# Beliefs regarding nicotine replacement therapy among rural residing people who smoke: a step towards promoting uptake

## TL;DR

This study explores rural smokers' beliefs about nicotine replacement therapy to help design better strategies for increasing its use in these areas.

## Contribution

The study identifies specific beliefs and barriers to nicotine replacement therapy use among rural smokers in the U.S.

## Key findings

- High cost is the most cited barrier to NRT use among rural smokers.
- Free or lower-cost NRT is the top facilitator for its use.
- Misconceptions about NRT addiction and effectiveness are common concerns.

## Abstract

Rural areas in the United States (U.S.) have a higher smoking prevalence than urban areas. This disparity is influenced by lower odds of quitting smoking in rural versus urban areas, and lower use of evidence-based treatments, including nicotine replacement therapy (NRT). To inform strategies for promoting NRT, this qualitative study elicited and ranked NRT beliefs among rural people who smoke cigarettes.

In 2023, we conducted an online, semi-qualitative, elicitation survey with US rural residing adults (ages 21+) who smoke (n = 52), using open-ended questions to probe about: perceived advantages/disadvantages of using NRT to quit smoking and facilitators/barriers towards using NRT. Responses were coded based on belief themes and the frequencies of these themes were tabulated.

Leading perceived advantages of NRT for a quit attempt included help with cravings (42 %), making quitting easier (23 %) and easing withdrawal (17 %), while perceived disadvantages were concerns about becoming addicted to another product (29 %), high cost (23 %), side effects (19 %), and being ineffective (13–17 %). Leading perceived barriers to NRT use referred to high cost (52 %), negative taste (19 %), not enough nicotine (13 %), and lack of access (11 %), while leading perceived facilitators to use were free or lower cost (54 %) and better access/availability (13 %) and flavors/taste (13 %).

Boosting NRT use among rural communities could be achieved by (1) adopting approaches to enhance the affordability and accessibility of NRT, (2) rectifying NRT misperceptions, and (3) offering guidance on the proper use of NRT and managing side effects.