Mailed nicotine patches with no behavioral support associated with cessation

January 25, 2016

Mailing free nicotine patches to smokers without providing behavioral support was associated with higher rates of tobacco cessation than not offering the patches, according to an article published online by JAMA Internal Medicine.

Smoking is a leading cause of preventable disease worldwide. There is a need for randomized clinical trials on the effectiveness of nicotine replacement therapy (NRT) where there is no additional behavioral support.

John A. Cunningham, Ph.D., of the Centre for Addiction and Mental Health, Toronto, Canada, and coauthors conducted a randomized clinical trial to evaluate the efficacy of providing free nicotine replacement therapy (NRT) in nicotine patches by mail without behavioral assistance to smokers interested in receiving it. Adult smokers were recruited from across Canada by random-digit dialing of home and cell phone numbers.

Participants in the experimental group (n=500) were mailed a five-week course of nicotine patches with no behavioral support provided and participants in the control group (n=499) were not offered the nicotine patches or any other intervention. Other than age (average age 48 years in the experimental group and 49.7 years in the control group) there were no significant differences between the two groups on demographics or smoking characteristics. Researchers measured 30-day smoking abstinence at six months as their main outcome.

Self-reported 30-day abstinence at six months was higher among participants sent nicotine patches (38 of 500 [7.6 percent]) than those who received no intervention 15 of 499 [3.0 percent]), according to the results.

While only 51 percent of participants returned usable saliva samples, biochemically validated abstinence at six months was found in 14 (2.8 percent ) of 500 participants who were mailed nicotine patches compared with 5 (1.0 percent) of 499 who were not, the results also indicate.

The authors note their findings do not provide direct evidence of the efficacy of mass distribution initiatives because the recruitment method for their trial was random-digit dialing rather than interested participants calling a toll-free number.

"However, the results of the trial provide general support for direct-to-smoker programs with free mailed nicotine patches," the study concludes.
(JAMA Intern Med. Published online January 25, 2016. doi:10.1001/jamainternmed.2015.7792. Available pre-embargo to the media at

Editor's Note: The study includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures.

Media Advisory: To contact study corresponding author John A. Cunningham, Ph.D., call Kate Richards at 416-535-8501 x36015 or email

The JAMA Network Journals

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