title: Stop-Smoking Medication Use, Subsidization Policies, and Cessation in Canada.
abstract: BACKGROUND
  In 2000, Quebec began reimbursing stop-smoking medications (SSMs) through their provincial public drug insurance plan. Several other Canadian provinces have since begun offering SSM subsidies. Clinical trials indicate that SSMs can increase quit success; however, little evidence exists on patterns of use in "real-world" settings and impact on population quit rates. This study examines Canadian trends in SSM use and quit success over time, comparing provinces with differing subsidization policies.
  
  
  METHODS
  Secondary analyses were conducted in 2014 using nationally representative Canadian Tobacco Use Monitoring Survey data, 2004-2012, for current and former smokers who made a quit attempt in the past 2 years (N=26,094). Regression models tested for differences in SSM use and quit success in provinces with differing SSM coverage (i.e., none, partial, or comprehensive).
  
  
  RESULTS
  Smokers were more likely to use nicotine replacement therapy (NRT) in jurisdictions with comprehensive SSM coverage versus jurisdictions with partial (OR=1.39, 95% CI=1.22, 1.59) or no coverage (OR=1.43, 95% CI=1.21, 1.68). Prescription medication use was more likely in provinces with partial (versus no) coverage (OR=1.27, 95% CI=1.01, 1.59). Overall, smokers who attempted to quit were more likely to remain abstinent in jurisdictions with comprehensive versus partial (OR=1.20, 95% CI=1.12, 1.28) or no coverage (OR=1.23, 95% CI=1.00, 1.50). An interaction between coverage and cigarettes per day was observed, suggesting potentially greater impact of comprehensive coverage among heavier smokers.
  
  
  CONCLUSIONS
  Comprehensive subsidization policies are associated with modest increases in NRT use and quit success, but do not appear to impact prescription SSM use.
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Christine M
authors.initials: CM
authors.lastname: White
authors.affiliation: Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Rynard
authors.affiliation: Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Reid
authors.affiliation: CancerCare Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Rashid
authors.initials: R
authors.lastname: Ahmed
authors.affiliation: Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: Burkhalter
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada. Electronic address: dhammond@uwaterloo.ca.
authors.forename: David
authors.initials: D
authors.lastname: Hammond
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D011792:Quebec; D012044:Regression Analysis; D012051:Reimbursement Mechanisms; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000191:economics / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D013997:Time Factors; D061485:Tobacco Use Cessation Devices / Q000191:economics*; D055815:Young Adult