Use of Nicotine Replacement Therapy for Smoking Reduction and Temporary Abstinence: An Update of Beard Et Al. (2011)

In a recent paper 1, we analysed data from the Smoking Toolkit Study (http://www.smokinginengland.info) between February 2007 and June 2009 to assess whether the use of nicotine replacement therapy (NRT) to aid smoking reduction (SR) and temporary abstinence (TA) might undermine or promote complete cessation, and whether it was associated with meaningful reductions in cigarette consumption. We reported positive associations between the use of NRT for SR and TA and recent attempts to quit smoking. After adjustment for socio-demographic characteristics and time to first cigarette, those using NRT for SR smoked 0.6 cigarettes per day more than those reducing without NRT, while those using NRT for TA smoked slightly, but not significantly, more than other smokers. From this, we concluded that the use of NRT by continuing smokers probably does little to reduce the harm from smoking, but far from undermining quitting, it may promote it. However, due to the available sample size, our report did not separate out the individual and combined ‘effects’ of NRT for SR and for TA. There may be differences between smokers who use NRT for SR alone, TA alone or both. The use of multiple harm reduction approaches has been reported previously to be more effective than the use of only one approach 2. The UK's National Institute for Health and Clinical Excellence is currently reviewing NRT use for harm reduction, and this issue has arisen; it may also arise in other jurisdictions such as the United States, where extending the licence for NRT may be considered. Now that a sufficient sample size has been accumulated we wish to report a re-analysis and update of our previous study, using data from the Smoking Toolkit Study between February 2007 and November 2011. Smokers (n = 23 137) were classified into those using NRT for SR alone (6.0%; n = 1391), those using NRT for TA alone (5.0%; n = 1163), those using NRT for both SR and TA (7.3%; n = 1683), those attempting SR without NRT (39.4%; n = 9113) and smokers doing none of these things (42.3%; n = 9788). Figure 1a shows the mean daily cigarette consumption according to the five categories listed above, while Fig. 1b shows the percentage of smokers reporting a quit attempt in the previous 12 months. Differences in cigarette consumption and attempts to quit smoking among the five groups were assessed using analysis of variance (ANOVA) and χ2 analyses, respectively. Smoker behaviour as a function of harm reduction activities. (a) Mean cigarette consumption; (b) percentage of smokers reporting a quit attempt in the previous 12 months. Data are weighted to match the 2001 census. SR: smoking reduction; TA: temporary abstinence; NRT: nicotine replacement therapy; every category in both graphs differs significantly from every other category: P < 0.001 for all pairwise comparisons except for the comparison in cigarette consumption between SR with NRT and SR and TA with NRT where P < 0.05; post-hoc tests were conducted using Scheffé's method for cigarette consumption and the standardized residual method for the percentage making a quit attempt. Error bars: 95% confidence intervals A significant difference was found in cigarette consumption across the five categories of smoker (F(2,23051) = 138.347, P = 0.001). The lowest cigarette consumption was reported among those attempting SR, followed by those using NRT for SR and TA, those using NRT for SR, other smokers generally and those using NRT for TA. A significant difference was also found in attempts to quit smoking across the five categories of smoker (χ2(4) = 3276.571, P = 0.001). Those using NRT for SR and TA were the most likely to report a previous quit attempt, followed by those using NRT for SR, those using NRT for TA, those attempting SR without NRT and other smokers generally. Similar findings emerged following adjustment for confounding variables (i.e. socio-demographic characteristics and time to first cigarette of the day). These new analyses show that there is a need to differentiate between use of NRT for SR and for TA, and that using NRT for both is associated with a higher propensity to quit and lower cigarette consumption than is the case for either alone. E.B. has received conference funding from Pfizer. R.W. 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. Data collection was funded by the English Department of Health, Cancer Research UK, Pfizer, Glaxo-SmithKline, 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. E.B. is funded by a fellowship from the UK Centre for Tobacco Control Studies. R.W. is funded by Cancer Research UK.