Extensive literature exists about nicotine replacement therapy (NRT) efficacy in randomised clinical trials of smoking cessation,¹ yet population data do not show sustained effectiveness after NRT became available over the counter in the USA.^2,3 Some claim that product cost is the main obstacle for its lack of population effectiveness.⁴ A large population based natural experiment is underway in New York that will test this hypothesis. Others suggest that smokers may be using NRT for reasons other than quitting, such as harm reduction or to mitigate withdrawal symptoms when they are unable to smoke.⁵

We present data from the 2002 California Tobacco Survey (CTS) which is part of large population based, random digit dialled surveys conducted triennially to monitor changes in tobacco use and attitudes in California. The methods for this survey are described in detail elsewhere.⁶ In order to assess the purpose and pattern of NRT use among California smokers, the 2002 CTS asked 5498 current smokers the following: Have you ever used a nicotine substitute product such as a patch, gum, inhaler or lozenge? If they answered yes, they were then asked an open ended question: Why did you use it? They could respond with multiple reasons. Interviewers coded responses into four pre-determined categories: to try to quit, to tide me over in situations where I cannot smoke, to replace some cigarettes so I smoke less, and just curious.

In table 1, we present these results, categorised by smoking level. Ever use of NRT increased with the amount smoked, with almost half (47%) of moderate to heavy daily smokers (15+ cigarettes/day), potentially who would benefit the most, having used it in the past. Overall, about one third of smokers tried NRT and most used it to quit (86.4%). Less than 10% used it for any other single reason. Despite the fact that nearly half of current moderate to heavy smokers reported having used NRT in the past, data from the 2002 CTS indicate only 27% reported using it for their most recent quit attempt that lasted for a day or longer.

These findings suggest that California smokers have tried NRT mainly for cessation, not supporting suggestions that this therapy is used mainly to decrease consumption or to overcome craving when smoking is not allowed. However, it is notable that many moderate to heavy cigarette smokers who had previously used NRT did not do so on their most recent attempt. This suggests that some smokers may be questioning the efficacy of NRT for quitting. It is possible that this could be in response to a change in the advertising message promoting NRT, where the current message may be perceived as over selling the effectiveness of NRT. This is indirectly supported by our recent findings (among 12–17 year old adolescents) that established smokers were much less likely (19%) to believe NRT is a sure way to quit compared to never smokers (38%) in the same age group.⁷ Further studies are needed to understand the influence of NRT advertisement on the beliefs and use of NRT by smokers.