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PURPOSE: Nicotine replacement therapy (NRT) sales switched from prescription to over-the-counter (OTC) status in April 1996. The change was expected to benefit public health by increasing smokers' access to NRT, and industry data show a doubling of NRT sales since the switch. We used a population-based sample to assess whether OTC availability increased smokers' rates of 1) NRT use, 2) quit attempts, and 3) cessation.

METHODS: We analyzed data from the Massachusetts Tobacco Surveys, telephone surveys of a probability sample of Massachusetts (MA) residents (response rates 68%–78%). We compared responses from past-year smokers in 1993 (pre-OTC; N = 1784) to those from 1997–99 (post-OTC; N = 1240), using multiple logistic regression. We also compared the demographic characteristics of NRT users before and after the OTC switch among smokers who had made a quit attempt in the past year.

RESULTS: There was no significant change over time in the proportion of respondents using NRT at a quit attempt in the past year (20.1% pre-OTC vs. 19.9% post-OTC) and no significant change in the proportion of smokers who made a quit attempt or who quit smoking. Half of smokers who used NRT post-OTC used it to "delay or cut down" their smoking but not to make a quit attempt. Fewer non-whites used NRT post-OTC (3.3%) compared to pre-OTC (20.7%) (adjusted p = .002), but the proportion of whites using NRT did not change (20.6% pre-OTC to 21.9% post-OTC). A higher proportion of 18–30 year-olds and a lower proportion openface> 45 year-olds used NRT post-OTC compared to pre-OTC (adjusted p = .0004).

CONCLUSION: We find no evidence that the OTC switch was associated with increased NRT use, quit attempts, or cessation rates among MA smokers, and one explanation may be that smokers purchase OTC NRT for reasons other than cessation. Since the switch, access to NRT appears to have increased for young adults but decreased for older and minority smokers. Even though NRT is now sold OTC, it remains important for physicians to encourage and monitor its use.