Abstract
Nicotine Replacement Therapy (NRT) is the most frequently used pharmacological intervention for smoking cessation. Research on the effect of NRT showed serious nonadherence among users. We investigated adherence to NRT in cardiovascular patients. A number of 174 outpatients (N = 174), who smoked > 5 cigarettes a day, received free patches and intensive instructions from nurses. Questionnaires were sent to patients assessing patient characteristics, adherence to a 7–8 weeks time frame and appliance instructions, side effects/withdrawal symptoms, and reasons for non-adherence. Only 38% of the patients was adherent to the time frame. Appliance instructions were followed in 76–96% of the cases, except for smoking; 50% continued to smoke during NRT. In conclusion, despite considerable attention to appliance instructions, access to free patches and additional behavioral support, adherence to NRT in these patients is rather low.
References
Abelin, T., Buehler, A., Müller, P., Vesanen, K., & Imhof, P. R. (1989). Controlled trial of transdermal nicotine patch in tobacco withdrawal. The Lancet, 1, 7–10.
The Agency for Health Care Policy and Research Smoking Cessation Clinical Practice Guideline. (1996). JAMA, 275(16), 1270–1280.
Alterman, A. I., Gariti, P., Cook, T. G., & Cnaan, A. (1999). Nicodermal patch adherence and its correlates. Drug & Alcohol Dependence, 53, 159–165.
Bolliger, C. T., Zellweger, J. P., Danielsson, T., van Biljon, X., Robidou, A., Westin, A., et al. (2000). Smoking reduction with oral nicotine inhalers: Double blind, randomised clinical trial of efficacy and safety. British Medical Journal, 321, 329–333.
Bolman, C., De Vries, H., & Van Breukelen, G. A. (2002). Minimal-contact intervention for cardiac inpatients: Long-term effectson smoking cessation. Preventive Medicine, 35, 181–192.
Burling, T., Singleton, E., Bigelow, G., Baile, W. F., Gottlieb, S. H. (1984). Smoking following myocardial infarction: A critical review of the literature. Health Psychology, 3, 83–86.
Cheng, J. W. M., & Feifer, S. F. (2001). Patient-reported adherence to guidelines of the sixth joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Pharmacotherapy, 21, 828–841.
Chesney, M. A., Ickovics, J. R., Cahnbers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care, 12(3), 255–266.
Cohen, J. (1988). Statistical power analyses for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Crouse, J. R., & Hagaman, A. P. (1991). Smoking cessation in relation to cardiac procedures. American Journal of Epidemiology, 134, 699–703.
Cummings, K. M., Biernbaum, R. P., Zevon, M. A., Delourghry, T., & Jaen, C. R. (1994). Use and effectiveness of transdermal nicotine in primary care settings. Archives of Family Medicines, 3, 682–689.
DiClemente, C. C., Prochaska, J. O., Fairhurst, S. K., Velicer, W. F., Velasquez, M. M., & Rossi, J. S. (1991). The process of smoking cessation: An analysis of pre-contemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology, 59, 295–304.
Dijkstra, A., De Vries, H., Roijackers, J., & Van Breukelen, G. (1998). Tailored interventions to communicate stage-matched information to smokers in different motivational stages. Journal of Consulting and Clinical Psychology, 3, 549–557.
Fagerströ;m, K. O., Heatherton, T. F., & Kozlowski, L. T. (1990). Nicotine addiction and its assessment. Ear, Nose, & Throat Journal, 69(11), 763–765.
Fagerström, K. O., Tejding, R., Westin, A., & Lunell, E. (1997). Aiding reduction of smoking with nicotine replacement medications: Hope for the recalcitrant smoker? Tobacco Control, 6, 311–316.
Fiore, M. C., Jorenby, D. E., Baker, T. B., & Kenford, S. L. (1992). Tobacco dependence and the nicotine patch. Clinical guidelines for effective use. JAMA, 268(19), 2687–2694.
Fiore, M. C., Smith, S. S., Jorenby, D. E., & Baker, T. B. (1994). The effectiveness of the nicotine patch for smoking cessation. JAMA, 271(4), 1940–1944.
Fornai, E., Desideri, M., Pistelli, F., Carrozzi, L., Puntoni, R., Avino, S., et al. (2001). Smoking reduction in smokers compliant to a smoking cessation trial with nicotine patch. Monaldi Archive of Chest Disease, 56(1), 5–10.
Frid, D., Ockene, I., Ockene, J., Merriam, P., Goldberg, R., Kristeller, J., et al. (1991). Severity of angiographically proven coronary artery disease predicts smoking cessation. American Journal of Preventive Medicine, 7, 131–135.
Gourlay, S. G., Forbes, A., Marriner, T., Pethica, D., & McNeil, J. J. (1995). Double blind trial of repeated treatment with transdermal nicotine for relapsed smokers. British Medical Journal, 311, 363–366.
Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerström, K. O. (1991). The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. British Journal of Addiction, 86(9), 1119–1127.
Hobbs, S. D., & Bradbury, A. W. (2003). Smoking cessation strategies in patients with peripheral arterial disease: An evidence-based approach. European Journal of Vascular & Endovascular Surgery, 26(4), 341–347.
Hughes, J. R., Cummings, M., & Hyland, A. (1999) Ability of smokers to reduce their smoking and its association with future smoking cessation. Addiction, 94, 109–114.
