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An exploratory examination of the mechanisms through which pre-quit patch use aids smoking cessation

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Abstract

Rationale and objectives

Patches are traditionally started on the day a quit attempt begins. Recently, a number of studies have established that the patch’s effectiveness is improved by starting the treatment before quitting [pre-quit patch (PQP) use]. In an exploratory study, we investigate a proposed mechanism through which PQP use might promote abstinence: that PQP reduces satisfaction with smoking (either directly or via craving), which in turn leads to reduction and that smoking reduction promotes abstinence.

Methods

Fifty-seven interested quitters used handheld computers to monitor their smoking satisfaction, withdrawal and smoking in real time for 17 days, leading up to a quit attempt. All participants received 21 mg/24 h patches for 2 weeks before and for up to 10 weeks after quitting. Carbon dioxide (CO)-verified 28-day abstinence was assessed.

Results

During PQP treatment, participants reported significant reductions in both the satisfaction gained from smoking (p < 0.001) and their daily cigarette consumption (p < 0.001). Craving did not decrease; however, there was an interaction between time and nicotine dependence; craving decreased only among low dependent participants. Multilevel structural equation modelling revealed a direct effect of satisfaction on smoking rate. Craving did not mediate this relationship. Smoking reduction during the PQP treatment phase was not significantly associated with abstinence.

Conclusions

The real-time data collection protocol utilised allowed for a fine-grained examination of smoking during PQP treatment. The results suggest that the reduction in daily cigarette smoking typically observed during PQP treatment is due to reductions in satisfaction with smoking. Unlike previous studies, however, smoking reduction was not significantly related to later abstinence, even though the odds ratio was comparably. Potential clinical implications of these findings are discussed.

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Acknowledgments

This work was supported by an internal grant from the University of Tasmania awarded to SGF. Dr. Ferguson is supported through a fellowship from Cancer Council Tasmania (Australia). The authors would like to thank Isabelle Morris, Jodie Bower and Dr. Mai Frandsen for their assistance with conducting the study and Dr. Julia Walters for feedback on the study design.

Conflict of interest

Through his work at Pinney Associates, SGF provides consulting services to GlaxoSmithKline Consumer Healthcare (GSKCH), makers of nicotine replacement products for smoking cessation. However, GSKCH had no role in the current study, did not support it financially, nor review it prior to submission. NS has nothing to declare.

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  1. School of Medicine, University of Tasmania, Private Bag 34, Hobart, TAS, 7001, Australia

    Natalie Schüz & Stuart G. Ferguson

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  1. Natalie Schüz
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  2. Stuart G. Ferguson
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Correspondence to Natalie Schüz.

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Schüz, N., Ferguson, S.G. An exploratory examination of the mechanisms through which pre-quit patch use aids smoking cessation. Psychopharmacology 231, 2603–2609 (2014). https://doi.org/10.1007/s00213-013-3430-0

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