title: Reach and effectiveness of mailed nicotine replacement therapy for smokers: 6-month outcomes in a naturalistic exploratory study.
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.
authors.affiliation: Addictions Program, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Zawertailo
authors.forename: Rosa
authors.initials: R
authors.lastname: Dragonetti
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Bondy
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Peter
authors.initials: P
authors.lastname: Selby
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion / Q000191:economics / Q000379:methods; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011177:Postal Service; D015397:Program Evaluation; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D061485:Tobacco Use Cessation Devices / Q000600:supply & distribution*