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Abstract
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
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Footnotes
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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.).
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Correction notice This article has been corrected since it was published Online First. The Competing interests statement has been updated.
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Competing interests The contributing authors have the following disclosures: L.Z. has received speaker honoraria from Pfizer Canada Inc. and has received research funding from the Canadian Institutes of Health Research, the Canadian Tobacco Control Research Initiative, The Ontario Lung Association and Cancer Care Ontario. P.S. has received: speaker's honoraria from Schering Canada, Johnson & Johnson Consumer Health Care Canada, Pfizer Canada Inc., Pfizer Inc., Sanofi-Synthelabo Canada, GlaxoSmithKline Canada Inc., Genpharm Canada, Prempharm Canada, NABI Pharmaceuticals; and consulting fees from Schering Canada, Johnson & Johnson Consumer Health Care Canada Pfizer Canada Inc., Pfizer Inc., Sanofi-Synthelabo Canada, GlaxoSmithKline Canada Inc., Genpharm Canada, Prempharm Canada, NABI Pharmaceuticals, V-CC Systems Inc., eHealth Behaviour Change Software Company, and AstraZeneca Canada Inc. R.D. has received speaker honoraria from Pfizer Inc. S.B. and J.C.V. have no conflicts of interest to declare.
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Ethics approval Centre for Addiction and Mental Health Research Ethics Board.
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Provenance and peer review Not commissioned; externally peer reviewed.