Mailed distribution of free nicotine patches without behavioral support: Predictors of use and cessation

•Age, unemployment, past NRT use and intent to quit associated with free patch use.•Past NRT use was predictive of abstinence at 6 months.•Odds of quitting were higher only among users of all 5 weeks of nicotine patches.

IntroductionThere 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.MethodsIn the context of a randomized controlled trial, 500 adult smokers across Canada hypothetically interested in free NRT were mailed a 5 week 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 8 week follow-up of 421 patch recipients, as well as examined the association between patch use and smoking cessation at 6 months.ResultsAt 8 weeks, 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 30 days 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).ConclusionsThe 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.