Understanding Hesitation to Use Nicotine Replacement Therapy: A Content Analysis of Posts in Online Tobacco-Cessation Support Groups

PURPOSE: We aimed to better understand hesitancy to use nicotine replacement therapy (NRT) to quit smoking. DESIGN: We content coded and analyzed NRT-related posts in online quit smoking support groups to understand NRT-use hesitancy and to examine associations with health outcomes. SETTING: NRT posts were analyzed in unmoderated social-media support groups with free NRT. SAMPLE: Adults who smoked daily (n = 438) and posted about NRT were studied, 339 of whom reported on NRT usage and 403 reported on smoking abstinence. MEASURES: Surveys at 1-month post-quit date assessed NRT usage and smoking abstinence. ANALYSIS: Relationships among NRT posts, NRT usage and smoking abstinence were analyzed using GEE models accounting for support group and covariates. RESULTS: Nearly all (96.17%) participants reported using the study-provided NRT once, most (70.21%) used NRT during the past week, but less than half (45.72%) used NRT daily for the full month as recommended. Nearly two-thirds (65.34%) of NRT posts were negative. Posts reflecting dislike or no longer needing NRT were associated with a lower likelihood of using NRT in the past week at least once (B = −.66, P = .005 and B = −.37, P = .045), use occasions (B = −1.86, P = .018 and B = −1.10, P = .016) and used daily for full month (B = −.56, P = .044 and B = −.53, P = .009). Posts related to the effectiveness of NRT related to past-week NRT used at least once (B = .15, P = .023), used daily for full month (B = .25, P = .001), and smoking abstinence (B = .27, P = .002). CONCLUSION: Strategies are needed to address dislike of NRT and strengthen perceptions of NRT efficacy, especially on social media where posts may be amplified.