Objectives: Stopping smoking leads to greater happiness and life satisfaction. This raises the question as to whether harm reduction, i.e. smoking reduction (SR) and the use of Nicotine Replacement Therapy (NRT) for SR, might lead to a similar benefit. This is of importance, given that the National Institute of Clinical Excellence in the UK is due to release guidance on harm reduction in 2013.

Design: Data were collected from 1,532 smokers involved in the Smoking Toolkit Study.

Method: Participants were asked if they were cutting down and if they were using Nicotine Replacement Therapy (NRT). Smokers also rated happiness and life satisfaction.

Results: There was no evidence of an association between SR or use of NRT for SR and either reported ‘happiness’ or ‘life satisfaction’. Nor was there an association between measures of ‘happiness’ or ‘life satisfaction’ and cigarette consumption.

Conclusion: It appears that SR is not associated with mental health benefits. This suggests that complete cessation may be necessary for benefits to be incurred. Prospective studies are necessary to confirm these findings.

Aims: To review population surveys to assess (a) prevalence of the use of NRT for smoking reduction (SR) and temporary abstinence (TA) and (b) how far this is associated with attempts to stop smoking, smoking cessation and reduction in cigarette consumption.

Methods: An electronic search was undertaken of EMBASE, MEDLINE, Web of Science and PsycINFO. Articles were selected if they (1) assessed whether smokers had used or were currently using NRT for SR and/or TA; (2) involved smokers who had not taken part in a harm reduction programme; and (3) assessed prevalence and/or association of SR and/or TA with reductions in cigarette consumption and/or attempts to stop smoking and/or with smoking cessation. Twelve studies met the inclusion criteria and results were extracted independently by two researchers.

Results: Data were available from five countries (US, UK, Canada, Switzerland and Australia). Between 1% and 23% of smokers reported having ever used NRT for smoking reduction and between 2% and 14% during periods of temporary abstinence. Use of NRT for SR and/or TA was associated with little or no reduction in cigarette consumption. There was some evidence that it was positively associated with attempts to stop smoking and smoking cessation.

Conclusion: In smoking populations use of NRT to aid SR and in situations where smoking is not permitted appears to be having little effect on achieving a reduction in cigarette consumption but does not undermine cessation and may promote it.

The majority of smokers indicate that they would like to quit. It has been estimated that approximately three quarters of Australian smokers have tried to change their behaviour in the last 12 months (Scollo & Winstanley, 2008); similarly, more than half of US smokers report having tried to quit in the last year (Centers for Disease Control and Prevention [CDC], 2011). Despite their interest in quitting, the proportion of smokers who successfully quit each year is very low (CDC, 2011). While other factors are also important, poor cessation rates can partly be attributed to the low uptake of efficacious smoking cessation methods, particularly pharmacotherapies (Shiffman, Brockwell, Pillitteri, & Gitchell, 2008).

Background and aims: This study examined whether providing smokers with a personal monitor for measuring expired-air carbon monoxide (CO) concentrations would be a feasible method of achieving a reduction in smoke intake. Methods: Ten smokers were given a CO monitor and asked to use it regularly throughout the day for 6 weeks with the aim of maintaining their CO reading below 10 ppm. They were advised to use nicotine replacement therapy, but this was not provided. At baseline and follow-up, smokers were asked to comment on their use of the monitors and motivation to stop smoking. Demographic characteristics, cigarette consumption, and nicotine dependence, was also assessed. Additionally, during the first 2 weeks participants were instructed to record how often they used their CO monitor, their average readings and cigarette consumption. Results: Eight smokers had an average daily CO concentration below their baseline on at least 93% of the days in the 2 weeks of daily monitoring, while three had CO levels below 10 ppm on 36% of the days. At the 6-week follow-up, all participants’ CO concentrations were below their baseline value; two were below 10 ppm. Average daily cigarette consumption reduced from 14.1 (SD 6.03) at baseline to 9.8 (SD 4.95) during the 2 weeks of daily CO monitoring (t = 2.46, df 9, p = 0.036) and 9.5 (SD 5.50) at 6 weeks follow-up (t = 1.73, df 7, p = 0.127). Use of the CO monitors was generally found to be acceptable and to increase motivation to stop smoking completely. Five smokers attempted to quit smoking. Conclusions: Regular personal CO monitoring may be a useful method for reducing smokers’ cigarette intake and increasing their motivation to stop completely. A controlled trial with long-term follow up is warranted.

The hypotheses that smokers hold misconceptions around nicotine replacement therapy (NRT) safety, and that these concerns limit the use of NRT, was tested with two large face-to-face surveys of current smokers in Great Britain in 2004 (N = 605) and 2006 (N = 1,434). In both studies, participants were questioned regarding the safety of nicotine and NRT products, their past experience with NRT and anticipated future use. Across both surveys, approximately two thirds of smokers believed that, or were unsure whether, NRT was as harmful as cigarette smoking. Combining information across surveys, smokers with safety misconceptions reported being less likely to want to quit in the future (63% vs. 73%; p < .001), and, among those who were interested in quitting, were less likely to report an intention to use NRT during their next quit attempt. The majority of smokers were misinformed about the safety of NRT products, and smokers with safety misconceptions were less likely to report that they plan to use NRT during future quit attempts, suggesting that safety concerns are a barrier to NRT utilisation.

This preliminary laboratory study investigated nicotine absorption rates of seven current nicotine replacement therapy (NRT) products and a new wide-bore nicotine delivery device (the ‘Nicotine Cannon’). The nicotine products (Cannon, inhalator, nasal spray, microtab, 2 mg and 4 mg gum and 2 mg and 4 mg lozenge) were used for ten minutes by two non-nicotine tolerant subjects. Blood was taken at frequent intervals for the next 60 minutes and plasma nicotine concentrations assessed. Of current NRT products investigated the 4 mg lozenge performed best with the highest blood nicotine levels at each time point, the 2 mg gum delivered the lowest concentrations at each time point. The nicotine nasal spray delivered nicotine the fastest of all the products. The Cannon delivered the highest blood nicotine concentration (mean 8.95 ng/ml) of all products one minute after device use had stopped, and the highest concentration (11 ng/ml) five minutes after termination of use. The Cannon showed it could deliver nicotine relatively rapidly in a manner that was readily tolerated by users.