Use of nicotine replacement therapy among never smokers in the 1999-2006 National Health and Nutrition Examination Surveys

Drug Alcohol Depend. 2008 Nov 1;98(1-2):154-8. doi: 10.1016/j.drugalcdep.2008.05.001. Epub 2008 Jun 24.


Nicotine replacement therapies (NRT) have been available without a prescription in the United States since 1996. Given that nicotine, at least as it is delivered through tobacco products, is addictive, we examined whether NRT was being used by individuals who have never smoked cigarettes. Adults (n=18,986) and adolescents (n=9187) who participated in the in-home survey and physical examination components of the 1999-2006 National Health and Nutrition Examination Surveys were assessed for cigarette smoking status, other tobacco use or exposure, and use of NRT. Among the 8415 adults (ages 20 and older) who reported never having smoked 100 cigarettes and who provided a blood sample during their physical exam, 3 (0.08%; 95% CI=0.02-0.28%) reported using NRT within the 5 days prior to being examined. Among the 5510 adolescents (aged 12-19 years) who reported never smoking and who provided a blood sample, 5 (0.12%; 95% CI=0.04%-0.36%) reported using NRT. Analyses of cotinine (a metabolite of nicotine) from their blood samples, along with analysis of their other survey responses regarding additional nicotine exposures suggest that it is unlikely that any of the adults were never smokers using NRT and perhaps 2 adolescents may have been never smokers who used NRT. Based on these assessments, the re-estimated prevalence of NRT use by never smokers would be 0% among adults and 0.05% (95% CI=0.01-0.27%) among adolescents.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cotinine / blood
  • Cross-Sectional Studies
  • Female
  • Health Surveys
  • Humans
  • Male
  • Nicotine* / administration & dosage
  • Nonprescription Drugs*
  • Smoking / blood
  • Smoking / epidemiology
  • Substance-Related Disorders / blood
  • Substance-Related Disorders / epidemiology*
  • United States
  • Young Adult


  • Nonprescription Drugs
  • Nicotine
  • Cotinine