# Decision-Making on Nicotine Replacement Therapy Use and Product Selection: An Explorative Qualitative Study Among Chinese Americans Who Smoke

## TL;DR

This study explores why Chinese American smokers avoid nicotine replacement therapy and how they choose products, revealing cultural and practical barriers.

## Contribution

The study identifies culturally specific and general barriers to nicotine replacement therapy use among an understudied population.

## Key findings

- Many Chinese American smokers are skeptical of pharmacotherapy and prefer unassisted quitting.
- Product choice is influenced by taste, side effects, and ease of integration into daily routines.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Chinese Americans who smoke have low use of nicotine replacement therapy (NRT).This study identified barriers to NRT use and decision-making around NRT product choice among Chinese Americans who smoke and received NRT.

Chinese Americans who smoke have low use of nicotine replacement therapy (NRT).

This study identified barriers to NRT use and decision-making around NRT product choice among Chinese Americans who smoke and received NRT.

Public health significance—Why is this work of significance to public health?
The study focuses on an understudied population with low uptake of NRT.Findings highlight both culturally specific barriers (e.g., skepticism toward pharmacotherapy) and general barriers (e.g., lack of readiness to quit) to NRT use.

The study focuses on an understudied population with low uptake of NRT.

Findings highlight both culturally specific barriers (e.g., skepticism toward pharmacotherapy) and general barriers (e.g., lack of readiness to quit) to NRT use.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Targeted efforts are needed to strengthen NRT education among Chinese Americans who smoke.Cessation programs targeting this population should address cultural beliefs about medication, reframe perceptions about willpower, engage those not ready to quit, and provide diverse NRT options with guidance on side effect management and integration into daily routines.

Targeted efforts are needed to strengthen NRT education among Chinese Americans who smoke.

Cessation programs targeting this population should address cultural beliefs about medication, reframe perceptions about willpower, engage those not ready to quit, and provide diverse NRT options with guidance on side effect management and integration into daily routines.

Chinese Americans who smoke have low use of nicotine replacement therapy (NRT). This study explored perceptions of NRT and decision-making around product choice among Chinese American smokers who received NRT. From September 2023 to January 2024, we conducted in-depth phone interviews with 20 participants recruited in New York City from a WeChat-based cessation pilot trial and a community-based cessation program, both providing free nicotine patches, gum, or lozenges. Participants (aged 26–72; 85% male; 60% current smoking) included 12 consistent NRT users (≥2 weeks), four trial users (<2 weeks), and four non-users. Five participants (25%) had never heard of NRT before program enrollment, and 14 (70%) had never used it previously. Consistent users generally viewed NRT as helpful in reducing cravings. Others reported barriers, including culturally rooted skepticism toward pharmacotherapy, preference for unassisted quitting, lack of readiness to quit, prior negative experiences, and unpleasant taste or side effects. Product choice was influenced by lay knowledge, ease of integrating NRT into daily routines, perceived effectiveness, and taste and side effects. Cessation programs addressing cultural beliefs, reframing willpower, engaging individuals not ready, and providing diverse NRT options with guidance on side effect management and routine integration may increase NRT use among this population.