title: Mailed distribution of free nicotine patches without behavioral support: Predictors of use and cessation.
abstract: There is growing evidence that the mailed distribution of free nicotine replacement therapy (NRT), usually as part of smokers' helplines, can been effective in increasing the odds of cessation on a population level. However, limited information is available on the utilization of NRT when it is provided for free, and factors associated with regimen adherence have remained largely unexplored.
  
  
  
  In the context of a randomized controlled trial, 500 adult smokers across Canada hypothetically interested in free NRT were mailed a 5week supply of nicotine patches, but no other support was offered. Analyses evaluated which a priori-defined demographic and smoking characteristics predicted nicotine patch use at 8week follow-up of 421 patch recipients, as well as examined the association between patch use and smoking cessation at 6months.
  
  
  
  At 8weeks, 10.9% had used all, 47.5% had used some but not all, and 41.6% had not used any of the provided nicotine patches. Lower age, unemployment, past NRT use and intent to quit in the next 30days at baseline (preparation stage of change) were all identified as independent predictors of some nicotine patch use. Only use of all patches was associated with greater odds of smoking cessation, compared to non-users (Adj. OR=2.96; 95%CI=1.06-8.27).
  
  
  
  The mailed distribution of free nicotine patches to smokers at large can be effective at promoting cessation, particularly among financially disadvantaged groups, those with previous NRT experience and among individuals with already advanced intent to quit.
authors.affiliation: Centre for Addiction and Mental Health, Toronto M5S 2S1, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto M5S 3M2, Canada. Electronic address: vlad.kushnir@camh.ca.
authors.forename: Vladyslav
authors.initials: V
authors.lastname: Kushnir
authors.affiliation: Centre for Addiction and Mental Health, Toronto M5S 2S1, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto M5S 3M2, Canada.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Sproule
authors.affiliation: Centre for Addiction and Mental Health, Toronto M5S 2S1, Canada; Department of Psychiatry, University of Toronto, Toronto M5T 1R8, Canada; Research School of Population Health, The Australian National University, Canberra 2601, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Cunningham
mesh_terms: D000367:Age Factors; D002170:Canada; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011177:Postal Service; D061485:Tobacco Use Cessation Devices / Q000191:economics / Q000706:statistics & numerical data*; D014478:Unemployment / Q000706:statistics & numerical data
keywords: Adherence; Free distribution; Nicotine replacement therapy; Smoking; Smoking cessation; Tobacco