Simple Interventions Can Make a Big Difference in Helping People Quit Cigarettes

From JAMA Internal Medicine, “Effect of Mailing Nicotine Patches on Tobacco Cessation Among Adult Smokers: A Randomized Clinical Trial“:

Importance  The efficacy of nicotine replacement therapy (NRT) is well demonstrated in clinical trials in which NRT is accompanied by behavioral support. Epidemiologic data, however, indicate that people using NRT are no more likely to successfully quit smoking than those who do not use NRT.

Objective  To evaluate the effect of mailing nicotine patches to smokers without behavioral support on quit success rates.

Design, Setting, and Participants  A single-blinded, 2-group randomized clinical trial of adult smokers recruited across Canada by random-digit dialing of home and cell telephone numbers from June 4, 2012, through June 26, 2014. Follow-up was completed on January 5, 2015, and data were analyzed from May 24, 2015, through July 6, 2015. A total of 2093 individuals who smoked more than 10 cigarettes per day were interviewed at baseline and asked if they would be hypothetically interested in receiving nicotine patches by mail to quit smoking. Those who were interested and deemed eligible to participate (no contraindications to NRT) were randomized to the experimental group to be mailed a 5-week supply of nicotine patches or to a control group. Telephone follow-ups were conducted at 8 weeks and 6 months.

Interventions  Participants in the experimental group were sent a 5-week course of nicotine patches by expedited postal mail (3 weeks of step 1 [21 mg of nicotine], 1 week of step 2 [14 mg of nicotine], 1 week of step 3 [7 mg of nicotine], no behavioral support provided). Participants randomized to the control group were not offered the nicotine patches or any other intervention.

Main Outcomes and Measures  The primary outcome was 30-day smoking abstinence at 6 months.

We know that nicotine patches work to help people quit smoking. That doesn’t mean everyone uses them. This trial was an attempt to make things easier for smokers to see if that would help them quit.

Adult smokers in Canada were recruited by random digit dialing over two years. They managed to enroll 1000 people who smoked more than 10 cigarettes a day. They were interviewed and randomized to one of two groups. The first was mailed a 5-week supply of nicotine patches. The other was not. That’s the study.

They were called 8 weeks later and six months later. The outcome of interest was whether people had been smoke-free for at least 30 days at six months.

The quit rate among those who did not receive the nicotine patches was 3%. The quit rate among those who did receive the patches was 7.6%. Of course, that’s what people “said”. It’s possible they weren’t telling the truth.

The researchers tried to get them to send in saliva samples, but only about half of the people did. Of those who did, the verified quit rate in the control group was 1% versus 2.8% in the intervention group.

The magnitude differs based on whether you rely on self-reported quitting or saliva tests, but it’s clear that simply mailing people nicotine patches at least doubled the quit rate of people quitting smoking. Compared to the effort and cost of behavioral interventions, this is a reasonably cost-effective intervention.



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