Examining retail purchases of cigarettes and nicotine replacement therapy in Finland
David S. Timberlake 1, 2  
Terhi Kurko 3
Arja H. Rimpelä 1, 4, 5
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Faculty of Social Sciences, Tampere University, Tampere, Finland
Program in Public Health, University of California, Irvine, United States
The Social Insurance Institute of Finland, Helsinki, Finland
PERLA - Tampere Centre for Childhood, Youth and Family Research, Tampere University, Tampere, Finland
Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
David S. Timberlake   

Program in Public Health, University of California, Anteater Instruction & Research Offices, Irvine, CA, United States
Publish date: 2019-05-03
Tob. Induc. Dis. 2019;17(May):39
Finland’s success in achieving the goal of its tobacco endgame largely depends on rectifying deficiencies in the delivery of smoking cessation services. One such weakness, which has not been documented with empirical data, is misuse of nicotine replacement therapy (NRT). This study’s objective was to examine purchase patterns of NRT for estimating improper use of the medication. The study was based on the assumption that duration of a purchase episode is indicative of either proper use or misuse of NRT.

The participants (n=728), who purchased at least one NRT product in 2016 (mostly gum/lozenge), were selected through enrollment in a large customer loyalty program in Finland (LoCard). Participants were categorized into one of five groups according to their longest purchase episode of NRT, defined by purchases made in consecutive, 4-week intervals.

Most participants, who did not adhere to NRT guidelines, either purchased the medication for too short (≤4 weeks, 63.5%) or too long (>24 weeks, 13.2%) of a purchase episode. Median purchases of NRT in the first month of use were one and four in the former and latter, respectively. In contrast to other groups, persistent users (>24 weeks) did not curtail purchases of NRT across several 4-week intervals, suggesting potential for dependence on NRT.

The observation that most purchase episodes were terminated prematurely is consistent with surveys reporting widespread NRT misuse. Given uncertainty of greater regulation of NRT sales through legislation, it would be prudent for Finnish retailers to promote proper use of the therapy.

The authors thank the S Group for the use of retail purchases from members of the customer loyalty program. The primary author thanks the Fulbright Finland Foundation for providing salary and other resources which made this project possible. We thank three anonymous reviewers for their helpful suggestions.
The authors declare that they have no competing interests, financial or otherwise, related to the current work. T. Kurko is a member of the working group appointed by the Finnish Medical Society Duodecim and the Finnish Association for General Practice of the Tobacco and Nicotine Dependency, Prevention and Treatment Current Care Guideline. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
The study was supported by the Finland Fulbright Foundation.
D.S.T., J.J. and J.N. formulated the hypothesis and analytical methodology. D.S.T. and J.J. coded the data and conducted the statistical analyses. T.K. and A.H.R. provided policy insight, guidance on clinical recommendations and patterns of N.R.T. use typically observed in practice. D.S.T. wrote most of the manuscript and J.J., T.K., A.H.R. and J.N. provided critical review and editing.
Not commissioned; externally peer reviewed.
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