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Association between use of nicotine replacement therapy for harm reduction and smoking cessation: a prospective study of English smokers
  1. Emma Beard1,
  2. Ann McNeill2,
  3. Paul Aveyard3,
  4. Jenny Fidler1,
  5. Susan Michie4,
  6. Robert West1
  1. 1Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
  2. 2UK Centre for Tobacco Control Studies, City Hospital, Nottingham, UK
  3. 3Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
  4. 4University College London Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
  1. Correspondence to Emma Beard, Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK; e.beard{at}


Aims It is important to know how far smokers' attempts at using nicotine replacement therapy (NRT) for smoking ‘harm reduction’ (reducing harm from continued smoking) promote or undermine cessation. To contribute to that goal, this study aimed to assess whether smokers' reports of smoking reduction (SR) and the use of NRT for SR and temporary abstinence (TA) predicted subsequent attempts to quit smoking and smoking status in a population sample. It also examined whether use of NRT for SR or TA was associated with reduced cigarette consumption compared with SR without NRT and non-use of NRT for TA.

Method Data were collected from 15 539 smokers involved in the Smoking Toolkit Study, a series of monthly household surveys of adults aged 16+; of whom 23% (n=3149) completed a 6-month follow-up questionnaire. At baseline, participants were asked whether they were currently using NRT for SR or TA. They were also asked for demographic information and daily cigarette consumption. At 6-month follow-up, data on attempts to quit smoking and smoking status were collected.

Results NRT use for SR and TA prospectively predicted attempts to quit smoking (OR 1.61, 95% CI 1.30 to 2.01 and OR 1.94, 95% CI 1.56 to 2.38 for SR and TA respectively) and abstinence (OR 1.51, 95% CI 1.06 to 2.16 and OR 2.09, 95% CI 1.51 to 3.34 for SR and TA respectively) at 6-months follow-up. Use of NRT for SR or TA was associated with a small reduction in cigarette consumption (two cigarettes per day) compared with SR without NRT or non-use of NRT for TA.

Conclusions The use of NRT for SR or TA appears to be positively associated with subsequent attempts to quit smoking and abstinence among smokers in England, despite very little apparent effect on daily cigarette consumption. With replication, these findings support the potential benefit of using NRT for harm reduction but primarily as a means of promoting cessation.

  • Harm reduction
  • smoking reduction
  • temporary abstinence
  • nicotine replacement therapy
  • addiction
  • nicotine
  • primary healthcare
  • tobacco product regulation
  • cessation
  • health services
  • prevalence

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  • Funding This study was funded by the English Department of Health, Cancer Research UK, Pfizer, GlaxoSmithKlein and Johnson and Johnson, who had no involvement in the design of the study, the analysis or interpretation of the data, the writing of the report or the decision to submit the paper for publication.

  • Competing interests PA has undertaken consultancy work on smoking cessation for Celtic (Xenova), Pfizer and McNeil. EB has received conference funding from Pfizer. RW undertakes research and consultancy and receives fees for speaking from companies that develop and manufacture smoking cessation medications. He also has a share of a patent for a novel nicotine delivery device.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by UCL.

  • Provenance and peer review Not commissioned; externally peer reviewed.