Trends in smoking cessation: a Markov model approach

Intervention trials such as studies on smoking cessation may observe multiple, discrete outcomes over time. When the outcome is binary, participant observations may alternate between two states over the course of the study. The generalized estimating equation (GEE) approach is commonly used to analyze binary, longitudinal data in the context of independent variables. However, the sequence of observations may be assumed to follow a Markov chain with stationary transition probabilities when observations are made at fixed time points. Participants favoring the transition to one particular state over the other would be evidence of a trend in the observations. Using a log-transformed trend parameter, the determinants of a trend in a binary, longitudinal study may be evaluated by maximizing the likelihood function. A new methodology is presented here to test for the presence and determinants of a trend in binary, longitudinal observations. Empirical studies are evaluated and comparisons are made with the GEE approach. Practical application of the proposed method is made to the data available from an intervention study on smoking cessation.