Adherence to nicotine replacement therapy versus quitting smoking among Chinese smokers: A preliminary investigation

Department of Community Medicine, The University of Hong Kong, Hong Kong, China.
Psychopharmacology (Impact Factor: 3.88). 03/2005; 177(4):400-8. DOI: 10.1007/s00213-004-1971-y
Source: PubMed


There are over 300 million Chinese smokers, but use of nicotine replacement therapy (NRT) is rare. On the other hand, data on the factors associated with quitting and adherence to NRT use are scarce in the East.
To describe adherence and other predictors of quitting smoking at the 12-month follow-up amongst Chinese smokers in Hong Kong.
Chinese smokers (1186) who attended the Smoking Cessation Health Centre from August 2000 through January 2002 were studied. Trained counsellors provided individual counselling and carried out follow-up interviews. We used structured questionnaires at baseline and at 1, 3 and 12 months and an intention-to-treat approach for analysis.
Among those who received NRT (1051/1186), the prevalence of adherence (self-reported NRT use for at least 4 weeks) was 16% (95% confidence interval 14-18%). The 7-day point prevalence quit rate at 12 months (not smoking any cigarette during the past 7 days at the 12 month follow-up) was 27% (95% CI, CI 24-29%). Stepwise logistic regression model showed that adherence to NRT use, a higher income, good perceived health and having more confidence in quitting were significant predictors of quitting. The quit rate in the adherent group (40%) was greater than that of the non-adherent group (25%) (P<0.001). Older age, male, higher education, experience of NRT use, perceiving quitting as more difficult and willingness to pay were significant predictors of adherence.
Clinically significant smoking cessation rates can be achieved among Chinese smokers in a clinic-based smoking cessation service. The NRT adherence was low and low adherence was associated with a lower quit rate. Trials of interventions to improve adherence and increase quit rates are needed.

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    • "Smokers’ concerns about NRT side effects, such as worries about the accumulation of nicotine in the body, have been reported in other studies with Chinese and Vietnamese smokers (19,24) and studies of other racial/ethnic groups (25). Only one of the former smokers received advice on NRT use from a physician; however, that person chose to use NRT according to his own preference but not the provider’s recommendation. "
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    ABSTRACT: Population-based studies have reported high rates of smoking prevalence among Chinese and Vietnamese American men. Although nicotine replacement therapy (NRT) is effective, recommended, and accessible without prescription, these populations underuse NRT for smoking cessation. The aim of this study was to assess understanding and use of NRT and nonpharmacologic treatments among Chinese and Vietnamese American male smokers and their families. In-depth qualitative interviews were conducted with 13 smoker-family pairs, followed by individual interviews with each participant. A total of 39 interviews were conducted in Vietnamese or Chinese, recorded, translated, and transcribed into English for analysis. Four themes were identified: use and understanding of NRT, nonpharmacologic strategies, familial and religious approaches, and willpower. Both smokers and their family members believed strongly in willpower and a sense of personal responsibility as the primary drivers for stopping smoking. Lack of these 2 qualities keeps many Chinese and Vietnamese men from using NRT to quit smoking. Those who do use NRT often use it incorrectly, following their own preferences rather than product instructions. Our findings indicate the importance of culturally appropriate patient education about NRT. It may be necessary to teach smokers and their families at an individual level about NRT as a complementary approach that can strengthen their resolve to quit smoking. At a community level, public health education on the indication and appropriate use of evidence-based smoking cessation resources, such as NRT, would be an important component of effective tobacco control.
    Full-text · Article · Feb 2014 · Preventing chronic disease
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    • "Although a higher proportion in the A2 group used NRT for at least 2 weeks probably due to the free supply, there was no impact on the reported overall quit rates. One possible explanation was that giving 1- week or 2-week free NRT did not change smokers' adherence to NRT use (defined as NRT use for 4 weeks or longer [20]), as the prevalence of NRT use was almost identical in both groups, (22.9% in A1 group versus 24.8% in A2 group). Another explanation was that 1-week free NRT was enough to encourage motivated smokers to continue to use it for a longer duration, because some smokers who attended the clinic were already motivated to quit and giving 1-week or 2-week supply did not have any measurable effect on their determination to quit and buy NRT afterwards. "
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    ABSTRACT: This study examined if 2-week free nicotine replacement therapy (NRT) would be more effective than 1-week free NRT to help smokers quit smoking at 6 and 12 months. In a single-blinded randomized controlled trial design, 562 Chinese smokers who attended a smoking cessation clinic in Hong Kong, China, were randomly allocated into two groups (A1 and A2): A1 (n = 284) received behavioural counselling with free NRT for 1 week; A2 (n = 278) received similar counselling with free NRT for 2 weeks. All subjects received printed self-help materials to support their quitting efforts. A structured questionnaire was used for data collection, including pattern of NRT use and self-reported 7-day point prevalence quit rate at 6 months and 12 months. Among the participants, the mean number of cigarettes smoked per day was 18.8 (SD = 10.9). By intention-to-treat analysis, 7-day point prevalence quit rates were not significantly different between A1 and A2 groups at 6-month (27.5% versus 27.3%; P = 0.97) and 12-month (21.1% versus 21.2%; P = 0.98) followup. The findings suggest that two-week free NRT was not more effective than 1-week free NRT to increase smoking cessation rate among Chinese smokers.
    Full-text · Article · Sep 2013
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    • "In a study on pregnant smokers helped to quit with nicotine replacement therapy, adherence was a strong predictor of cessation.104 Similarly, in a study among Chinese smokers the quit rate in the adherent group was significantly greater (40%) than that in the nonadherent one (25%).105 "
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    ABSTRACT: Nicotine dependence is characteristically a chronic and relapsing disease. Although 75%-85% of smokers would like to quit, and one-third make at least three serious lifetime attempts, less than 50% of smokers succeed in stopping before the age of 60. Relevant and complex factors contributing to sustained cigarette consumption, and strongly implicated in the clinical management of smokers, are the level of nicotine dependence and psychological distress. In this review of the literature, these two factors will be examined in detail to show how they may affect smoking cessation outcome and to encourage clinicians to assess patients so they can offer tailored support in quitting smoking.
    Full-text · Article · Sep 2011 · Psychology Research and Behavior Management
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