Journal of Smoking Cessation

Review Article

Does Use of Nicotine Replacement Therapy While Continuing to Smoke Undermine Cessation?: A Systematic Review

Emma Bearda1 c1, Paul Aveyarda3, Susan Michiea4, Ann McNeilla2 and Robert Westa1

a1 Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BT, UK

a2 UK Centre for Tobacco Control Studies, University of Nottingham, City Hospital, Nottingham, UK

a3 Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK

a4 University College London Research Department of Clinical, Educational and Health Psychology, University College London, London, UK


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.


  • harm reduction;
  • smoking reduction;
  • temporary abstinence;
  • NRT


c1 Address for correspondence: Emma Beard, PhD, Cancer Research UK Health Behaviour Research Centre, University College London, WC1E 6BP. E-mail: Tel: 020 31083179.