Muhammad Riaz

Physical activity for smoking cessation in pregnancy: randomised controlled trial

Objective To determine the effectiveness of a physical activity intervention for smoking cessation during pregnancy. Design Parallel group, randomised controlled, multicentre trial. Setting 13 hospitals in England, April 2009 to January 2014. Participants 789 pregnant smokers, aged 16-50 years and at 10-24 weeks’ gestation, who smoked at least one cigarette daily and were prepared to quit smoking one week after enrollment were randomised (1:1); 785 were included in the intention to treat analyses, with 392 assigned to the physical activity group. Interventions Interventions began one week before a target quit date. Participants were randomised to six weekly sessions of behavioural support for smoking cessation (control) or to this support plus 14 sessions combining supervised treadmill exercise and physical activity consultations. Main outcome measures The primary outcome was continuous smoking abstinence from the target quit date until end of pregnancy, validated by exhaled carbon monoxide or salivary cotinine levels. To assess adherence, levels of moderate-vigorous intensity physical activity were self reported and in a 11.5% (n=90) random subsample of participants, physical activity was objectively measured by an accelerometer. Results No significant difference was found in rates of smoking abstinence at end of pregnancy between the physical activity and control groups (8% v 6%; odds ratio 1.21, 95% confidence interval 0.70 to 2.10). For the physical activity group compared with the control group, there was a 40% (95% confidence interval 13% to 73%), 34% (6% to 69%), and 46% (12% to 91%) greater increase in self reported minutes carrying out physical activity per week from baseline to one week, four weeks, and six weeks post-quit day, respectively. According to the accelerometer data there was no significant difference in physical activity levels between the groups. Participants attended a median of four treatment sessions in the intervention group and three in the control group. Adverse events and birth outcomes were similar between the two groups, except for significantly more caesarean births in the control group than in the physical activity group (29% v 21%, P=0.023). Conclusion Adding a physical activity intervention to behavioural smoking cessation support for pregnant women did not increase cessation rates at end of pregnancy. During pregnancy, physical activity is not recommended for smoking cessation but remains indicated for general health benefits. Trial registration Current Controlled Trials ISRCTN48600346.

Which measures of cigarette dependence are predictors of smoking cessation during pregnancy? Analysis of data from a randomized controlled trial.

Abstract Aims To examine the ability of different common measures of cigarette dependence to predict smoking cessation during pregnancy. Design Secondary analysis of data from a parallel‐group randomized controlled trial of physical activity for smoking cessation. The outcomes were biochemically validated smoking abstinence at 4 weeks post‐quit and end‐of‐pregnancy. Setting Women identified as smokers in antenatal clinics in 13 hospital trusts predominantly in southern England, who were recruited to a smoking cessation trial. Participants Of 789 pregnant smokers recruited, 784 were included in the analysis. Measurements Using random‐effect logistic regression models, we analysed the effects of baseline measures of cigarette dependence, including numbers of cigarettes smoked daily, Fagerström Test of Cigarette Dependence (FTCD) score, the two FTCD subscales of Heaviness of Smoking Index (HSI) and non‐Heaviness of Smoking Index (non‐HSI), expired carbon monoxide (CO) level and urges to smoke (strength and frequency) on smoking cessation. Associations were adjusted for significant socio‐demographic/health behaviour predictors and trial variables, and area under the receiver operating characteristic (ROC) curve was used to determine the predictive ability of the model for each measure of dependence. Findings All the dependence variables predicted abstinence at 4 weeks and end‐of‐pregnancy. At 4 weeks, the adjusted odds ratio (OR) (95% confidence interval) for a unit standard deviation increase in FTCD was 0.59 (0.47–0.74), expired CO = 0.54 (0.41–0.71), number of cigarettes smoked per day 0.65 (0.51–0.84) and frequency of urges to smoke 0.79 (0.63–0.98); at end‐of‐pregnancy they were: 0.60 (0.45–0.81), 0.55 (0.37–0.80), 0.70 (0.49–0.98) and 0.69 (0.51–0.94), respectively. HSI and non‐HSI exhibited similar results to the full FTCD. Conclusions Four common measures of dependence, including number of cigarettes smoked per day, scores for Fagerström Test of Cigarette Dependence and frequency of urges and level of expired CO, all predicted smoking abstinence in the short term during pregnancy and at end‐of‐pregnancy with very similar predictive validity.

