# The effectiveness of nicotine replacement therapy on oral smokeless tobacco cessation and reduction rate: A systematic review

## TL;DR

This review examines how well nicotine replacement therapy helps people quit or reduce oral smokeless tobacco use, finding it can be effective but with some limitations.

## Contribution

The study addresses gaps in prior research by analyzing recent data from diverse populations on NRT's effectiveness for oral smokeless tobacco.

## Key findings

- Seven studies showed NRT improved oral smokeless tobacco abstinence with effect sizes from d=0.10 to d=0.54.
- One study found NRT reduced tobacco use frequency (d=0.16 for dips/day and d=0.17 for cans/week).
- Factors like nicotine dependence, NRT dosage, self-efficacy, and social support influence effectiveness.

## Abstract

Oral smokeless tobacco (OST) is a major preventable risk factor for oral
cancer. Nicotine replacement therapy (NRT), a commonly used pharmacological
treatment in tobacco cessation interventions that help in reducing the
withdrawal symptoms that individuals might experience in their attempt to
quit. This systematic review aimed to assess NRT's effectiveness on
OST cessation and reduction rates, addressing gaps in prior studies by
incorporating recent research across diverse populations, including
developing and developed countries.

A systematic search was conducted across PubMed, Cochrane, Embase, and Web of
Science. The inclusion criteria were: English articles (2004 to June 2024),
OST users of both genders, NRT intervention, control group (generic,
placebo, or no intervention), and a 7-day point prevalence of OST abstinence
and reduction at week 12. Studies were excluded if they lacked relevant
outcomes, were non-English, or published before 2004. Data abstraction forms
were used to extract study characteristics and results. The Practical
Meta-Analysis Effect Size Calculator determined the effect sizes and
directions. The risk of bias was assessed using Cochrane
Collaboration’s tool.

Eleven studies were included with 40–1067 sample size. Seven were
effective on OST abstinence, with effect sizes ranging from d=0.10 to d=0.54
and odds ratios from OR=1.67 to OR=4.10. One study demonstrated OST
reduction (d=0.16 for dips/day and d=0.17 for cans/week). Nicotine
dependence, NRT dosage, self-efficacy and social support were identified as
key factors influencing the NRT’s effectiveness in the included
studies.

NRT can aid in OST cessation. Combination of NRT with other interventions
such as coach calls and web-based interactive setting can enhance the OST
abstinence rate. The evidence, though promising, is limited by study
variability, and inconsistent outcome reporting. Future studies should
explore self-efficacy, social support, and NRT dosage with larger sample
sizes for better assessment.