Electronically Monitored Nicotine Gum Use Before and After Smoking Lapses: Relationship With Lapse and Relapse

INTRODUCTION Greater use of nicotine replacement therapy (NRT) is related to smoking cessation success but the causal direction is unclear. This study characterized relations between NRT use and smoking lapse and relapse. METHODS Participants (N=416 smokers; 57% female, 85% White) were recruited from primary care for a smoking cessation factorial experiment and analyzed if abstaining ≥1 day in the first 2 weeks post-target quit day (TQD). Participants were randomized to counseling and 8 versus 26 weeks of nicotine patch plus nicotine gum post-TQD. Participants carried electronic dispensers that time-stamped each gum use. Participants who lapsed (smoked after abstaining) within 6 weeks post-TQD were matched with non-lapsers (n=146 pairs) on multiple variables. We compared lapsers' versus matched non-lapsers' gum use in the 5 days before and after the lapsers' first lapse. RESULTS By week 6 post-TQD, 63% of participants lapsed. Compared to non-lapsers, lapsers used less gum 1 and 2 days pre-"lapse" and on the 5 post-lapse days. Lapsers used less gum during the 5 days post-lapse than the 5 days pre-lapse. Univariate survival analyses with lapsers showed greater gum use during both pre- and post-lapse periods predicted longer latency to relapse in the first 6 weeks. CONCLUSIONS In a smoking cessation attempt using nicotine patch plus gum, lapsers versus matched non-lapsers used less gum immediately preceding and following their first lapse. Lower mean gum use before and after lapses predicted a more rapid escalation to relapse. Decreased nicotine gum use both precedes and follows returns to smoking during cessation attempts.