Response parameters for SMS text message assessments among pregnant and general smokers participating in SMS cessation trials

Introduction: Despite a substantial increase in use of SMS text messages for collecting smoking-related data, there is limited knowledge on the parameters of response. This study assessed response rates, response speed, impact of reminders and predictors of response to text message assessments among smokers. Methods: Data were from two SMS cessation intervention trials using clinical samples of pregnant (n = 198) and general smokers (n = 293) sent text message assessments during 3-month cessation programs. Response rates were calculated using data from the host web-server. Changes in response over time, impact of reminders and potential demographic (age, gender, ethnicity, parity, and deprivation) and smoking (nicotine dependence, determination to quit, prenatal smoking history, smoking status at follow-up) predictors of response were analyzed. Results: Mean response rates were 61.9% (pregnant) and 67.8% (general) with aggregated median response times of 0.35 (pregnant) and 0.64 (general) hours. Response rate reduced over time (P = .003) for general smokers only. Text message reminders had a significant effect on response (Ps < .001), with observed mean increases of 13.8% (pregnant) and 17.7% (general). Age (odds ratio [OR] = 0.95, 95% confidence interval [CI] 0.90–1.00) and deprivation (OR = 0.98, 95% CI 0.96–1.00) weakly predicted response among pregnant smokers and nonsmoking status at 4 weeks follow-up (OR = 8.63, 95% CI 3.03–24.58) predicted response among general smokers. Conclusions: Text message assessments within trial-based cessation programs yield rapid responses from a sizable proportion of smokers, which can be increased using text reminders. While few sources of nonresponse bias were identified for general smokers, older and more deprived pregnant women were less likely to respond. Implications: This study demonstrates that most pregnant and general smokers enrolled in a cessation trial will respond to a small number of questions about their smoking sent by text message, mostly within 1 hour of being sent the assessment text message. For those who do not initially respond, our findings suggest that 24- and 48-hour text message reminders are likely to increase response a small but meaningful amount. However, older age and higher deprivation among pregnant smokers and relapse among general smokers is likely to reduce the chance of response.

The effect of sand storms on acute asthma in Riyadh, Saudi Arabia

Objective: Major sand storms are frequent in the Middle East. This study aims to investigate the role of air particulate matter (PM) level in acute asthma in children in Riyadh, Saudi Arabia. Methods: An aerosol spectrometer was used to evaluate PM < 10μm in diameter (PM 10 ) and PM < 2.5 μm in diameter (PM 2.5 ) concentrations in the air every 30 minutes throughout February and March 2012 in Riyadh. Data on children 2-12 years of age presenting to the emergency department of a major children′s hospital with acute asthma during the same period were collected including their acute asthma severity score. Results: The median with interquartile range (IQR) levels of PM 10 and PM 2.5 were 454 μg/m 3 (309,864) and 108 μg/m 3 (72,192) respectively. There was no correlation between the average daily PM 10 levels and the average number of children presenting with acute asthma per day (r = -0.14, P = 0.45), their daily asthma score (r = 0.014, P = 0.94), or admission rate ( r= -0.08, P = 0.65). This was also true for average daily PM 2.5 levels. In addition, there was no difference in these variables between days with PM 10 >1000 μg/m 3 , representing major sand storms, plus the following 5 days and other days with PM 10 < 1000 μg/m 3 . Conclusion: Sand storms, even major ones, had no significant impact on acute asthma exacerbations in children in Riyadh, Saudi Arabia. The very high levels of PM, however, deserve further studying especially of their long-term effects.

Feasibility study to assess the effect of a brief mindfulness intervention for patients with chronic obstructive pulmonary disease: A randomized controlled trial:

Psychological distress is common among patients with chronic obstructive pulmonary disease (COPD). This study aimed to assess whether a 10-minute mindfulness intervention reduces distress and breathlessness, improves mood and increases mindfulness among hospital inpatients following acute exacerbation of COPD.Fifty patients were recruited following an acute admission. The immediate effects of a 10-minute mindfulness-based body scan were compared with a control intervention. Participants were randomized to receive either a mindfulness-based body scan (n = 24) or a control condition (n = 26) via a 10-minute audio recording. Participants completed a self-assessment survey, including the Borg scale for breathlessness, Philadelphia Mindfulness Scale and Hospital Anxiety and Depression Scale. They then completed six brief single item measures of dyspnoea, anxiety, depression, happiness, stress and mindfulness before and after the intervention daily for three consecutive days. Acceptability was rated according to ‘usefulness’ and whether they would recommend the intervention to other patients. Results showed that there was a tendency for change in most outcomes, but no significant differences between the groups. Most participants rated the intervention as useful and would recommend it. Existing knowledge of mindfulness interventions among these patients is very limited and this study may be helpful in the development of other brief interventions.

Physical activity for antenatal and postnatal depression in women attempting to quit smoking: randomised controlled trial

BackgroundAntenatal depression is associated with harmful consequences for both the mother and child. One intervention that might be effective is participation in regular physical activity although data on this question in pregnant smokers is currently lacking.MethodsWomen were randomised to six-weekly sessions of smoking cessation behavioural-support, or to the same support plus 14 sessions combining treadmill exercise and physical activity consultations.ResultsAmong 784 participants (mean gestation 16-weeks), EPDS was significantly higher in the physical activity group versus usual care at end-of-pregnancy (mean group difference (95% confidence intervals (CIs)): 0.95 (0.08 to 1.83). There was no significant difference at six-months postpartum.ConclusionA pragmatic intervention to increase physical activity in pregnant smokers did not prevent depression at end-of-pregnancy or at six-months postpartum. More effective physical activity interventions are needed in this population.Trial registrationCurrent Controlled Trials ISRCTN48600346. The trial was prospectively registered on 21/07/2008.