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Barriers to tobacco cessation

Scientist, Centre for Addiction and Mental Health, Toronto, Ont.

Physicians and other health care providers play an important role in tobacco cessation efforts, providing valuable tools and advice to cigarette smokers.¹ One of the key tools is nicotine replacement therapy (NRT), but some smokers are reluctant to use NRT.^2–4 Finding simple ways to overcome this reluctance is of great importance because NRT promotes the chances of tobacco cessation.

In a recent random-digit dialing telephone survey of adult cigarette smokers in Ontario (conducted in August and September 2005), we found that three-quarters of the 434 respondents believed nicotine was one of the harmful components of cigarettes. Further, smokers who believed nicotine was harmful perceived their smoking as more risky (p < 0.02) and were less likely to intend to quit in the next 30 days (p = 0.01) than smokers who did not think that nicotine was harmful.

The clinical implication of these findings is that beliefs about the nature of nicotine may act as a barrier to tobacco cessation. When recommending NRT as a means to promote smoking cessation, it may be useful to make the following points: (1) NRT roughly doubles a smoker's chances of quitting successfully;⁵ (2) NRT is less addictive than cigarettes, so the smoker is not replacing one addiction with another;⁶ and (3) it is not the nicotine in cigarettes that makes them harmful, but the carbon monoxide, tar and other toxins.⁷

REFERENCES

1. Schroeder SA. What to do with a patient who smokes. JAMA 2005;294(4):482-7.[Abstract/Free Full Text]
2. Etter JF, Perneger TV. Attitudes toward nicotine replacement therapy in smokers and ex-smokers in the general public. Clin Pharmacol Ther 2001;69(3): 175-83.[CrossRef][Medline]
3. Cummings KM, Hyland A, Giovino GA, et al. Are smokers adequately informed about the health risks of smoking and medicinal nicotine? Nicotine Tob Res 2004;6 Suppl 3:S333-40.
4. Bansal MA, Cummings KM, Hyland A, et al. Stop-smoking medications: Who uses them, who misuses them, and who is misinformed about them? Nicotine Tob Res 2004;6 Suppl 3:S303-10.
5. Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation [Cochrane review]. In: The Cochrane Library; Issue 3, 2004. Oxford (UK): Cochrane Collaboration.
6. Hughes JR. Motivating and helping smokers to stop smoking. J Gen Intern Med 2003;18(12):1053-7.[CrossRef][Medline]
7. Benowitz NL. Nicotine safety and toxicity. New York: Oxford University Press; 1998.

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