Avoiding common mistakes: brochures may boost anti-smoking therapy.

SCOTTSDALE, ARIZ. -- Receiving an informational brochure may help patients better comply with nicotine replacement therapy, Beth Quinio Edwards said in a poster presentation at the annual meeting of the Society for Research on Nicotine and Tobacco.

Ms. Edwards of the biobehavioral health department at Pennsylvania State University in University Park and her colleagues held two focus groups with 6-10 smokers who regularly received health care at the Primary Care Center of Mount Morris, Pa., a rural health clinic run by nursepractitioners. The investigators wanted to find out what problems participants had encountered with nicotine replacement therapy (NRT)--including the nicotine patch and nicotine gum--and whether they were receptive to trying long-term NRT.

Recalling prior nicotine gum use, the patients cited problems such as chewing the gum too quickly (leading to an unpleasant taste), chewing the gum while drinking, and not chewing enough gum. Smokers who had tried the nicotine patch said that they had been hesitant to put the patch on because they were afraid they might relapse to smoking and then get sick from the patch. Some smokers addressed this fear by removing the patch to smoke and then did not replace it.

A problem with both patch and gum was lack of awareness of the nicotine dose, causing some participants to get either too much or too little nicotine to ease withdrawal symptoms, Ms. Edwards said.

Based on the information that they got from the focus groups, the researchers developed a brochure that was given to smokers at the center. The brochure, entitled "Tips for Using the Nicotine Patch, Gum and Lozenge," discussed ways to avoid common mistakes. Half of the brochures also contained additional information on how NRT could be used beyond the recommended 10-12 weeks.

Pilot testing involving 27 patients showed that most found the brochure informative. Researchers then recruited 124 subjects from the clinic waiting room and randomized them to receive either the standard brochure or the brochure with the additional information on long-term use of NRT. The average age of the participants was 38 years, and 37% listed 12th grade as their highest level of education.

The participants who received a long-term safety message about NRT products "more commonly reported acceptability of long-term use and less often reported that long-term use would be dangerous," Ms. Edwards noted. "This indicates that the brochure may be a useful tool for presenting long-term NRT use instructions to less highly educated smokers. The tips in this brochure may also prevent those who haven't previously tried NRT from making common mistakes and encourage those who have used it unsuccessfully in the past to try again."

Finally, "the brochure may also serve as a useful tool for busy clinicians who want to counsel patients about quitting, as participants reported that their clinicians spent an average of 10.7 minutes reviewing the brochure with them," she said.

BY JOYCE FRIEDEN

Associate Editor, Practice Trends