Elsevier

The Lancet

Volume 365, Issue 9474, 28 May–3 June 2005, Pages 1849-1854
The Lancet

Articles
Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation

https://doi.org/10.1016/S0140-6736(05)66615-9Get rights and content

Summary

Background

After an increase in cigarette taxes and implementation of smoke-free workplace legislation, the New York City Department of Health and Mental Hygiene, the New York State Department of Health, and the Roswell Park Cancer Institute undertook large-scale distribution of free nicotine replacement therapy (NRT). We did a 6 month follow-up survey to assess the success of this programme in improving smoking cessation on a population basis.

Methods

34 090 eligible smokers who phoned a toll-free quitline were sent a 6-week course of nicotine patches (2 weeks each of 21 mg, 14 mg, and 7 mg per day). Brief follow-up counselling calls were attempted. At 6 months after treatment, we assessed smoking status of 1305 randomly sampled NRT recipients and a non-randomly selected comparison group of eligible smokers who, because of mailing errors, did not receive the treatment. NRT recipients were compared with local survey-derived data for heavy smokers in New York City.

Findings

An estimated 5% of all adults in New York City who smoked ten cigarettes or more daily received NRT; most (64%) recipients were non-white, foreign-born, or resided in a low-income neighbourhood. Of individuals contacted at 6 months, more NRT recipients than comparison group members successfully quit smoking (33% vs 6%, p<0·0001), and this difference remained significant after adjustment for demographic factors and amount smoked (odds ratio 8·8, 95% CI 4·4–17·8). Highest quit rates were associated with those who were foreign born (87 [39%]), older than 65 years (40 [47%]), and smoked less than 20 cigarettes per day (116 [35%]). Those who received a counselling call were more likely to stop smoking than those who did not (246 [38%] vs 189 [27%], p=0·001). With the conservative assumption that every 6-month follow-up survey non-respondent continued to smoke, the stop rate among NRT recipients was 20%. At least 6038 successful quits were attributable to NRT receipt, and cost was US$464 per quit.

Interpretation

Easy access to cessation medication for diverse populations could help many more smokers to stop.

Introduction

The use of tobacco kills about 5 million people worldwide every year.1 If present patterns continue, it will cause 10 million deaths yearly by 2025.1 Although prevention of smoking initiation is important, increased cessation will provide rapid health benefits. The benefits of giving up smoking are well documented,2 and more than 70% of smokers in the USA are interested in stopping, with roughly half trying to quit each year.3 Of these, most attempt to stop smoking without counselling or medication.4 As a result, only 7% successfully stop smoking for a year or more.5 Universal access to effective treatment of tobacco dependence could prevent millions of premature deaths.6, 7

Smokers who use nicotine replacement therapy (NRT) are 1·5 to 2 times more likely to quit than those who do not use such treatment.5, 8 Improved management of tobacco dependence in clinical settings5, 7 is a strategy used to improve use of NRT and other effective treatments. Insurance coverage of NRT can increase both use of this treatment and stopping rates among smokers.9 However, since many smokers will not be reached by cessation treatment offered in clinical settings, provision of free NRT outside the health-care system is a complementary and potentially effective strategy.10, 11, 12, 13

In 2003, the New York City Department of Health and Mental Hygiene (NYC DOHMH), in collaboration with the New York State Department of Health and the Roswell Park Cancer Institute, undertook a large-scale distribution programme of free NRT. The programme was done in the context of rises in city and state cigarette taxes, implementation of smoke-free workplace regulations that covered virtually all establishments (including restaurants and bars), public anti-smoking messages focused on the health risks of second-hand smoke, and promotion of tobacco cessation in clinical practice through education of physicians citywide. Our aim was to help people to stop smoking and to assess the effectiveness of the programme.

Section snippets

Intervention

On April 2, 2003, the NYC DOHMH announced the availability of free 6 week courses of NRT patches to the first 35 000 eligible smokers to call the New York State Smokers' Quitline. All major metropolitan newspapers and television and radio stations reported the programme launch. Neighbourhood-specific media and promotional efforts were used to reach populations with the highest prevalence of heavy smokers. Call volume overwhelmed available response lines in the first days of the programme. From

Results

Of the people in the random sample, about 60% of NRT recipients participated in the 6-month follow-up survey (figure); of these, 966 (74%) were interviewed 24–33 weeks (median 29 weeks) after their intake call, and 339 (26%) returned completed questionnaires 28–39 weeks (median 33 weeks) after their intake call. Of non-respondents, 793 (94%) could not be reached, 34 (4%) were ineligible to participate in the programme or submitted incomplete surveys, and 18 (2%) refused to participate. Of the

Discussion

Our findings show the feasibility and effectiveness of a large-scale programme that used existing telephone helplines to screen smokers for NRT eligibility and to post a full course of free NRT patches directly to those who were eligible, reaching an estimated 5% of all heavy smokers in New York City in a 6-week period. On the conservative assumption that all the non-respondents to our follow-up survey sample continued to smoke, one in five NRT recipients, more than 6000 New Yorkers (about 1%

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