{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T01:01:48Z","timestamp":1774659708694,"version":"3.50.1"},"reference-count":17,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012632","name":"Nazarbayev University","doi-asserted-by":"publisher","award":["11022021CRP1514"],"award-info":[{"award-number":["11022021CRP1514"]}],"id":[{"id":"10.13039\/501100012632","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Tobacco use is a major cause of premature death and disease in Kazakhstan, with over 22,500 deaths per year. Although efforts have been made to control tobacco use, smoking-related deaths have continued to increase. One strategy to help smokers quit is to use nicotine replacement therapy (NRT), with combination NRT resulting in higher long-term quit rates than a single form of NRT. A study aims to determine the effectiveness of preloaded combination NRT on smoking cessation, the change in health-related quality of life due to smoking cessation, and explore treatment adherence perceptions.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and analysis<\/jats:title>\n<jats:p>The study will be conducted as a randomized, single-blind superiority trial, with 100 participants in each arm. The trial will be carried out at the National Research Cardiac Surgery Center, Astana, Kazakhstan, and will recruit current smokers aged 18 years and above with a motivation to quit. Participants will be randomly allocated to either the intervention group or the control group. The former will receive preloaded combination NRT, while the latter will receive fast-acting NRT alone. The primary outcome measure will be sustained abstinence from smoking after six months. Secondary outcome measures will include health-related quality of life and adherence to the treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>The study may gather further evidence that a combination NRT is more efficient than a fast-acting NRT alone. The findings of this study may help to improve tobacco cessation strategies in Kazakhstan and other countries with high smoking prevalence rates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Trial registration number<\/jats:title>\n<jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05484505\" xlink:type=\"simple\">NCT05484505<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0292490","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T18:57:12Z","timestamp":1701111432000},"page":"e0292490","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preloaded combination nicotine replacement therapy for smoking cessation in Kazakhstan: A randomized controlled trial study protocol"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8643-9767","authenticated-orcid":true,"given":"Chethan","family":"Purushothama","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4663-1874","authenticated-orcid":true,"given":"Byron Lawrence","family":"Crape","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Stolyarov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Altynshash","family":"Jaxybayeva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-1550","authenticated-orcid":true,"given":"Philip","family":"la Fleur","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeby Jose","family":"Olickal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"key":"pone.0292490.ref001","author":"World Health Organization","journal-title":"2019 GATS Fact Sheet Kazakhstan."},{"key":"pone.0292490.ref002","author":"World Health Organization","journal-title":"Tobacco"},{"key":"pone.0292490.ref003","doi-asserted-by":"crossref","first-page":"e0227042","DOI":"10.1371\/journal.pone.0227042","article-title":"Tobacco smoking and health-related quality of life among university students: Mediating effect of depression.","volume":"15","author":"M Milic","year":"2020","journal-title":"PLoS One"},{"key":"pone.0292490.ref004","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2991\/jegh.k.190212.002","article-title":"Intention to Quit among Smokers in Kazakhstan: Data from 2014 Global Adult Tobacco Survey.","volume":"9","author":"Q Wang","year":"2019","journal-title":"J Epidemiol Glob Health."},{"key":"pone.0292490.ref005","article-title":"Tobacco use: achieving the global target of 30% reduction by 2025.","author":"World Health Organization","journal-title":"In: World Health Organizacion [Internet]."},{"key":"pone.0292490.ref006","first-page":"425","article-title":"Nicotine Replacement Therapy: An Overview","volume":"10","author":"U Wadgave","year":"2016","journal-title":"Int J Health Sci (Qassim)."},{"key":"pone.0292490.ref007","first-page":"CD000146","article-title":"Nicotine replacement therapy versus control for smoking cessation.","volume":"5","author":"J Hartmann-Boyce","year":"2018","journal-title":"Cochrane Database Syst Rev."},{"key":"pone.0292490.ref008","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/B978-0-12-398338-1.00035-X","volume-title":"Interventions for Addiction.","author":"AI 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Lindson-Hawley","year":"2014","journal-title":"Trials"},{"key":"pone.0292490.ref012","volume-title":"Methods in Observational Epidemiology","author":"J Kelsey","year":"1996"},{"key":"pone.0292490.ref013","journal-title":"OpenEpi Menu"},{"key":"pone.0292490.ref014","article-title":"Toolkit for delivering the 5A\u2019s and 5R\u2019s brief tobacco interventions in primary care.","author":"World Health Organization","year":"2014","journal-title":"In: World Health Organization [Internet]."},{"key":"pone.0292490.ref015","doi-asserted-by":"crossref","first-page":"e28864","DOI":"10.1371\/journal.pone.0028864","article-title":"Assessing recent smoking status by measuring exhaled carbon monoxide levels.","volume":"6","author":"A Sandberg","year":"2011","journal-title":"PLoS One"},{"key":"pone.0292490.ref016","first-page":"2551","article-title":"Using salivary cotinine to validate self-reports of tobacco use by Indian youth living in low-income neighborhoods","volume":"12","author":"P Dhavan","year":"2011","journal-title":"Asian Pac J Cancer Prev"},{"key":"pone.0292490.ref017","first-page":"ZE04","article-title":"Diagnostic Methods for Detection of Cotinine Level in Tobacco Users: A Review.","volume":"10","author":"M Raja","year":"2016","journal-title":"J Clin Diagn Res."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292490","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T18:57:22Z","timestamp":1701111442000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0292490"}},"subtitle":[],"editor":[{"given":"Maria 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