence by increasing behavioral treatment (BT) utilization. Methods: Data for this post-hoc analysis were from a randomized trial of 149 adults with current or past MDD treated with BT and either varenicline (n = 81) or placebo (n = 68). Arms were matched on medication regimen. Early medication adherence was measured by the number of days in which medication was taken at the prescribed dose during the first six of 12 weeks of pharmacological treatment (weeks 2–7). BT consisted of eight 45-minute sessions (weeks 1–12). Bioverified abstinence was assessed at end-of-treatment (week 14). A regression-based approach was used to test whether the effect of early medication adherence on abstinence was mediated by BT utilization. Results: Among 141 participants who initiated the medication regimen, BT utilization mediated the effect of early medication adherence on abstinencea) an interquartile increase in early medication days from 20 to 42 predicted a 4.2 times increase in abstinence (Total Risk Ratio (RR) = 4.24, 95% CI = 2.32–13.37; p <.001); b) increases in BT sessions predicted by such an increase in early medication days were associated with a 2.7 times increase in abstinence (Indirect RR = 2.73, 95% CI = 1.54–7.58; p <.001); and c) early medication adherence effects on abstinence were attenuated, controlling for BT (Direct RR = 1.55, 95% CI = 0.83–4.23, p =.17). Conclusions: The effect of early medication adherence on abstinence in individuals with current or past MDD is mediated by intensive BT utilization.
| Original language | English (US) |
|---|---|
| Article number | 107952 |
| Journal | Addictive Behaviors |
| Volume | 151 |
| DOIs | |
| State | Published - Apr 2024 |
Funding
We thank Lawrence Price, MD, for his advice on study design and methodology; Grisel Marie Robles-Schrader, MPA, and the Northwestern University Center for Community Health's Stakeholder and Community Academic Research Panel for community engagement support; Mita S. Goel, MD, MPH, for assistance with participant recruitment; and Pfizer for its donation of varenicline and matching placebo. In addition, we thank Amanda R. Mathew, PhD and Celine M. Reyes, MS for assistance with project coordination; Sarah Boulton, MSW, Allison J. Carroll, PhD, Charles Culpepper, MS, Samantha Giovannetti, MA, LSW, Jonnie Handschin, BA, Mackenzie Hosie Quinn, BA, Nancy A. Jao, PhD, Doukessa Lerias, MA, Michael Maloney, MA, Andrew Miele, BA, Matthew Olonoff, MS, Sara Price, BA, Stephanie Prymas, MA, LPC, Emily Turturici, BA, and Jessica Weisbrot, MSW, MPH, for their contributions to participant recruitment, assessment, and/or treatment; and Sue Ware, BS, for database development and management. This research was funded by the National Cancer Institute, grant R01 CA184211. Additional support was provided by the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Participant recruitment at Northwestern University was supported by the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1 TR001422.
Keywords
- Adults
- Behavioral treatment
- Major depression
- Medication adherence
- Pharmacotherapy
- Smoking
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Clinical Psychology
- Toxicology
- Psychiatry and Mental health