Nicotine Replacement Therapy For Smoking Reduction Research Articles

Addressing the evidence for FDA nicotine replacement therapy label changes: a policy statement of the Association for the Treatment of Tobacco use and Dependence and the Society for Research on Nicotine and Tobacco.

Cigarette smoking creates a substantial public health burden. Identifying new, effective smoking cessation interventions that optimize existing interventions and promoting effective use of approved medications is a priority. When used as directed, nicotine replacement therapy (NRT) aids smoking cessation, but there is opportunity for improving its effectiveness. Until recently, NRT use guidelines advised smokers to begin using NRT on their quit date, only to use 1 NRT formulation at a time, to refrain from using NRT while smoking, and to stop NRT within 3 months regardless of progress. The Food and Drug Administration (FDA) issued a recent announcement allowing for NRT labeling changes with applications from pharmaceutical companies for such changes, and we applaud this decision. Nevertheless, additional revisions are warranted by current research. There is robust evidence that combining a longer-acting form (e.g., patch) with a shorter-acting form (e.g., lozenge) is more effective than NRT monotherapy and is safe. Moreover, extant evidence suggests that NRT use prior to a quit attempt or for smoking reduction as part of a quit attempt is safe and as effective as starting NRT on quit date. Specifically, prequit nicotine patch increases quit rates and may engage additional recalcitrant smokers. Last, NRT use longer than 3 months is safe and may be beneficial for relapse prevention in some smokers. This report summarizes the FDA announcement, reviews the evidence for further revisions to current FDA NRT guidelines, and makes recommendations for over-the-counter (OTC) NRT labeling to allow for (1) combined use of faster-acting NRT medications with nicotine patch, (2) nicotine patch use prior to quit date or NRT for smoking reduction as part of a quit attempt, and (3) prolonged NRT for up to 6 months without healthcare provider consultation.

Does smoking reduction make smokers happier? Evidence from a cross-sectional survey

Objectives: Stopping smoking leads to greater happiness and life satisfaction. This raises the question as to whether harm reduction, i.e. smoking reduction (SR) and the use of Nicotine Replacement Therapy (NRT) for SR, might lead to a similar benefit. This is of importance, given that the National Institute of Clinical Excellence in the UK is due to release guidance on harm reduction in 2013.Design: Data were collected from 1,532 smokers involved in the Smoking Toolkit Study.Method: Participants were asked if they were cutting down and if they were using Nicotine Replacement Therapy (NRT). Smokers also rated happiness and life satisfaction.Results: There was no evidence of an association between SR or use of NRT for SR and either reported ‘happiness’ or ‘life satisfaction’. Nor was there an association between measures of ‘happiness’ or ‘life satisfaction’ and cigarette consumption.Conclusion: It appears that SR is not associated with mental health benefits. This suggests that complete cessation may be necessary for benefits to be incurred. Prospective studies are necessary to confirm these findings.

The Use of Nicotine Replacement Therapy for Smoking Reduction and Temporary Abstinence: An Interview Study

Nicotine replacement therapy (NRT) is commonly used to aid smoking reduction (SR) or in situations of enforced temporary abstinence (TA). National Surveys have suggested that in the general population of smokers, the use of NRT in these ways has little effect on cigarette consumption and that use of the nicotine patch is common. This study aimed to gain a better understanding of what might underlie this. Semistructured telephone interviews were conducted with 36 smokers who reported that they were using NRT for SR and/or TA. Open-ended questions explored smokers' knowledge, beliefs, and experience of using NRT for SR and/or TA. Interviews were analyzed using a variant of framework analysis. Smokers reported using a variety of methods to reduce their cigarette consumption, including increasing the interval between cigarettes and attempting nondaily or social smoking. Smokers also modified how they smoked their cigarettes by trying to inhale less, not inhaling at all, or only smoking part of the cigarette. Nicotine patches appeared to be popular because they were discreet, easy to use, provided a prolonged effect, and had an established history. Smokers had little knowledge of the regulatory restrictions on the use of NRT. Smokers used a wide variety of means of reducing smoke exposure without stopping completely, including ones that did not involve reducing consumption. Nicotine patches were considered convenient to help with this, and there appeared to be little awareness of regulatory restrictions on their use.

Assessing the association between the use of NRT for smoking reduction and attempts to quit smoking using propensity score matching

BackgroundSmokers who use nicotine replacement therapy (NRT) to aid smoking reduction (SR) are more likely to quit smoking than those who try to reduce without NRT. This could be because NRT enhances the likelihood of quitting or because those who are motivated to quit choose to use NRT (i.e., selection bias). Methods‘Propensity score matching’ was used to assess whether the increased likelihood of a quit attempt in those using NRT for SR would remain in a subsample of smokers paired on variables indicative of the likelihood of making a quit attempt and using NRT (i.e., when selection bias is reduced). Measures were obtained on a range of smoking and socio-demographic variables at baseline, then after 3 and 6 months. Fifty-eight smokers who were attempting SR at 3 months were matched on baseline measures to 58 smokers not using NRT for SR. The odds of their going on to make a quit attempt in the following 3 months were then compared. ResultsIn smokers matched on motivational and other variables for their propensity to use NRT to aid smoking reduction, those using NRT for SR had three times greater odds of reporting a quit attempt than those not using NRT (OR 3.23; CI 1.49–7.01; p<0.01). ConclusionThe increased likelihood of subsequently trying to stop smoking among smokers who use NRT to aid SR versus those who try to reduce without NRT, remains following the matching of participants on motivational and other potentially relevant variables.

Mediation analysis of the association between use of NRT for smoking reduction and attempts to stop smoking

Objectives: Use of nicotine replacement therapy (NRT) for smoking reduction (SR) is linked to higher quit attempt rates than SR without NRT. This study aimed to assess the possible mediating roles of confidence in ability to quit, enjoyment of smoking and motivation to quit in this association. Design: Cross-sectional survey. Main outcome measures: Smokers were asked if they were currently attempting SR, and if they were, whether they were using NRT. Motivation to stop, enjoyment of smoking, confidence in ability to stop, and previous quit attempts, were also assessed. Results: There was no evidence that confidence in ability to quit or enjoyment of smoking mediated the association between the use of NRT for SR and attempts to quit. Only motivation to stop partially mediated between the use of NRT for SR and attempts to stop (indirect effect: odds ratio 1.08, p < 0.001). Conclusion: Although this study is limited by its cross-sectional design, the findings point towards the possibility that the use of NRT to aid SR may promote attempts to stop through increasing motivation to quit but not by increasing confidence or by reducing enjoyment of smoking. Longitudinal studies are required to draw firmer conclusions about the possible mediating effects of motivation to quit.