Evaluating the Long-term Utilization of NRT in Smoking Cessation

This study examined the effectiveness of nicotine replacement therapy (NRT) in services across the United Kingdom. The findings suggest that long-term use of NRT is not prevalent among clients who have quit smoking, and relapsed smokers are more likely to use NRT on a short-term basis. The study also highlights the importance of patient education in conjunction with NRT as an effective approach for quitting smoking. Additionally, the research notes concerns regarding the safety of long-term NRT use, particularly among pregnant women. Overall, the study emphasizes the need for further research to integrate NRT into interventional strategies for smoking cessation and to address low adherence rates among patients.

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Running head:HEALTH ADVANCEMENT AND HEALTH PROMOTION
Health advancement and health promotion
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HEALTH ADVANCEMENT AND HEALTH PROMOTION
Search strategy
The present systematic research aimed at highlighting health promotion strategy,
particularly Nicotine Replacement Therapy (NRT) as an effective intervention for smoking
cessation. The databases used for this purpose were PubMed, CINAHL and Science Direct.
The keywords used for the search were Nicotine Replacement Therapy, NRT, smoking
cessation, tobacco, quit, prevent, cessation. The Boolean operations used were AND and OR,
with the purpose of making the research more narrowed and productive by eliminating the
inappropriate hits.
Inclusion/ exclusion of paper
A reliable and effective search is fruitful for the researched if the selection of the
papers to be included in the systematic review is done meticulously. Rejection of research
papers and successive inclusion of them needs to be thoroughly guided by a proper and
justified research criteria established before commencing on the research. Exhaustive
assessment process restates the appropriate requirement of vigorous inclusion criteria (Flick
2015). In the present case, articles that have been published in the last five years, that is on or
after the year 2012 were considered. The primary criteria for selecting the papers was that
full-text articles were to be included in the study. Databases were searched, and 29 articles
were included for the first round of screening. After assessing the title of the papers, the
abstract was read in order to understand their alignment with the research objective. 15
articles made into the second round of screening. The full-text articles were thereby read, and
their credibility was therefore judged. Six articles were finally selected for the resent review.
These articles were available in English language and were successful addressing the research
question.

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Evidence on topic
According to Coleman et al., (2012) there lies a common viewpoint that nicotine-
replacement therapy (NRT) can be effective in helping women to quit smoking at the time of
pregnancy. The researchers carried out a double-blinded, randomised, placebo-controlled,
parallel-group trial for assessing the safety as well as efficacy of a standard dose of nicotine-
replacement patches in abstinence from the habit of smoking. From the research, it was
indicated that the addition of a nicotine patch, about 15 mg per 16 hours, to behavioural
cessation for supporting women who smoke at the time of pregnancy does not significantly
bring an increase in the rate of abstinence from smoking. The supplementation when assessed
was found to be not better than placebo in the promotion of sustained abstinence throughout
pregnancy. In addition, there was no prominent evidence that such therapy had a harmful or a
beneficial impact on the birth outcomes. It is to be however noted that the inability to attain a
noteworthy longer-term impact of the applied nicotine-replacement therapy is to be rightfully
justified by the low adherence rates of the study participants.
Tonnesen (2013) discussed the usefulness of NRT as a smoking cessation practice. As
per the authors, the foundation of smoking cessation can be attributed to counselling along
with NRT, or bupropion SR and vareniciline. Combination of two NRTs and varenciline is
effective on an equal basis. Lower levels of nicotine use can be attained with NRT in
compared with smoking.
Abdullah et al., (2013) highlighted that two week free NRT is not more effectual
when compared to 1-week free NRT for helping smokers quitting smoking at 12 months and
at times six months. From a single-blinded randomized controlled study undertaken by the
researchers, it was found that there was no statistically significant difference in the smoking

