Get access

Perceived safety and efficacy of nicotine replacement therapies among US smokers and ex-smokers: relationship with use and compliance


Saul Shiffman, Pinney Associates, 201 North Craig Street, Suite 320, Pittsburgh, PA 15213, USA.


Aim  Nicotine replacement therapy (NRT) is effective for smoking cessation, but most smokers try to quit without using it. We examined the impact of misperceptions of NRT safety and efficacy on its use.

Design and participants  A total of 3203 current and former US smokers completed a national mail-out survey of issues and attitudes related to smoking cessation.

Findings  Two-thirds (66%) of respondents either agreed that ‘Stop-smoking products with nicotine are just as harmful as cigarettes’ or were unsure whether the statement was true. These respondents were less likely to have used NRT in the past [30% versus 49%; odds ratio (OR) = 0.45, 95% confidence interval (CI): 0.39–0.53] and less likely to consider using NRT during future quit attempts (40% versus 53%; OR = 0.60, 95% CI = 0.51–0.71). Additionally, of the respondents who had used nicotine gum in the past 12 months (n = 407), those who had concerns about the safety of NRT reported using fewer pieces of gum per day during treatment (six versus eight pieces/day; P < 0.05), and were less likely to report that they used the gum for greater than 4 weeks (28.5% versus 46.8%; OR = 0.45, 95% CI: 0.27–0.76). A large proportion of the respondents also stated that they did not believe NRT to be efficacious.

Conclusions  The findings suggest that many smokers are misinformed about the health risks of NRT and that these misperceptions impede not only the adoption of NRT but also compliance during treatment. Misperception of NRT safety is one barrier to effective use of NRT and probably reduces success in quitting.