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Can we increase smokers’ adherence to nicotine replacement therapy and does this help them quit?



To examine the effects of five intervention components on smokers’ adherence to combined nicotine patch and nicotine gum during a quit attempt and assess whether adherence is related to cessation.


Smokers interested in quitting (N = 513; 59% female; 87% White) received nicotine patch plus nicotine gum and participated in a 2x2x2x2x2 randomized factorial experiment (i.e., 32 treatment conditions) evaluating five intervention components: (1) medication adherence counseling versus none; (2) automated medication adherence calls versus none; (3) electronic medication monitoring with feedback and counseling versus e-monitoring alone; (4) 26 versus 8 weeks of nicotine patch plus nicotine gum; and (5) maintenance counseling versus none. Adherence was assessed over the first 6 weeks post-target quit day via timeline follow-back (nicotine patch) and electronic medication dispenser (gum).


In the first 6 weeks post-quit day, 12% of participants used no patches or gum, and 40% used the patch every day. Only 1.4% used both patch and gum adherently every day in the 6 weeks post-target quit day. E-monitoring counseling increased gum use (from 1.9 to 2.6 pieces/day; p < .001) but did not increase abstinence. More adherent patch and gum use in the first 6 weeks were each associated with higher point-prevalence abstinence rates through 1 year.


This large experiment with electronic monitoring of nicotine gum adherence showed that e-monitoring counseling increased gum use but not abstinence. Adherence to nicotine patch and to gum were each strongly related to abstinence, but it is unclear whether adherence increases abstinence, or relapse causes medication discontinuation.

Clinical Trial Registration NCT01120704.

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We would like to acknowledge the staff at Aurora Health Care, Deancare, and Epic Systems Corporation for their collaboration in this research. We are very grateful to the staff and students at the Center for Tobacco Research and Intervention in the University of Wisconsin School of Medicine and Public Health for their help with this research.


This research was supported by grants 15P50CA143188, 1P01CA180945, and 1K05CA139871 from the National Cancer Institute to the University of Wisconsin Center for Tobacco Research and Intervention and by the Wisconsin Partnership Program. Dr. Cook is also supported by Merit Review Award 101CX00056 from the US Department of Veterans Affairs.

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Correspondence to Tanya R. Schlam.

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The study was approved by the University of Wisconsin Health Sciences Institutional Review Board, and all participants gave written informed consent.

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The authors declare that they have no conflict of interest.

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Schlam, T.R., Cook, J.W., Baker, T.B. et al. Can we increase smokers’ adherence to nicotine replacement therapy and does this help them quit?. Psychopharmacology 235, 2065–2075 (2018).

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  • Smoking cessation
  • Tobacco dependence
  • Medication adherence
  • Electronic medication monitoring
  • Nicotine replacement therapy