Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services

findings from the ELONS study

Lion Shahab, Fiona Dobbie, Rosemary Hiscock, Ann McNeill, Linda Bauld

Research output: Contribution to journalArticle

9 Citations (Scopus)
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Abstract

Background: 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.Methods: 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).Results: 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 χ2 (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.Conclusions: 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.IMPLICATIONS 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.
Original languageEnglish
Pages (from-to)1-8
JournalNicotine & Tobacco Research
Early online date24 Sep 2016
DOIs
Publication statusPublished - 24 Sep 2016

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Nicotine
Smoking
Therapeutics
Cotinine
Harm Reduction
alpha-Amylases
Saliva
Tobacco Products
Biomarkers

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Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services : findings from the ELONS study. / Shahab, Lion; Dobbie, Fiona; Hiscock, Rosemary; McNeill, Ann; Bauld, Linda.

In: Nicotine & Tobacco Research, 24.09.2016, p. 1-8.

Research output: Contribution to journalArticle

@article{781712af79334c489744d80a9130946c,
title = "Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services: findings from the ELONS study",
abstract = "Background: 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.Methods: 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).Results: 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 χ2 (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.Conclusions: 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.IMPLICATIONS 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.",
author = "Lion Shahab and Fiona Dobbie and Rosemary Hiscock and Ann McNeill and Linda Bauld",
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T1 - Prevalence and impact of long-term use of nicotine replacement therapy in UK Stop-Smoking Services

T2 - findings from the ELONS study

AU - Shahab, Lion

AU - Dobbie, Fiona

AU - Hiscock, Rosemary

AU - McNeill, Ann

AU - Bauld, Linda

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N2 - Background: 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.Methods: 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).Results: 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 χ2 (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.Conclusions: 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.IMPLICATIONS 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.

AB - Background: 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.Methods: 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).Results: 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 χ2 (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.Conclusions: 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.IMPLICATIONS 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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DO - 10.1093/ntr/ntw258

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