Beard, E.V.; (2012) Smokers' attempts at 'harm reduction'; their effectiveness and associations with cessation. Doctoral thesis , UCL (University College London).

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Abstract

Interest has grown in the concept of using Nicotine Replacement Therapy (NRT) during attempts at smoking reduction (SR) and temporary abstinence (TA). This is partially due to data from clinical trials showing that the concurrent use of NRT and cigarettes can result in significant reductions in cigarette consumption, and increases the propensity of smokers to quit. However, it is not clear whether similar findings will emerge outside of that structured setting. Data are also limited on the acceptability among smokers of using NRT in these ways, and whether healthcare professionals will be opposed to offering such a strategy. This thesis aimed to address these issues using three methodologies: population-based surveys of English smokers; in-depth telephone interviews with smokers; and surveys of stop smoking practitioners and managers. More than 1/10th of smokers in England were found to be using NRT for SR and/or TA. Prevalence did not appear to have changed since 2007. The use of NRT for SR and/or TA was associated with greater probability of reporting a quit attempt and of subsequently stopping smoking, but any reduction in concurrent cigarette consumption was very small. Nicotine intake was similar whether smokers were or were not using NRT whilst smoking. This suggests that smokers may have instead been compensating for the additional nicotine attained from NRT by adapting the way they smoked their cigarettes. The interview study indicated a number of factors which may account for the lack of reductions in cigarette intake, including smokers’ failure to set specific goals. A significant proportion of those working in stop smoking services did not agree with offering NRT for SR. Overall, the research reported in this thesis supports the idea that the use of NRT for SR and/or TA may promote cessation in the general population, but in itself is currently conferring little health benefit. Future research should examine the range of methods smokers use to reduce smoke exposure, and whether interventions which promote clear goal setting and monitoring of intake, such as through the use of expired carbon monoxide readings, can lead to effective SR.

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