An exploratory examination of the mechanisms through which pre-quit patch use aids smoking cessation

Rationale and objectives: Patches are traditionally started on the day a quit attempt begins. Recently, a number of studies have established that the patch’s effectiveness is improved by starting the treatment before quitting [pre-quit patch (PQP) use]. In an exploratory study, we investigate a proposed mechanism through which PQP use might promote abstinence: that PQP reduces satisfaction with smoking (either directly or via craving), which in turn leads to reduction and that smoking reduction promotes abstinence.

Methods: Fifty-seven interested quitters used handheld computers to monitor their smoking satisfaction, withdrawal and smoking in real time for 17 days, leading up to a quit attempt. All participants received 21 mg/24 h patches for 2 weeks before and for up to 10 weeks after quitting. Carbon dioxide (CO)-verified 28-day abstinence was assessed.

Results: During PQP treatment, participants reported significant reductions in both the satisfaction gained from smoking (p = 0.001) and their daily cigarette consumption (p = 0.001). Craving did not decrease; however, there was an interaction between time and nicotine dependence; craving decreased only among low dependent participants. Multilevel structural equation modelling revealed a direct effect of satisfaction on smoking rate. Craving did not mediate this relationship. Smoking reduction during the PQP treatment phase was not significantly associated with abstinence.

Conclusions

: The real-time data collection protocol utilised allowed for a fine-grained examination of smoking during PQP treatment. The results suggest that the reduction in daily cigarette smoking typically observed during PQP treatment is due to reductions in satisfaction with smoking. Unlike previous studies, however, smoking reduction was not significantly related to later abstinence, even though the odds ratio was comparably. Potential clinical implications of these findings are discussed.