At the same time, they report, the number of people trying to quit has gone up dramatically as has the use of NRTs. Further, more than a third of the most recent NRT users are considered light smokers – those who smoke fewer than 15 cigarettes a day – a group for whom these products are known to be ineffective.
"Since becoming available without prescription in mid-1996, these products have been heavily promoted to the public," said the report's co-author John P. Pierce, Ph.D., director of the Cancer Prevention and Control Program at the Rebecca and John Moores UCSD Cancer Center. "Unfortunately, advertising does not distinguish between light smokers and those in the medium-to-heavy smoking category."
This new information was compiled from the California Tobacco Surveys (CTS), large population surveys undertaken annually since 1990. Researchers focused on the 1992, 1996 and 1999 surveys. During those surveys, interviews were completed on more than 15,000 adult smokers statewide. Among other things, respondents were asked about whether they had in the past year quit intentionally for a day or longer (the standard research definition of a meaningful quit attempt), if they had used a pharmaceutical aid or had other assistance for their last quit attempt, and how long they were off cigarettes the last time they tried.
Over the seven-year span of the surveys in the study (1992-1999), the percentage of smokers trying to quit increased by more than 60 percent (from 38.1 percent to 61.5 percent). At the same time, NRT use increased more than threefold; there were an estimated 116,209 smokers in 1992 who used NRT, 337,142 in 1996, and 423,290 in 1999. Significantly, of the additional smokers using NRT in 1999 compared to 1996, when these products became available over the counter, 37 percent were from the lighter smoking group. Pharmaceutical aids have never proven beneficial for lighter smokers.
Analysis of the duration of smoking abstinence in each of the study years indicated a significant effect for NRT use. However, in contrast to 1992 and 1996, the effect in 1999 was only short term; after about three months, the effect is about the same as for those who used no aids.
The researchers hypothesize that this shift happened in large part because of the context within which NRTs were available, and the nature of the products themselves.
"When physicians prescribed these products, they likely discussed their proper use and only prescribed them for appropriate users, the moderate-to-heavy smokers," said co-author Elizabeth Gilpin, M.S., of the Cancer Prevention and Control Program at the Moores UCSD Cancer Center. "Also, the products are designed to help with the cravings associated with smoking, but not the behavioral aspects."
Pierce added: "If you believe you can't concentrate without a cigarette, the patch or gum will not help you to overcome that trigger to smoke."
The researchers write that this study "highlights the need for more research nationwide concerning the barriers to more appropriate use of NRT," and they suggest that NRTs should be used in combination with other types of smoking-cessation assistance, such as behavioral counseling.
This work was supported by a grant from the University of California Tobacco Related Disease Research Program.
Founded in 1979, UCSD Cancer Center was recently renamed the Rebecca and John Moores UCSD Cancer Center in honor of the Moores leadership gift to the Center. The Center is one of just 40 in the United States to hold a National Cancer Institute (NCI) designation as a Comprehensive Cancer Center. As such, it ranks among the top centers in the nation conducting basic and clinical cancer research, providing advanced patient care, and serving the community through outreach and education programs.
NOTE: For PDF of research paper, contact Nancy Stringer, 619-543-6163 or email: nstringer@ucsd.edu
Journal
JAMA