Characterization of long-term users of nicotine replacement therapy: evidence from a national survey

Harm reduction involving partial or complete substitution of cigarettes with nicotine replacement therapy (NRT) is likely to benefit smokers by reducing exposure to carcinogens and by increasing the likelihood of permanent cessation. This article aimed to assess the determinants of short- and long-term NRT use for harm reduction in order to inform interventions aimed at helping smokers struggling to quit to switch to complete NRT substitution.

Data were used from the Smoking Toolkit Study, a population-based survey of adults in England aged 16 years and older (n = 9,224). Participants were asked about their sociodemographic characteristics and tobacco use. Attitudes toward smoking were also assessed using questions covering 4 factors: motives, identity, evaluations, and plans.

Concurrent short-term (<3 months) and long-term (≥ 3 months) NRT use was uncommon among smokers at 10.8% (95% confidence interval [CI] = 10.1-11.4) and 5.0% (95% CI = 4.6-5.4), respectively. Long-term NRT users had higher odds of being older, in nonmanual occupations, and more addicted than smokers with short-term or no NRT use (all p < .01). They reported lower odds of attempting to stop and higher odds of exhibiting a positive smoker identity than short-term users (p < .001). Conversely, long-term NRT users had higher odds of having made a recent quit attempt, to have plans to stop, and lower odds of a positive smoker identity than smokers not using NRT (all p < .001).

While users of NRT for harm-reduction purposes are a heterogeneous group, it appears they are more critical of smoking than never users and tend to positively modulate their behavior, setting them on a path toward cessation.