Understanding Hesitation to Use Nicotine Replacement Therapy: A Content Analysis of Posts in Online Tobacco-Cessation Support Groups

PURPOSE

We aimed to better understand hesitancy to use nicotine replacement therapy (NRT) to quit smoking.

DESIGN

We content coded and analyzed NRT-related posts in online quit smoking support groups to understand NRT-use hesitancy and to examine associations with health outcomes.

SETTING

NRT posts were analyzed in unmoderated social-media support groups with free NRT.

SAMPLE

Adults who smoked daily (n = 438) and posted about NRT were studied, 339 of whom reported on NRT usage and 403 reported on smoking abstinence.

MEASURES

Surveys at 1-month post-quit date assessed NRT usage and smoking abstinence.

ANALYSIS

Relationships among NRT posts, NRT usage and smoking abstinence were analyzed using GEE models accounting for support group and covariates.

RESULTS

Nearly all (96.17%) participants reported using the study-provided NRT once, most (70.21%) used NRT during the past week, but less than half (45.72%) used NRT daily for the full month as recommended. Nearly two-thirds (65.34%) of NRT posts were negative. Posts reflecting dislike or no longer needing NRT were associated with a lower likelihood of using NRT in the past week at least once (B = -.66, P = .005 and B = -.37, P = .045), use occasions (B = -1.86, P = .018 and B = -1.10, P = .016) and used daily for full month (B = -.56, P = .044 and B = -.53, P = .009). Posts related to the effectiveness of NRT related to past-week NRT used at least once (B = .15, P = .023), used daily for full month (B = .25, P = .001), and smoking abstinence (B = .27, P = .002).

CONCLUSION

Strategies are needed to address dislike of NRT and strengthen perceptions of NRT efficacy, especially on social media where posts may be amplified.

Improving the continuity of smoking cessation care delivered by quitline services

OBJECTIVES

This study identified smokers' intended use of new quitline features aimed at improving smoking cessation such as having the same quitline advisor for each call, longer-term telephone counselling and provision of additional cessation treatments.

METHODS

Smokers who had previously used quitline counselling completed a computer-assisted telephone interview examining intended use of potential quitline enhancements.

RESULTS

The majority of smokers (61.1%) thought their chances of quitting would have increased a lot/moderately if they had the same quitline advisor for each call. Most smokers reported likely use of longer-term quitline telephone support after a failed (58.3%) or successful (60%) quit attempt. Smokers were likely to use quitline support long-term (mean=9.9 months). Most smokers would be likely to use free or subsidised nicotine replacement therapy (NRT) (74.9%) if offered by quitlines. Younger smokers had greater odds of being likely to use text messages, whereas less educated smokers had greater odds of being likely to use free or subsidised NRT.

CONCLUSIONS

Smokers appear interested in quitlines offering longer-term telephone support, increased continuity of care and additional effective quitting strategies.

PRACTICE IMPLICATIONS

Quitlines could adopt a stepped care model that involves increasingly intensive treatments and extended telephone counselling delivered by the same quitline advisor.

Effect of nicotine replacement therapy on quitting by young adults in a trial comparing cessation services

CONTEXT

Young adult smokers have the highest smoking prevalence among all US age groups but are least likely to use evidence-based cessation counseling or medication to quit.

OBJECTIVE

Use and effectiveness of nicotine patch were explored in a randomized trial evaluating smoking cessation interventions with this population.

PARTICIPANTS

Smokers aged 18 to 30 (n = 3094) were recruited through online and off-line methods and from telephone quit lines and analyzed.

DESIGN

Smokers were enrolled in a pretest-posttest trial, and randomized to 1 of 3 cessation services.

SETTING

Trial delivering counseling services by self-help booklet, telephone quit lines, or online expert system in the 48 continental United States.

INTERVENTION

Smokers could request a free 2-week course of nicotine replacement therapy (NRT) patches from the project.

MAIN OUTCOME MEASURE

Follow-up surveys at 12 and 26 weeks assessed smoking abstinence, use of NRT, counseling, and other cessation medications, and smoking-related variables.

RESULTS

Overall, 69.0% of smokers reported using NRT (M = 3.2 weeks) at 12 weeks and 74.8% (M = 3.3 weeks) at 26 weeks. More smokers who were sent the free nicotine patches (n = 1695; 54.8%) reported using NRT than those who did not receive them (12 weeks: 84.3% vs 41.9%, P < .001; 26 weeks: 87.6% vs 51.1%, P < .001). The use of NRT was associated with greater smoking abstinence at 12 weeks (P < .001) and 26 weeks (P < .05), especially if used for more than 2 weeks (P < .001). Smokers assigned to a self-help booklet or cessation Web site and heavier smokers were most likely to use NRT (P < .05), whereas those reporting marijuana use and binge drinking used NRT less (P < .05).

CONCLUSIONS

Many young adults were willing to try NRT, and it appeared to help them quit in the context of community-based cessation services. Strategies should be developed to make NRT available to this age group and support them in using it to prevent lifelong smoking.

State-level tobacco control and adult smoking rate in the United States: an ecological analysis of structural factors

CONTEXT

A variety of population-level tobacco control measures (TCMs) exist, such as excise taxation, smoking restrictions, cessation program funding, counter-advertising, and restrictions on tobacco marketing. Several factors may contribute to often-suboptimal levels of implementation of TCMs at the state level.

OBJECTIVE

To use the American Lung Association (ALA) grading framework to assess impacts of TCMs and to explore relationships between environmental factors and level of implementation of TCMs as rated by the ALA.

DESIGN

Secondary data analysis of publicly available data, using linear regression to examine relative effects of state TCMs on adult smoking rates and the extent to which environmental factors influence the strength of each TCM in states.

SETTING AND PARTICIPANTS

The 50 US states, excluding territories, districts, and possessions.

INTERVENTIONS

Cigarette excise taxes, state-level tobacco control expenditures relative to Center for Disease Control and Prevention recommendations, smoking restrictions, and support for smoking cessation by state Medicaid programs.

MAIN OUTCOME MEASURES

Adult smoking rate in each state for 2010; strength of TCMs as measured by the ALA.

RESULTS

The ALA smokefree score (β = -.045, P = .005) and tax rate per pack (β = -1.205, P = .019) were significant negative predictors of state adult smoking rates in 2010. Percentage of seats in lower houses of state legislatures held by Republicans was significant in predicting tax per pack (β = -.032, P < .001), and ALA smokefree score was negatively influenced by tobacco revenue as a percentage of state gross product (β = -15.663, P = .039), although this effect was not significant in the presence of covariates. State funding both for TCMs and for cessation coverage was also negatively influenced by tobacco-related economic factors.

CONCLUSIONS

Consistent with previous literature, taxation and smoking restrictions have the most immediate statewide impacts on smoking rate. Probusiness/antitax politics and tobacco manufacturing affect level of implementation of these and other effective TCMs.