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Publication Detail
Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services: findings from the ELONS study.
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Shahab L, Dobbie F, Hiscock R, McNeill A, Bauld L
  • Publication date:
    24/09/2016
  • Journal:
    Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
  • Medium:
    Print-Electronic
  • Print ISSN:
    1462-2203
  • Language:
    eng
  • Addresses:
    Department of Epidemiology and Public Health, University College London and UK Centre for Tobacco and Alcohol Studies, UK lion.shahab@ucl.ac.uk.
Abstract
Nicotine Replacement Therapy (NRT) was licensed for harm reduction in the UK in 2005, and guidance to UK Stop Smoking Services (SSS) to include long-term partial or complete substitution of cigarettes with NRT was issued in 2013. Yet, NRT prevalence data and data on changes in biomarkers associated with long-term NRT use among SSS clients are scarce.SSS clients abstinent 4 weeks post-quit date were followed up at 12 months. At baseline standard socio-demographic, smoking and SSS use characteristics were collected and of those eligible, 60.6% (1,047/1,728) provided data on smoking status and NRT use at follow-up. A subsample also provided saliva samples at baseline and of those eligible, 36.2% (258/712) provided follow-up samples. Saliva was analysed for cotinine (a metabolite of nicotine) and alpha-amylase (a stress biomarker).Among those who had used NRT during their initial quit attempt (61.5%, 95%CI 58.4-64.6), 6.0% (95%CI 4.3-8.3%) were still using NRT at one year, significantly more ex-smokers than relapsed smokers (9.5% vs. 3.7%; p=0.005). In adjusted analysis, NRT use interacted with smoking status to determine change in cotinine, but not alpha-amylase, levels (Wald χ(2) (1)=13.0, p<0.001): cotinine levels remained unchanged in relapsed smokers and ex-smokers with long-term NRT use but decreased in ex-smokers without long-term NRT use.Long-term NRT use is uncommon in SSS clients, particularly among relapsed smokers. Its use is associated with continued high intake of nicotine among ex-smokers but does not increase nicotine intake in smokers. It does not appear to affect stress response.Little is known about the long-term effects of Nicotine Replacement Therapy (NRT). Given an increasing shift towards harm reduction in tobacco control, reducing the harm from combustible products by complete or partial substitution with non-combustible products, more data on long-term use are needed. This study shows that in the context of stop smoking services, clients rarely use products for up to a year and that NRT use does not affect users' stress response. Ex-smokers using NRT long-term can completely replace nicotine from cigarettes with nicotine from NRT; long-term NRT use by continuing smokers does not increase nicotine intake. Long-term NRT appears to be a safe and effective way to reduce exposure to combustible nicotine.
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