title: Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy.
abstract: BACKGROUND
  Tobacco users receiving behavioural and pharmacological assistance are more likely to quit. Although telephone quitlines provide population access to counselling, few offer pharmacotherapy.
  
  
  OBJECTIVE
  To assess change in cessation rates and programme impact after the addition of free nicotine replacement therapy (NRT) to statewide quitline services.
  
  
  METHODS
  An observational study of cohorts of callers to the Minnesota QUITPLAN(SM) Helpline before (n = 380) and after (n = 373) the addition of access to free NRT.
  
  
  METHODS
  Mailing of NRT (patch or gum) to callers enrolling in multi-session counselling.
  
  
  METHODS
  Thirty-day abstinence six months after programme registration.
  
  
  RESULTS
  The number of callers increased from 155 (SD 75) to 679 (180) per month pre-NRT to post-NRT (difference 524, 95% confidence interval (CI) 323 to 725). Post-NRT, the proportion of callers enrolling in multi-session counselling (23.4% v 90.1%, difference 66.6%, 95% CI 60.8% to 71.6%) and using pharmacotherapy (46.8% v 86.8%, difference 40.0%, 95% CI 31.3% to 47.9%) increased. Thirty-day abstinence at six months increased from 10.0% pre-NRT to 18.2% post-NRT (difference 8.2%, 95% CI 3.1% to 13.4%). Post-NRT the average number of new ex-smokers per month among registrants increased from 15.5 to 123.6 (difference 108.1, 95% CI 61.1 to 155.0). The cost per quit pre-NRT was 1362 dollars (SD 207 dollars). The cost per quit post-NRT was 1934 dollars (215 dollars) suggesting a possible increase in cost per quit (difference 572 dollars, 95% CI -12 dollars to 1157 dollars).
  
  
  CONCLUSIONS
  The addition of free NRT to a state quitline is followed by increases in participation and abstinence rates resulting in an eightfold increase in programme impact. These findings support the addition of access to pharmacological therapy as part of state quitline services.
authors.affiliation: University of Minnesota, Department of Internal Medicine, Division of General Medicine, Minneapolis, Minnesota 55455, USA. lcan@umn.edu
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: An
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Schillo
authors.forename: Annette M
authors.initials: AM
authors.lastname: Kavanaugh
authors.forename: Randi B
authors.initials: RB
authors.lastname: Lachter
authors.forename: Michael G
authors.initials: MG
authors.lastname: Luxenberg
authors.forename: Ann H
authors.initials: AH
authors.lastname: Wendling
authors.forename: Anne M
authors.initials: AM
authors.lastname: Joseph
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D002638:Chewing Gum; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D003376:Counseling / Q000379:methods*; D005260:Female; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009538:Nicotine / Q000627:therapeutic use*; D018722:Nicotinic Agonists / Q000627:therapeutic use*; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D062789:Tobacco Products
chemical_list: D002638:Chewing Gum; D018722:Nicotinic Agonists; D009538:Nicotine