Impact of Nicotine Replacement Therapy on Smoking Behavior

Abstract

This review summarizes evidence pertaining to the role of nicotine medications in smoking cessation and focuses particularly on evaluating evidence of the impact that nicotine replacement therapies (NRT) have had on altering population trends in smoking behavior. Accumulated evidence from controlled clinical trials has demonstrated that available forms of NRT (e.g., gum, transdermal patch, nasal spray, inhaler, and lozenge) increase quit rates compared with placebos by 50%-100%. However, despite the positive results from these studies, fewer than one in five smokers making a quit attempt do so with the benefit of NRT. Because not enough smokers are using NRT, the availability of NRT has not had a measurable impact on influencing population trends in smoking behavior. Among the factors contributing to the low utilization of nicotine medications are the inadequacies of the current dosage strengths and formulations of existing medications, smokers' perceptions of the high cost of the drugs, and concerns that many smokers have about safety and efficacy of nicotine medications. INTRODUCTIONConsiderable evidence supports the view that cigarette smoking is primarily maintained by an addiction to nicotine (51,91). Nicotine creates dependence by activating the mesolimbic dopaminergic reward system, and physiologic withdrawal symptoms occur when nicotine is no longer administered (59,67,71). Nicotine is an agonist of neural nicotinic acetylcholine receptors (NAChRs), which are found presynaptically in the central nervous system and postsynaptically in the autonomic nervous system (73). These receptors modulate the release of neurotransmitters. As a person's exposure to nicotine increases, NAChRs also are increased, which results in nicotine tolerance (60). Thus, factors that decrease the bioavailability of nicotine are hypothesized to increase an individual's cravings and decrease the likelihood of cessation because more of the drug is needed to achieve a given level of dopamine (13). Extrapolating from this evidence has led to the development of smoking cessation treatment methods that emphasize nicotine replacement (31). 584CUMMINGS HYLANDThe present review provides a brief summary of evidence pertaining to the role of nicotine medications, alone or in combination with other therapies in smoking cessation, and a critical analysis of the impact that these medications have had on altering population trends in smoking behavior. The discussion considers the role of nicotine replacement therapy (NRT) in a comprehensive population-based program developed to reduce the harms caused by tobacco. NICOTINE MEDICATION FOR SMOKING CESSATIONIn the mid-1980s, the vast majority (>90%) of former smokers reported that they stopped smoking without using medications or receiving formal assistance or help from anyone (33). However, this statistic has changed dramatically in the past two decades with the introduction and wide-scale availability of nicotine medications (46). Two-milligram prescription-only nicotine gum was first int...

A Test of Motivational Plus Nicotine Replacement Interventions for HIV Positive Smokers

“…Nine of 40 were bio-chemically confirmed (CO < 3 ppm) quitters at 3-month follow-up, while an additional eight achieved between 3 ppm and 8 ppm on expired CO, consistent with occasional smoking. These reductions in cigarette smoking and CO levels at 3-month follow-up are superior to no intervention, as well as behavioral interventions without medication, which yield quit rates of 3-18% (Feenstra et al 2005;Sutton and Gilbert 2007) and are comparable to studies of NRT with and without behavioral intervention components that yield quit rates of 22-28% in general populations (Cummings and Hyland 2005). We observed low rates of attrition and positive comments from research participants, regardless of assigned condition, suggesting that participants liked both interventions and the process of being in the study.…”

Tracing the cigarette epidemic: An age-period-cohort study of education, gender and smoking using a pseudo-panel approach

“…In theory, health warnings on cigarette packaging (1975), laws banning smoking in pubs and bars (2004) and new technological innovations such as nicotine replacement products may have contributed to a downward shift in cigarette consumption, although studies indicate that such measures have likely been more effective for reducing smoking initiation among adolescents than having a synchronous effect on all age groups (Cummings and Hyland, 2005;Hammond, 2011). Conversely, introduction of "light" or "mild" cigarettes in the 1980s and increased access to imported cigarettes may have contributed to increased opportunities for smoking.…”

Barriers to Effective Tobacco-Dependence Treatment for the Very Poor

“…Further, 29% thought hypnosis was effective, whereas only 24% thought telephone counseling was effective. Also, beliefs that cessation medications are ineffective, dangerous, addicting, or too costly were more prevalent among those living in poverty and correlated negatively with intention to quit and quit attempts Borland et al, 2011;Cummings and Hyland, 2005;Cummings et al, 2004;Fu et al, 2007; Okuyemi et al, 2006;Roddy, et al, 2006;Vogt et al, 2008). Finally, qualitative studies with both smokers in general and impoverished smokers have determined that many smokers believe "willpower" to be a crucial element in successful quitting (Roddy et al, 2006;Vogt et al, 2008;Wiltshire et al, 2003).…”