NRT sampling and selection to Increase Medication Adherence

University Of Alabama At Birmingham, Birmingham AL

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Linked publications & trials

Abstract

Smoking remains the leading cause of death and disability in the United States, resulting in death for 1 out of every 2 smokers. While smoking rates have declined to about 16.8% among the general population, smoking rates remain disproportionately high among low income smokers (40.9% among individuals without a high school diploma in Alabama). Despite high rates of smoking, few interventions have been tested in this population. While medication adherence for smoking cessation is generally poor, nonadherence is particularly high among low income populations. Misperceptions about the safety and efficacy of NRT appear to undermine effective use of these medications, particularly among disadvantaged populations. Developing interventions to increase medication adherence has been cited as the most important means to reducing disparities; however, the few interventions that have investigated increasing adherence have been psychoeducational only and have yielded poor results. But evidence from our work with low income populations demonstrates that smokers who have previous experience using bupropion have higher subsequent cessation rates, and this relationship may be mediated by improved medication adherence. Thus, exposure to medication may be a critical factor in improving subsequent adherence. The current application proposes a pilot trial (N=80) to maximize medication adherence with this population of smokers by testing an in vivo NRT experiential intervention (In vivo). Participants randomized to the In vivo condition will sample four different short-acting NRT products (gum, lozenge, nasal spray, inhaler, counterbalanced within participant across sessions) in combination with nicotine patch in session. During each 30-minute session, they will discuss their expectancies and in vivo session effects of these medications on withdrawal symptomatology, including urge to smoke. Between sessions, participants will be given acute NRT along with patch to use during that week to practice quit attempts and to become familiar with the medication. At the end of four weeks of product sampling, participants will select their preferred combination to use over the next eight weeks for smoking cessation. Participants randomized to the control group will receive four 30-minute sessions of standard smoking cessation behavioral counseling following best treatment guidelines. Control participants will select an acute NRT to use with the nicotine patch based on a written description of each NRT product to use for cessation attempts for 8 weeks. Follow-ups will occur up to one month after NRT completion. Primary outcomes include feasibility and acceptability of this novel intervention as well as medication adherence. Secondary outcomes include examination of process measures believed to be associated with medication adherence including nicotine dependence, withdrawal, craving, abstinence self-efficacy, motivation and NRT- related expectancies. If promising, this pilot would provide preliminary support for a novel approach to increase medication adherence, which may ultimately improve smoking cessation rates among low income smokers.