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quit rates between participants at six months and one year. The inference drawn from the
study was that free NRT is to be based on the availability of resources as per the needs of the
patient and the capability of the organisation to deliver so.
Heydari et al., (2014) attempted to identify the most useful and effective smoking
cessation method from a literature review. 932 articles were considered for the critical
analysis, of which 352 articles highlighted NRT as the most supported method for smoking
cessation. The three methods considered for a comparative analysis were NRT, Champix and
patient education. Further research was demanded to carry out a comparative examiantion on
both quantitative and qualitative smoking cessation methods. The finding was informative in
bringing an update to the healthcare services being provided at that time.
Shahab et al., (2016) studied the long term utilisation of NRT in services in the united
kingdom. The examination was done for highlighting the changes in biomarkers due to use of
long-term NRT. Follow up of data was done with clients of UK Stop-Smoking Services
(SSS) by abstinent four weeks post quit date. It was indicated that long term use of NRT was
not prevalent highly among the SSS client and relapsed smokers. The use of NRT does not
give rise to increased nicotine intake. It was suggested that ex-smokers who use NRT on the
long run might consider replacing intake of nicotine from cigarettes with that from NRT.
Fllowers (2016) put forward a significant article on the implications of use of NRT.
NRT is much safer, and the most prominent factor is that it is less prone to medical
interactions and is less addictive. NRT in the form of patches, nasal spray, gum, inhaler
improve the ability of people trying to quit smoking. Research indicates that use nicotine
patch with gum or lozenge has more far-reaching consequences for patient use. Such therapy
is to be approached with a high degree of cautiousness while given to pregnant patients. NRT
increases the chances of successful smoking quit attempt. Policies are to focus more on use of

HEALTH ADVANCEMENT AND HEALTH PROMOTION
this technique in a wider context. However, some concerns have arisen regarding the safety
of longterm use of NRT. The idea is that long term use might bring a reduction in the benefits
brought about regarding cessation.
Conclusion
Smoking cessation has gained increased prominence recent times due to the wide
ranging morbidity and mortality effects. The use of pharmacotherapy, including NRT has
been discussed in details in literature. Multidimensional approaches have been considered
while carrying out this pool of research. There is no clear indication about how NRT should
be included in the interventional strategies for smoking cessation. The concern remains on a
similar level about women and men pertaining to smoking cessation. Though research
indicates the usefulness of NRT at various levels, the exact impact on pregnant women has
not been established yet. The longer-term impact of NRT has been linked with the low
adherence rates of the study participants. Consideration is to be given for reducing low
adherence rate of patients for achieving the desired outcomes of the therapy. NRT in different
forms such as patches, nasal spray, gum, inhaler have been prominently used for the purpose.
Since NRT has been proved to be better that sole intervention with Champix and patient
education, a combination therapy of the three might have more diverse usefulness. Research
is required at the earliest to bring into focus the exact manner in which NRT can be integrated
into the interventional approach for combating smoking cessation challenges.
Study objectives arising from evidence
Based on the undertaken research it can be stated that though NRT has been
established to be effective as a smoking cessation technique, the exact manner in which it
results in the desired outcomes is still vague. There is a huge scope for research in the area of

HEALTH ADVANCEMENT AND HEALTH PROMOTION
NRT intervention for pregnant women. Association of NRT with patient education is also to
be explored. The study objectives arising from the accumulation of evidence are as follows-
• How can patient education and NRT be together given out to patients for achieving better
results?
• What are the driving factors for low adherence rate of NRT for pregnant women and how
can these be addressed?
• How can safety issues regarding long term use of NRT be reduced?
• What are the different approaches that policy reformers must take to better integrate NRT
across healthcare sectors?

HEALTH ADVANCEMENT AND HEALTH PROMOTION
References
Abdullah, A. S., Hedley, A. J., Chan, S. S., & Lam, T. H. (2013).A randomized controlled
trial of two different lengths of nicotine replacement therapy for smoking
cessation. BioMed research
international, 2013.http://dx.doi.org/10.1155/2013/961751
Coleman, T., Cooper, S., Thornton, J. G., Grainge, M. J., Watts, K., Britton, J., & Lewis, S.
(2012). A randomized trial of nicotine-replacement therapy patches in
pregnancy. New England Journal of Medicine, 366(9), 808-818.DOI:
10.1056/NEJMoa1109582
Flick, U., (2015). Introducing research methodology: A beginner's guide to doing a research
project.Sage.
Flowers, L. (2016).Nicotine replacement therapy. American Journal of Psychiatry Residents'
Journal, 11(06), 4-7.https://doi.org/10.1176/appi.ajp-rj.2016.110602
Heydari, G., Masjedi, M., Ahmady, A. E., Leischow, S. J., Lando, H. A., Shadmehr, M. B.,
&Fadaizadeh, L. (2014). A comparative study on tobacco cessation methods: a
quantitative systematic review. International journal of preventive medicine, 5(6),
673.
Shahab, L., Dobbie, F., Hiscock, R., McNeill, A., &Bauld, L. (2016). Prevalence and impact
of long-term use of nicotine replacement therapy in UK Stop-Smoking Services:
findings from the ELONS study. Nicotine & Tobacco Research,
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Tønnesen, P. (2013). Smoking cessation and COPD. European Respiratory Review, 22(127),
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