Tobacco kills around 5 million people worldwide every year and is the leading preventable cause of death in developed countries. It is estimated that more than 70% of smokers in the USA are interested in stopping but only 7% of those who try without medicine or counselling successfully stop for a year or more. Smokers who use nicotine replacement therapy (NRT) are much more likely to quit than those who do not use such treatment.
Thomas Frieden (New York City Department of Health and Mental Hygiene, New York, USA) and colleagues undertook a large-scale distribution programme of free NRT in New York. In April 2003 the New York City Department of Health and Mental Hygiene publicised the availability of a free 6-week course of NRT patches to the first 35,000 eligible smokers to call the New York State Smokers Quitline. The investigators sent NRT patches to 34,000 individuals and attempted follow-up counselling calls for all recipients. 1,300 randomly selected participants underwent a 6-month follow-up survey. Individuals who requested and were enrolled in the program but who, because of mailing errors, did not receive the treatment, were also surveyed. More NRT recipients (33%) successfully quit smoking than people in the comparison group (6%). Those who received a counselling call were more likely to quit than those who did not. At least 6,000 successful quits could be attributed to receipt of free NRT, at a cost of US$464 or less per quit, state the authors.
Dr Frieden states: "On the conservative assumption that all the non-respondents to our follow-up survey sample continued to smoke, one in five NRT recipients, more than 6000 New Yorkers, stopped smoking as a result of this programme. If [survey] non-respondents stopped in similar proportions to survey respondents, the programme accounted for more than 9000 quits.
"Although New York City implemented this programme at a time when new smoke-free workplace legislation and increased taxation on cigarettes focused public attention on cessation, these findings suggest the potential for similar interventions to encourage large numbers of smokers to attempt to quit smoking."
In an accompanying comment Mike Murphy and Paul Aveyard (University of Oxford, Oxford, UK) state: "Miller assessed outcomes in the softest way at 6 months: namely, without verification (so respondents could deceive if they wished), and by reporting smoking abstinence only during the previous week, not continuous abstinence since the quit attempt. We think the results of the distribution programme are therefore likely to be overestimated, but are not surprising."
Contact: Dr TR Frieden, Department of Health, 125 Worth Street, CN28, Room 331, New York, NY 10013, USA. T) 212 295 5427 tfreiden@health.nyc.gov
Comment: Dr Mike Murphy, Dr Michael Murphy, Childhood Cancer Research Group, 57 Woodstock Rd, Oxford OX2 6HJ. T) 01865 315939 Michael.murphy@ccrg.ox.ac.uk
Journal
The Lancet