Methods: Data are presented from Wave 1 (2002) and Wave 2 (2003) of the International Tobacco Control Policy Evaluation Survey, a telephone survey conducted with representative cohorts of over 8,000 adult smokers across four countries: Canada, United States, United Kingdom, and Australia, to estimate perceptions of NRT.

Results: At Wave 1, nearly all respondents had heard of NRT and approximately 40-45% from each country had ever used any medication; however, type of medication used and how they were obtained differed between countries. Australians were more likely to pay full price for NRT and obtain it over-the-counter compared to the other three countries. Less than 5% of smokers from all countries responded correctly to knowledge items regarding NRT, although percentages for individual items were similar across countries. Three-fourths of respondents found medications too expensive and half believe nicotine is the cause of most cancers and that NRT might harm their health. Longitudinal analyses show smokers hold many perceptions counter to NRT use, although more positive perceptions about efficacy are related to future use; however, this does not appear to translate to higher quit rates.

Conclusions: There were relatively little differences seen in beliefs, use, or quitting by country, suggesting lack of distinction between each country's cessation infrastructure. Additionally, the results show current efforts to educate people about nicotine and NRT need improvement.