Predictive validity of the Motivation To Stop Scale (MTSS): a single-item measure of motivation to stop smoking
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1 Predictive validity of the Motivation To Stop Scale (MTSS): a single-item measure of motivation to stop smoking SRNT-E XIV Annual Meeting, Helsinki, 31 August 2012 Daniel Kotz, Jamie Brown, Robert West Department of General Practice CAPHRI School for Public Health and Primary Care Maastricht University Medical Centre The Netherlands d.kotz@maastrichtuniversity.nl Background Motivation to stop as measure for effect of (population) interventions tracking trends over time comparing populations or subgroups Various (ad hoc) measures exist, many used in clinical samples No current standard with proven validity exists for population samples 2 1
2 MTSS Motivation To Stop Scale (MTSS) Robert West and English Department of Health Central Office of Information Single-item measure of key elements of motivation (West, Theory of addiction 2005) intention desire belief 3 Aims of this study Data from "Smoking Toolkit Study" Predictive validity baseline > quit attempts during 6 months Diagnostic accuracy sensitivity, specificity, ROC AUC Divergent validity (no gold standard) comparison measures of dependence 4 2
3 Smoking Toolkit Study All current smokers surveys November 2008 January ,483 respondents to 6-month followup questionnaire (21% response) MTSS categories "Which of the following describes you?" 1. "I don't want to stop smoking" 2. "I think I should stop smoking but don't really want to" 3. "I want to stop smoking but haven't thought about when" 4. "I really want to stop smoking but I don't know when I will" 5. "I want to stop smoking and hope to soon" 6. "I really want to stop smoking and intend to in the next 3 months" 7. "I really want to stop smoking and intend to in the next month". (1=lowest, 7=highest level of motivation to stop) 6 3
4 MTSS categories "Which of the following describes you?" 1. "I don't want to stop smoking" 2. "I think I should stop smoking but don't really want to" 3. "I want to stop smoking but haven't thought about when" 4. "I really want to stop smoking but I don't know when I will" 5. "I want to stop smoking and hope to soon" 6. "I really want to stop smoking and intend to in the next 3 months" 7. "I really want to stop smoking and intend to in the next month". (belief, desire, intention) 7 Outcome and covariates Any serious quit attempt between baseline and 6-month follow-up Sensitivity: 3-month follow-up Covariates age, sex, social grade Heaviness of Smoking Index (Kozlowski, Drug Alcohol Depend 1994) Strength of urges to smoke (Fidler, Addiction 2011) 8 4
5 Distribution scores baseline 9% 9% 21% 1: Not want to stop 2: Should stop but don't really want to 11% 17% 3: Want to stop but not thought about when 4: REALLY want to stop but dont know when 5: Want to stop and hope to soon 6: REALLY want to stop and intend to in <3 months 24% 9% 7: REALLY want to stop and intend to in <1 month 9 Attempts according to MTSS Percentage of smokers who made a quit attempt between baseline and 6- month follow-up 60% 50% 40% 30% 20% 10% % 692 (28%) made attempt 13% 1 Not want to stop 2 Should stop but don't really want to 3 Want to stop but not thought about when 4 REALLY want to stop but dont know when Motivation to quit measured at baseline 5 Want to stop and hope to soon 6 REALLY want to stop and intend to in <3 months 50% 7 REALLY want to stop and intend to in <1 month 10 5
6 Odds of making an attempt OR 95% CI aor 95% CI ( ) 1.70 ( ) ( ) 1.75 ( ) ( ) 2.96 ( ) ( ) 4.20 ( ) ( ) 6.30 ( ) ( ) 7.16 ( ) (1=lowest, 7=highest level of motivation to stop) 11 ROC for MTSS MTSS ROC AUC =0.67 (95%CI= ) HSI ROC AUC =0.47 ( ) Urges ROC AUC =0.53 ( ) 12 6
7 Sensitivity analysis MTSS baseline, quit attempt 3 months Association slightly stronger OR level 7 = 9.2 (vs. 6.8) Accuracy similar ROC AUC = 0.69 (vs. 0.67) 13 Strengths & limitations - Low response (21%) to follow-up (association underestimated?) - Retrospective self-report attempts over 6 months (small bias according to 3m data) - No other measure for comparison (divergent validity) + Large sample, long follow-up 14 7
8 Conclusions MTSS single-item measure combining belief, desire and intention to quit Strong ordinal association with quit attempts Acceptable level of accuracy for this field of research Valuable, cost-efficient tool for studies on motivation to stop Future research: external validation 15 Disclosures Role of funding source The Smoking Toolkit Study is funded by the English Department of Health, Cancer Research UK, Pfizer, GlaxoSmithKline, and J&J. Pfizer, J&J, and GlaxoSmithKline are manufacturers of smoking cessation products who had no involvement in the design of the study, collection, analysis or interpretation of the data, the writing of the report, or the decision to submit the paper for publication. Conflict of interest Robert West undertakes research and consultancy for, and has received travel expenses and hospitality from, companies that develop and market smoking cessation medications. He has a share on a patent for a novel nicotine delivery device. Daniel Kotz and Jamie Brown have no conflict of interest to declare. Acknowledgements We would like to thank Jennifer Fidler for her contribution to the design and coordinating of the Smoking Toolkit Study. 16 8
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