Inappropriate use of nicotine replacement therapy (NRT) related to age at first use & risk behavior attitudes in U.S. Air Force recruits

Purpose The public health impact of NRT (patches, gum, nasal spray, lozenges, and inhaler) balances the benefits of cessation and attempts to quit vs. unsuccessful cessation and the potential for inappropriate use. Methods As part of a tobacco use cessation/ prevention intervention, all new Air Force recruits who entered Basic Military Training (n = 36,013) were surveyed between October, 1999 to October, 2000; Items included smoking habits, NRT use, psychosocial factors, and demographics. Results About 5% of recruits indicated previously using NRT. Of these, 78% indicated appropriate use (i.e., status as former or current smoker and endorsed use “to try to quit smoking”) while 22% indicated inappropriate use (i.e., status as former or current smoker and endorsed NRT use “when I couldnʹt smoke” or were never or experimental smokers that claimed use “but am not a smoker”). Inappropriate NRT use was more likely in males, those with high school education or less, and those using NRT at a younger age. Inappropriate NRT use was more frequent at higher vs. lower levels of risk behavior attitudes such as rebelliousness, unhealthy behaviors, and dangerous legal and illegal behaviors. Independent associations were verified between inappropriate NRT use and younger age at first NRT use [OR = 1.25, 95% CI (1.18–1.32)], rebelliousness [OR = 0.54, 95% CI (0.41–071)], and enjoyment of risky health behaviors (e.g., overeating, inactivity, driving fast) [OR = 0.42, 95% CI (0.28–0.62)]. Conclusion Similar to smoking patterns, more frequent NRT misuse was related to higher risk-taking attitudes and younger age at first use. Implications for interpreting NRT benefits and promoting appropriate use of NRT will be discussed.