Motivating smokers in smoking hotspots to have quit attempt through nicotine replacement therapy sampling: A randomized controlled trial

Dr Cheung, Yee Tak Derek   (Principal Investigator (PI))

Miss Cheung Ka Ching   (Co-Investigator)

Emeritus Professor Lam Tai Hing   (Co-Investigator)

Dr Li William Ho Cheung   (Co-Investigator)

Dr Wang Man Ping   (Co-Investigator)

Dr Chen Jing   (Co-Investigator)

18

2015-04-01

24019

Motivating smokers in smoking hotspots to have quit attempt through nicotine replacement therapy sampling: A randomized controlled trial

Smoking cessation

Nursing

201409176211

Small Project Funding

2014

Completed

Each year over 5,000 deaths were attributable to active smoking in Hong Kong (McGhee, et al., 2006). Quitting smoking is the most effective preventive medicines to reduce the burden of many non-communicable diseases. Hong Kong has the lowest smoking prevalence in the developed world due to strong tobacco measures in the past few decades (Koplan, An, & Lam, 2010), but 53% of daily smokers in Hong Kong have never tried and have no intention to quit smoking. 37.9% of daily smokers have attempted to quit but failed (Census & Statistics Department (Hong Kong SAR government), 2013). We found that the proportion of Hong Kong hardcore smokers (defined as those who are strongly addicted to smoking, have no quit attempt history and have no intention to quit) increased from 21.8% in 2005 to 27.4% in 2008 (Leung, Chan, & Lam, 2011). In our experience of organizing the community-based ""Quit to Win Contest"" with the Hong Kong Council on Smoking and Health, which provided brief interventions to the smokers, the 6-month quit rate has been declining from 20.6% in 2009 to 9.5% in 2012 (Hong Kong Council on Smoking and Health, 2014). These results suggest that more effort to motivate the smokers to quit and use smoking cessation aids are needed. Smoking is highly addictive and many quit attempters are unable to quit successfully due to withdrawal symptoms and relapse. Nicotine replacement therapy (NRT) is a safe and effective pharmacotherapy to reduce these symptoms during early abstinence and increase quit rate (Kasza, et al., 2012; Lancaster, Stead, Silagy, & Sowden, 2000; Song, et al., 2002). In Hong Kong, NRT is now included in the Hospital Authority Drug Formulary, and can be legally purchased over-the-counter or freely prescribed from the Tobacco Control Office’s Quitline and many other smoking cessation clinics. However, the usage of NRT in Hong Kong is lower than most of the developed countries. While 96.8% of smokers, who had previous quit attempts, tried to quit with ""self-determination"", only 23.1% had used prescribed or over-the-counter medication (Census & Statistics Department (Hong Kong SAR government), 2013). On the contrary, the corresponding percentage of having used medications to quit smoking was at least 40% in Australia, Canada, United Kingdom and United States (Borland, et al., 2012). The standard duration for using NRT for smoking cessation is 12 weeks (Fiore, et al., 2008; National Institue for Clinical Excellence, 2002). Providing free NRT for one or two weeks (i.e. NRT sampling) to motivate smokers to quit is theoretically based on the catastrophic theory, in which motivation of quitting is not necessarily accorded to the stage of readiness to quit from the Transtheoretical model (Prochaska & Velicer, 1997), but can be initiated by various environmental cues such as sickness (West & Sohal, 2006). In addition to reducing withdrawal symptoms, two recent US RCTs found that NRT sampling increased quitting motivation, confidence, and quit attempts in smokers who were not motivated to quit, compared to those who did not receive the sampling (Carpenter, et al., 2011; Jardin, et al., 2014). Exploration of the effectiveness of promoting quit attempt through increasing the literacy of medication and enhancing smokers’ experience in using cessation aid is warranted. The NRT sampling might also be beneficial for smokers who have just developed the motivation to quit and will act soon. Clinical practice guideline for smoking cessation recommended that clinicians should advise all smokers to use effective medication for tobacco dependence treatment (Fiore, et al., 2008). Population studies have found that unplanned quit attempts, which mean smokers who started to quit shortly after their decisions to quit, are very common and have a higher likelihood to achieve long-term abstinence than planned quit attempts (Ferguson, Shiffman, Gitchell, Sembower, & West, 2009; Larabie, 2005; Murray, Lewis, Coleman, Britton, & McNeill, 2009). Providing samples and information of NRT to these motivated smokers might be a timely intervention to help them reduce any physical discomfort during quitting and hence increase their abstinence. Misconception about the safety and efficacy of NRT is associated with a lower interest of using the medication for quit attempt (Ferguson, et al., 2011; Shiffman, Ferguson, Rohay, & Gitchell, 2008; Vogt, Hall, & Marteau, 2008). Nearly half of the smokers thought that NRT was as dangerous as cigarettes, and hence underestimated its efficacy to increase quitting success (Ferguson, et al., 2009). Therefore, providing sufficient and scientific information of NRT is important to enhance the adherence to the NRT. As both abrupt and gradual cessation with NRT are effective to increase abstinence for motivated and unmotivated smokers (Asfar, Ebbert, Klesges, & Relyea, 2011; Lindson-Hawley, Aveyard, & Hughes, 2012), NRT users should be well informed about these approaches while making their own decisions. We propose to conduct a pilot randomized controlled trial to evaluate the effectiveness of NRT sampling in about 100 adult smokers recruited in the public and non-smokefree areas. The intervention group will receive 1-week NRT sampling and instructions. Our previous RCT study in Hong Kong suggested that there was no difference in the effectiveness of NRT between 1-week or 2-week sampling (Abdullah, Hedley, Chan, & Lam, 2013). Based on the experience in the previous trials, the choice of NRT (either patch, lozenge or gum) will be made according to subject’s preference, and the counsellors will provide adequate advice (Abdullah, et al., 2013; Chan, et al., 2011; Lam, et al., 2005). The primary research questions of the present RCT are (1) will NRT sampling increase quit attempt in smokers who are not motivated to quit and those who have just been motivated? (2) will NRT sampling increase abstinence? (3) will NRT sampling increase the motivation and confidence to quit?