Characteristics of selectors of nicotine replacement therapy

Abstract

Objective: To assess differences in demographic and smoking characteristics between smokers who have and have not used nicotine replacement therapy (NRT). Design: Mail survey of US smokers from a national research panel. Participants: Smokers 18 years and over who returned a survey on smoking (n = 9630). The sample was weighted to match the US smoker population on age and sex. Main outcome measures: Compared smokers who had/had not used NRT in a quit attempt (ever NRT use or over the counter (OTC) NRT use) on: demographic characteristics, nicotine dependence, history of craving and withdrawal, expected difficulty quitting, and self reported history of smoking related medical illness and psychopathology. Results: NRT users (both ever-users and OTC users) were more likely to be older, male, and better educated. They were also heavier smokers, had experienced more craving and withdrawal upon quitting, and scored higher on measures of dependence. These differences were evident among light smokers, and remained even when smoking rate and time to first cigarette were controlled. Conclusion: Smokers who elect to use NRT differ from non-NRT users in ways that predispose them to failure in cessation. Controlling for smoking rate and time to first cigarette does not eliminate these differences, even among light smokers. These differences must be considered when comparing the effectiveness of NRT among samples of smokers who self select their treatment and are likely to bias such outcome comparisons.

Clinical trials and tribulations: Lessons learned from recruiting pregnant ex-smokers for relapse prevention

“…Reactively recruited women were more likely to be employed (our proactive calls tended to reach women who were home rather than at work during the day and early evening), to report slightly poorer health, slightly greater proneness to depression, and to smoke more cigarettes per day, with greater nicotine dependence. These differences tended to be small, and had we controlled for multiple comparisons, only the two smoking-related variables (cigarettes per day and FTND score) would have retained statistical significance, consistent with previous research demonstrating that individuals seeking assistance for smoking cessation (including nicotine replacement) tend to be heavier, more dependent smokers (Shiffman et al, 2005). …”

Comparison of cannabis and tobacco withdrawal: Severity and contribution to relapse

“…The NRT users reported more, not less, withdrawal. This is likely due to "indication bias;" i.e., those who chose to use NRT have more severe tobacco dependence than those who tried to quit without NRT (Shiffman, Di Marino, & Sweeney, 2005). Importantly, the cannabis group did not report significantly less withdrawal than either the NRT users or nonusers, indicating cannabis withdrawal was perceived by participants to be similar in severity to tobacco withdrawal in both tobacco groups.…”

Systematic Biases in Cross-sectional Community Studies may Underestimate the Effectiveness of Stop-Smoking Medications

“…Such differential recall effects would result in the over -representation of failed quit attempts among the SSM users compared with unassisted attempters when relying on recall of attempts. An alternative explanation of the reduced effectiveness of SSMs observed in cross-sectional studies is that unassisted quitters may be less addicted than those who choose to use help ( Shiffman, Di Marino, & Sweeney, 2005 ;Walsh, 2008 ) .…”