Joseph, A. M., Norman, S. M., Ferry, L. H., Prochazka, A. V., Westman, E. C, Steele, B. G., et al. (1996). The safety of transdermal nicotine as an aid to smoking cessation in patients with cardiac disease. New England Journal of Medicine, 335, 1792–1798.
Kannel, W. B. (1994). Risk factors for atherosclerotic cardiovascular outcomes in different arterial territories. Journal of Cardiovascular Risk, 1, 333–339.
Kenford, S. L., Fiore, M. C, Jorenby, D. E., Smith, S. S., Wetter, D., & Baker, T. B. (1994). Predicting smoking cessation. Who will quit with and without the nicotine patch. JAMA, 271(8) 589–594.
Mahrer-Imhof, R., Froelicher, E. S., Li, W. W., Parker, K. M., & Benowitz, N. (2002). Women’s initiative for non-smoking (WINS V): Under-use of nicotine replacement therapy. Heart & Lung, 31(5), 368–373.
May, S., West, R., Hajek, P., Nilsson, F, Foulds, J., & Meadow, A. (2003). The use of videos to inform smokers about different nicotine replacement products. Patient Education and Counseling, 51, 143–147.
Mudde, A. N., Willemsen, M. C, Kremers, S., & de Vries, H. (2000). Meetinstrumenten voor onderzoek naar roken en stoppen met roken [Measurements for research on smoking and quitting]. The Hague, Netherlands: STIVORO.
Murray, M., Swan, A. V., Kiryluk, S., & Clarke, G. C. (1988). The Hawthorne effect in the measurement of adolescent smoking. Journal of Epidemiology and Community Health, 42(3), 304–306.
Nieuwkerk, P. T, Sprangers, M. A., Burger, D. M., Hoetelmans, R. M., Hugen, P. W., Danner, S. A., et al. (2001). Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Archives of Internal Medicine, 161(16), 1962–1968.
Piasecki, T. M., Fiore, M. C., & Baker, T. B. (1997). Profiles in discouragement: Two studies of variability in the time course of smoking withdrawal symptoms. Journal of Abnormal Psychology, 107(2), 238–251.
Pieterse, M. E., Seydel, E. R., De Vries, H., Mudde, A. N., & Kok, G. J. (2001). Effectiveness of a minimal contact smoking cessation program for Dutch general practitioners: A randomised controlled trial. Preventive Medicine, 32(2), 182–190.
Sastre Toraňo, J., & van Kan, H. J. M. (2003). Simultaneous determination of the tobacco smoke uptake parameters nicotine, cotinine and thiocyanate in urine, saliva and hair, using gas chromatography-mass spectrometry for characterization of smoking status of recently exposed subjects. Analyst, 128, 838–843.
Silagy, C., Lancaster, T., Stead, L., Mand, D., & Fowler, G. (2002). Nicotine replacement therapy for smoking cessation. In: The Cochrane Library. Oxford: Update Software, 2002: issue 4.
Stapleton, J. A., Russell, M. A., Feyerabend, C., Wiseman, S. M., Gustavsson, G., Sawe, U., et al. (1995). Dose effects and predictors of outcome in a randomized trial of transdermal nicotine patches in general practice. Addiction, 90, 31–42.
Svarstad, B. L., Chewning, B. A., Sleath, B. L., & Claesson, C. (1999). The brief medication questionnaire: A tool for screening patient adherence and barriers to adherence. Patient Education and Counseling, 37(2), 113–124.
Tønnessen, P., Nørregaard, J., Simonsen, K., & Sawe, U. (1991). A double-blind trial of a 16-hour transdermal nicotine patch in smoking cessation. The New England Journal of Medicine, 325(5), 311–315.
Tzivoni, D., Keren, A., Meyler, S., Khoury, Z., Lerer, T., & Brunel, P. (1998). Cardiovascular safety of transdermal nicotine patches in patients with coronary artery disease who try to quit smoking. Cardiovascular Drugs and Therapy, 12, 239–244.
U.S. Department of Health and Human Services. (1983). The health consequences of smoking: Cardiovascular disease. A report of the Surgeon General. Rockville, MD: Author.
Velicer, W. F., Prochaska, J. O., Fava, J. L., Rossi, J. S., Redding, C. A., Laforge, R. G., et al. (2000). Using the transtheoretical model for population-based approaches to health promotion and disease prevention. Homeostasis, 40, 174–195.
Ward, M. M., Swan, G. E., & Jack, L. M. (2001). Self-reported abstinence effects in the first month after smoking cessation. Addictive Behaviors, 26(3), 311–327.
Wiggers, L. C. W., Smets, E. M. A., de Haes, J. C. J. M., Peters, R. J. G., & Legemate, D. A. (2003). Smoking cessation interventions in cardiovascular patients. European Journal of Vascular & Endovascular Surgery, 26(5), 467–475.
World Health Organization. (2003). Disease-specific reviews: Tobacco smoking cessation. In World Health Report Organization (Ed.), Adherence to long-term therapies: evidence for action (pp. 115–120). Geneva: Author.
Zevin, S., Peyton, J., & Benowitz, N. (1998). Dose-related cardiovascular and endocrine effects of transdermal nicotine. Clinical Pharmacology & Therapeutics, 64(1), 87–95.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wiggers, L.C.W., Smets, E.M.A., Oort, F.J. et al. Adherence to nicotine replacement patch therapy in cardiovascular patients. Int. J. Behav. Med. 13, 79–88 (2006). https://doi.org/10.1207/s15327558ijbm1301_10
Issue Date:
DOI: https://doi.org/10.1207/s15327558ijbm1301_10