A Mechanistic Test of Nicotine Replacement Therapy Sampling for Smoking Cessation Induction

Studies that explore the mechanisms of treatment effect are needed in the area of smoking cessation induction, the primary goal of which is to promote the occurrence of a quit attempt among individuals who report little interest in smoking cessation. This study tested the mediational effect of 5 psychological variables (motivation to quit, abstinence self-efficacy, knowledge of nicotine replacement therapy (NRT), and both positive and negative attitudes toward NRT) on the relationship between NRT sampling and smoking outcomes. Adults who reported low levels of intention to quit in the next month (n = 593) were recruited for a nationwide randomized clinical trial of NRT sampling. Participants provided self-report data via telephone interview on multiple occasions, with the final follow-up at 6 months. Motivation to quit, and to a lesser degree, abstinence self-efficacy at the end of the 6-week intervention best accounted for the effect of NRT sampling as a promoter of quit attempts, smoking reduction, and 7-day point prevalence abstinence. Providing smokers with free NRT samples, in addition to encouraging them to engage in temporary abstinence, results in meaningful change in motivation and self-efficacy, which in turn influence smoking outcomes. Cessation induction interventions should aim to increase motivation to quit and abstinence self-efficacy, above and beyond any efforts to increase knowledge or prompt attitudinal shifts.