Daily use of nicotine replacement medications is related to daily smoking status: An ecological momentary assessment study

Drug Alcohol Depend. 2021 Dec 1;229(Pt A):109161. doi: 10.1016/j.drugalcdep.2021.109161. Epub 2021 Oct 29.


Background: Few studies have examined how daily adherence to nicotine replacement therapy (NRT) impacts daily smoking abstinence.

Methods: Data from a pilot randomized controlled trial of a smartphone-based smoking cessation intervention were used. Separate, generalized linear mixed models examined the association between ecological momentary assessments of NRT use and same-day and next day smoking status. Separate models examined the relationship between daily smoking status and (1) any use of NRT, (2) quantity of nicotine gum used, and (3) nicotine patch wear time. Reasons for medication non-adherence were also examined.

Results: Participants (n = 77) were predominantly White (66.2%) and female (50.6%), 50.4 years old (SD=11.6) on average, and they smoked an average of 21.8 cigarettes per day (SD=11.0) at baseline. Daily NRT use was significantly associated with a lower likelihood of smoking both within that same day and the following day. While using the gum and patch together, and using the patch alone were associated with reduced odds of same-day and next-day smoking, using the gum alone was not significantly associated with reduced odds of smoking. The most commonly cited reasons for not using the patch or gum was "other" (43.3%), followed by "side effects" (27.1%), and "forgot" (18.9%).

Conclusion: Daily use of the patch or both the patch and gum was associated with a lower risk of daily smoking. Low levels of nicotine gum use alone may not be an effective cessation strategy. Future studies should further explore reasons for NRT non-compliance, and ways to increase NRT adherence.

Keywords: Assessment; Ecological momentary; Nicotine replacement therapy; Smoking cessation; Tobacco.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Administration, Cutaneous
  • Ecological Momentary Assessment
  • Female
  • Humans
  • Middle Aged
  • Nicotine
  • Smoking
  • Smoking Cessation*
  • Smoking Prevention
  • Tobacco Use Cessation Devices


  • Nicotine