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Use of nicotine replacement therapy to reduce or delay smoking but not to quit: prevalence and association with subsequent cessation efforts

¹ Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
² Tobacco Research and Treatment Center, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA
³ Center for Survey Research, University of Massachusetts-Boston, Boston, MA, USA

Correspondence to:
Douglas E Levy, PhD, Institute for Health Policy, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA; douglas_levy{at}hms2.harvard.edu

Objective: To assess the prevalence of nicotine replacement therapy (NRT) use for purposes other than quitting smoking and examine the relation of this non-standard NRT use (NSNRT) with subsequent smoking cessation efforts.

Design: A population based cohort study of adult smokers who were interviewed by telephone at baseline (2001–2) and at two year follow-up. The association between NSNRT use to cut down on smoking or to delay smoking before baseline and cessation attempts and smoking outcomes at two year follow-up was assessed using logistic regression to adjust for multiple potential confounding factors.

Setting: Massachusetts, USA.

Subjects: 1712 adult smokers in Massachusetts who were selected using a random digit dial telephone survey.

Main outcome measures: Quit attempt in 12 months before follow-up, NRT use at quit attempt in 12 months before follow-up, smoking cessation by follow-up, or 50% reduction in cigarettes smoked per day between baseline and follow-up.

Results: 18.7% of respondents reported ever having used NSNRT. In a multiple logistic regression analysis, there was no statistically significant association between past NSNRT use and quit attempts (OR_{cut down} = 0.89, 95% CI 0.59 to 1.33; OR_delay = 1.29, 95% CI 0.73 to 2.29), smoking cessation (OR_{cut down} = 0.74, 95% CI 0.43 to 1.24; OR_delay = 1.22, 95% CI 0.60 to 2.50) or 50% reduction in cigarettes smoked per day (OR_{cut down} = 0.93, 95% CI 0.62 to 1.38; OR_delay = 0.80, 95% CI 0.43 to 1.49) at follow-up. Past use of NRT to cut down on cigarettes was associated with use of NRT at a follow-up quit attempt (OR_{cut down} = 2.28, 95% CI 1.50 to 3.47) but past use of NRT to delay smoking was not (OR_delay = 1.25, 95% CI 0.67 to 2.34).

Conclusions: Use of NRT for reasons other than quitting smoking may be more common than was previously estimated. This population based survey finds no strong evidence that NRT use for purposes other than quitting smoking is either harmful or helpful.

Abbreviations: NRT, nicotine replacement therapy; NSNRT, non-standard nicotine replacement therapy; OTC, over the counter

Keywords: smoking cessation; nicotine replacement therapy; reduce to quit; Massachusetts