Utilization of Nicotine Replacement Therapy Sampling and Its Impact on Tobacco Abstinence in Smokers Recruited in Outdoor Smoking Hotspots: A Secondary Analysis of a Cluster Randomized Controlled Trial

Introduction Evidence on real-world utilization of Nicotine Replacement Therapy Sampling (NRT-S) delivered in outdoor smoking hotspots remains limited. This study aimed to identify predictors of NRT-S utilization and examine its associations with cessation-related outcomes among Chinese adult smokers. Methods We conducted an exploratory secondary observational analysis among participants allocated to the NRT-S intervention arm of a cluster randomized controlled trial conducted at outdoor smoking hotspots. Chinese-speaking daily smokers (≥18 years, n=482) recruited at outdoor smoking hotspots received a 1-week NRT-S, nurse-led medication advice, and optional referral to cessation clinics. The primary outcome was NRT-S utilization at 1 month. Secondary outcomes were cessation-related outcomes at 6 months. Associations were assessed using generalized linear models. Results Among 482 participants in the NRT-S intervention arm, 384 received NRT-S and 162 used it. All effect estimates are adjusted risk ratios (aRRs). Receiving instruction on using NRT was associated with greater NRT-S use (aRR 1·55, 95% CI 1·01-2·41). Compared with non-users, more NRT-S users reported quit attempts (aRR 3·12, 95% CI 2·35-4·13) and use of smoking cessation service (aRR 3·14, 95% CI 2·07-4·78) at 1 month. At 6 months, using all 1-week NRT-S was associated with higher self-reported 7-day abstinence (aRR 1·94, 95% CI 1·21-3·10) and 30-day abstinence (aRR 1·81, 95% CI 1·09-2·99). Conclusion NRT-S use was limited despite high receipt among smokers recruited from outdoor smoking hotspots. Brief NRT-use instructions may improve uptake and support cessation-related outcomes, but causal effects require further evaluation. Medication-focused interaction may enhance uptake in community outreach settings.