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A recent paper by An et al found that offering free nicotine replacement therapy (NRT) through Minnesota’s state tobacco quitline (QL) was associated with large increases in calls and quit rates.1 Other state programmes might not be able to afford NRT for all QL callers, and instead could target specific at-risk populations. Washington State’s tobacco QL had a free NRT service enhancement targeted at young adults—a population whose smoking prevalence has recently increased in the United States.2 In this letter, we describe Washington’s QL service enhancement for young adults, and the associated changes in call volume and quit rates.
From January 2005 through January 2006, the Washington QL offered a five-call proactive counselling service that included free NRT for 8 weeks (that is, “Washington Benefit”) to all 18–29-year-olds willing to set a quit date within the next month or needing help staying quit. This enhancement was funded, in part, by the Centers for Disease Control and Prevention. Before this enhancement, 18–29-year-old callers eligible for the “Washington Benefit” through the state QL were mostly low income: they had to be (a) uninsured, enrolled in Medicaid, or Indian Health Service, or pregnant, and (b) willing to set a quit date within the next month or needing help staying quit. Others without a cessation benefit through their insurer or employer received a one-call intervention without free NRT. The state advertised the enhancement through various media channels.
When examining monthly QL call volume during 2004–6, we limited the dataset to smokers who were at least 18 years old and received a QL intervention. If there were multiple calls for a given smoker, we used only the call associated with their earliest registration date. In 2004 before the enhancement, the monthly number of adult smokers calling the QL remained stable (fig 1). Calls increased dramatically among 18–29-year-old smokers during the enhancement period, and then decreased to 2004 levels after the enhancement stopped. Although less money was spent on all QL promotions during the enhancement period ($1.1 million, including about $120 000 for promotions focused on the enhancement) than during 2004 ($1.4 million), calls also increased somewhat among smokers over 29 years old during the enhancement. The increase among older callers may have been caused by an increase in earned media resulting from the promotion of the enhancement, and also from the older callers hoping to obtain free NRT.
Quit rates among young adult callers also increased during the enhancement. Using data from a 3-month follow-up telephone survey (51% response rate), we compared 18–29-year-olds who called the QL between July 2004 and December 2004 (that is, before the enhancement, n = 114) with those who called between January 2005 and May 2005 (that is, during the enhancement, n = 218). The 7-day quit rate at three months increased from 21% before the enhancement to 38% during the enhancement (p = 0.014).
The enhancement attracted young adults with different characteristics. Specifically, our survey data suggested more young adults with annual household income of at least $20 000 called the QL after the enhancement began, probably because the eligibility criteria for free NRT expanded to include young adults with private insurance. Quit rates increased in each income group, but increased more dramatically among this higher income group (28% vs 48%) than among others (20% vs 29%). We did not find changes in quit rates or demographics among older survey participants, so the changes among young adults were probably not the result of some underlying temporal trend.
Our findings suggest that states wanting to increase QL call volume and quit rates among young adults should consider offering them free NRT.