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Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study
  1. Laurie Zawertailo1,2,
  2. Rosa Dragonetti1,
  3. Susan J Bondy3,4,
  4. J Charles Victor4,5,
  5. Peter Selby1,3,4,6,7
  1. 1Addictions Program, Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  2. 2Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
  3. 3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  4. 4Ontario Tobacco Research Unit, Toronto, Ontario, Canada
  5. 5Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
  6. 6Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  7. 7Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Peter Selby, Director, Addictions Program, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; peter_selby{at}


Background There are important inequities in smoker access to clinic-based smoking cessation services. Low barrier high-reach interventions are proposed as solutions to these inequities. Although effective, telephone quitlines, which provide multi-session counselling but no medication, have low utilization with high attrition. The objective of this study was to determine the effectiveness of free nicotine replacement therapy (NRT), brief advice and self-help materials on quit attempts and 6-month quit rates in motivated smokers.

Methods In this open-label naturalistic study, 14 000 treatments of 5 weeks in duration of either nicotine patch (n=10 000) or nicotine gum (n=4000) were made available to all eligible adult smokers in Ontario, Canada, who called a toll-free number to register with the STOP (Smoking Treatment for Ontario Patients) Study and receive a single brief intervention. The primary outcome measure was self-reported abstinence rates at 6 months post-treatment among STOP participants. These data were compared with quit rates that were reported in a concurrent no-intervention cohort of Ontario smokers matched for eligibility.

Results 16 405 callers were assessed and 13143 eligible participants were mailed a treatment package with 5 weeks of NRT (choice of patch or gum), self-help and community resource materials. Among the 6261 participants who consented to follow-up, 2601 (42%) had complete follow-up data. Of those with complete follow-up data, the percentage reporting abstinence after 6 months in the treatment cohort was 21.4%, relative to 11.6% in the no-intervention cohort (rate ratio of 1.84; 95% CI 1.79 to 1.89), with the 30-day point prevalence of 17.8% and 9.8% for the intervention and no-intervention cohorts, respectively (rate ratio 1.81; CI 1.75 to 1.87).

Conclusions Provision of free NRT by mail following a brief telephone intervention is an effective strategy to reach and assist a large number of smokers making a quit attempt.

  • Nicotine replacement therapy
  • smoking cessation
  • cessation
  • addiction
  • co-substance use
  • priority/special populations
  • primary healthcare
  • prevalence
  • environmental tobacco smoke
  • cessation
  • health services
  • smoking caused disease
  • concurrent mental health and addiction
  • harm reduction

Statistics from


  • Funding This study was supported by the Ontario Ministry of Health Promotion through the evaluation of the proposal for the study design and provision of funding support and resources for the study. Nicotine replacement therapy was purchased at a discounted rate from Pfizer Consumer Healthcare Canada (now McNeil Consumer Healthcare, Division of Johnson & Johnson Inc.).

  • Competing interests None.

  • Ethics approval Centre for Addiction and Mental Health Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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