Nicotine replacement therapy (NRT) may work fine in clinical trial settings, but not so much in the real world. That’s according to research published Monday afternoon in the journal Tobacco Control.

The study, conducted by researchers at the Harvard School of Public Health and the University of Massachusetts, Boston, tracked 787 adult smokers in Massachusetts who had recently quit smoking. Participants were interviewed three times, at two-year intervals; they were asked whether they still were abstaining from smoking, whether they used an NRT (either a prescription drug or an over-the-counter product such as nicotine-replacement gum, inhaler or patch), and whether they’d undergone professional counseling in support of their cessation efforts.

The key findings: At each followup, nearly a third of those those who had initially reported they’d recently tried to quit reported that they had relapsed. The relapse rate was no different for those who hadn’t used NRT and those who had used NRT for more than six weeks, with or without counseling support. And there was no difference between heavy and light smokers’ success at quitting via NRT.

Those population-based findings differ from recent reviews of existing randomized controlled clinical trials such as those published by Cochrane in 2008 and in the BMJ in 2009, both of which found nicotine replacement therapy to be an effective smoking cessation aid.

The authors note that a lot of federal health-care money is being used to provide NRT, despite the fact that even as such products have become more widely available since they went over-the-counter in 1996, earlier gains in reducing the number of people who smoke have stalled over the past five years. The authors suggest those earlier gains in population-wide smoking cessation likely resulted from media campaigns, promotion of no-smoking policies, and initiatives to make tobacco more expensive. Reverting to prevention and education efforts such as those might be more effective and cost-efficient than promoting NRT use by individuals, the study suggests.

Have you used nicotine replacement therapy to help you stop smoking? How’d that work out for you?