The Effectiveness of Nicotine Replacement Therapy in Light Versus Heavier Smokers

The prevalence of light smoking has increased in North America; however, research on the effectiveness of current treatments in this subpopulation of smokers is limited. We compared quit outcomes between light (1-10 cigarettes per day [CPD]) versus heavier smokers (>10 CPD) enrolled in a treatment program at their primary care clinic.

This secondary analysis analyzed 45 087 participants (light smokers [n = 9861]; heavier smokers [n = 35 226]) enrolled in a smoking cessation program between April 2016 and March 2020. The program offered cost-free nicotine replacement therapy (NRT) plus in-person counseling. Type, dose, and duration of NRT treatment were personalized. Data were collected at baseline, and at 6 months following enrollment to assess 7-day point prevalence abstinence (PPA), the primary outcome variable of interest. Logistic regression models were used for analyses.

Seven-day PPA at 6 months was significantly higher among light smokers (30.6%) than heavier smokers (26.0%; odds ratio = 1.25, 95% confidence interval = 1.18-1.33, p < .001). Heavier smokers were prescribed more weeks of NRT than light smokers (B = 0.82, 95% confidence interval = 0.64-1.0, p < .001). The association between smoking cessation and daily NRT dose did not differ between groups (p = .98). However, a stronger positive relationship between the number of clinic visits attended and 7-day PPA was found among heavier smokers in comparison to light smokers (p < .001). All findings remained significant after adjusting for baseline variables.

There is a paucity of scientific literature on the effectiveness of NRT for light smokers. Our findings suggest that individualized doses of NRT may be helpful in these subpopulations, and highlight the different treatment needs of light smokers.

Current clinical guidelines do not provide formal recommendations for light smokers who want to quit smoking. Similar to heavy smokers, light smokers are at substantial risk for many adverse health problems. As such, it is important to understand what treatment options are effective in assisting light smokers to quit smoking. Findings from this study support the use of personalized treatment for all smokers who are interested in quitting smoking, including light smokers.