Feasibility of offering extended courses of nicotine replacement therapy to prevent relapse by smokers who have recently stopped
Author(s)
Shade Agboola, Ann McNeill and Tim Coleman
Presenter(s)
Shade Agboola Lecturer in Public Health, University of Nottingham
Abstract
Introduction
NHS Stop Smoking Services (NHS SSS) are cost effective; however, although 15% of smokers quitting with services’ help are still smoke-free at 1 year, most relapse to smoking. ‘Relapse prevention’ interventions, principally extended courses of cessation drugs, have recently been shown to be extremely cost-effective. These are not routinely used in the NHS but could substantially reduce SSS relapse rates. We assessed the feasibility, acceptability and uptake of offering extended courses of nicotine replacement therapy (NRT) to smokers who were already abstinent after using NRT for 8 weeks.
Method
Between April 2010 and January 2011, Nottingham New Leaf SSS cessation advisors offered smokers, who had achieved at least 8 weeks’ abstinence, an additional 12 weeks NRT. Individuals aged <18yrs and > 65yrs old, pregnant women and those with contraindications to using nicotine were excluded from this offer. Consenting individuals filled in a baseline questionnaire, providing demographic and smoking behaviour data. Four week batches of NRT were issued as patches, gum, tablets, lozenges, microtabs or inhaler according to participant preference. Participants completed monthly follow-up questionnaires enquiring about smoking status and had this validated with expired air carbon monoxide readings in the first 3 months. At 6 months review, smoking status was collected via telephone. Participants who successfully stopped and those who relapsed gave their views in semi-structured telephone interviews. Individuals who refused to participate were invited to consent to being contacted at six months follow-up to ascertain smoking status.
Results
268 eligible participants were offered relapse prevention treatment over a nine month period and 43% of these accepted. Reasons for declining included concern about long term side effects, satisfaction with the support already received and inability to attend for review. Of the number that accepted relapse prevention treatment, 89 (77%) were still abstinent at one month follow-up, 64 (55%) were abstinent at second month follow-up. Third and six month follow-up data are still being collected and will be available for presentation. Framework analysis of interview transcripts revealed that a large number of participants were very pleased with NRT for relapse prevention. The method of delivery was acceptable to over half of respondents as they reported that they preferred to visit New Leaf to receive NRT. Side effects reported were mild and easily managed.
Conclusion
For the first time, the acceptability of relapse prevention treatment amongst abstinent smokers has been assessed. The high acceptance rate of extended NRT treatment amongst Nottingham quitters who have achieved abstinence using NHS SSS support, suggests that, if introduced across the NHS, relapse prevention interventions would be widely used.
