title: Characterization of long-term users of nicotine replacement therapy: evidence from a national survey.
abstract: BACKGROUND
  Harm reduction involving partial or complete substitution of cigarettes with nicotine replacement therapy (NRT) is likely to benefit smokers by reducing exposure to carcinogens and by increasing the likelihood of permanent cessation. This article aimed to assess the determinants of short- and long-term NRT use for harm reduction in order to inform interventions aimed at helping smokers struggling to quit to switch to complete NRT substitution.
  
  
  METHODS
  Data were used from the Smoking Toolkit Study, a population-based survey of adults in England aged 16 years and older (n = 9,224). Participants were asked about their sociodemographic characteristics and tobacco use. Attitudes toward smoking were also assessed using questions covering 4 factors: motives, identity, evaluations, and plans.
  
  
  RESULTS
  Concurrent short-term (<3 months) and long-term (≥ 3 months) NRT use was uncommon among smokers at 10.8% (95% confidence interval [CI] = 10.1-11.4) and 5.0% (95% CI = 4.6-5.4), respectively. Long-term NRT users had higher odds of being older, in nonmanual occupations, and more addicted than smokers with short-term or no NRT use (all p < .01). They reported lower odds of attempting to stop and higher odds of exhibiting a positive smoker identity than short-term users (p < .001). Conversely, long-term NRT users had higher odds of having made a recent quit attempt, to have plans to stop, and lower odds of a positive smoker identity than smokers not using NRT (all p < .001).
  
  
  CONCLUSIONS
  While users of NRT for harm-reduction purposes are a heterogeneous group, it appears they are more critical of smoking than never users and tend to positively modulate their behavior, setting them on a path toward cessation.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK lion.shahab@ucl.ac.uk.
authors.forename: Kabay
authors.initials: K
authors.lastname: Silla
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Beard
authors.affiliation: Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK.
authors.forename: Lion
authors.initials: L
authors.lastname: Shahab
mesh_terms: D000328:Adult; D004739:England; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009538:Nicotine / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D012907:Smoking / Q000188:drug therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy
chemical_list: D018722:Nicotinic Agonists; D009538:Nicotine