DOSE EFFECTS OF NICOTINE GUM

Nicotine gum has been shown to be effective in improving abstinence ra tes, and in reducing post-cessation withdrawal distress and weight gai n. However, the dose effects of nicotine gum on these outcomes is not known. In the present study, we varied the amount of 2 mg nicotine gum prescribed to motivated quitters to explore the hypotheses (a) that m otivated quitters would use more pieces of gum when coached and counse led to do so and (b) that there would be a dose-related effect of gum use on abstinence, withdrawal symptoms, and weight gain. One hundred s eventy-seven volunteers were assigned to chew either 0, 7, 15, or 30, pieces per day of 2 mg nicotine gum. Biological verification of gum us e and smoking abstinence were assessed in community volunteers who att ended an intensive behavioral counseling program for smoking cessation while using nicotine gum for 3 months. In the survival analysis at 12 weeks, gum-group assignment was not related to successful abstinence. In the subset of 42 abstinent subjects, there was a strong positive r elationship between pieces per day of nicotine gum used and saliva cot inine. However, there was substantial variability in groups of subject s reporting similar amounts of gum use. Withdrawal symptom reporting w as not related to either gum use or cotinine levels. Weight gain was s ignificantly related in a dose-dependent manner to salivary cotinine l evels, but not to gum group assignment, with high and low cotinine sub jects gaining on average, 4.0 and 6.6 pounds, respectively. Discussion of the use of high levels of nicotine gum is addressed. Consistent wi th earlier work, the study provided further support for the relationsh ip between nicotine replacement level and postcessation weight gain.