In September 2004, the Oklahoma Tobacco Helpline launched its NRT (nicotine replacement therapy) initiative for Medicare and uninsured tobacco users. This initiative provides eight weeks of NRT (gum or patch) at no cost to eligible registrants who also receive the Free & Clear intervention program. From September 2004 to April 2006, more than 10,000 tobacco users registered with the Oklahoma Tobacco Helpline and received free NRT. This report summarizes utilization, satisfaction and outcomes associated with the NRT initiative.
Although promotion of the NRT initiative was limited to press releases, earned media and word-of-mouth, both the total number of tobacco users registering for services and the proportion receiving NRT climbed immediately following the launch, and peaked in January 2005 (Figure 1). Overall, more than 50% of tobacco users who registered for services with the helpline were eligible, and received, free NRT.
FIG 1 - Number of Registrants by Month and NRT, September 2004 - April 2006
As part of the overall evaluation of the Oklahoma Tobacco Helpline, a sample of registrants is contacted at 4 and 7 months following registration. Among Helpline registrants from May to December 2005, 480 NRT recipients participated in the four-month follow-up evaluation. Among these, less than 10% (n=41) received nicotine gum, 429 received the patch and 10 received both.
Figure 2 displays the utilization of NRT in weeks. Nearly all recipients (94.5%) who participated in the follow-up survey at 4 months reported using the provided NRT for at least one day up to one week. Less than half of the respondents (43.4%) used the provided NRT for the entire 8-week course. On average, participants used the provided NRT for 5 weeks.
FIG 2 - Weeks of NRT Use, Eligible Helpline Registrants, May - December 2005 (n=254)
Tobacco users who called the Helpline and received free NRT report high satisfaction with the services. Among the 480 NRT recipients completing the 4-month telephone follow-up survey, 91% reported being somewhat or very satisfied, and 93% reported that the Helpline met their expectations. In addition, 97% said they would recommend the Helpline to others.
One measure of the effectiveness of the Oklahoma Tobacco Helpline is 30-day abstinence rates. At the 4-month follow-up survey, 43% of NRT recipients report not smoking for one month or longer. This proportion decreases slightly over time. At the 7-month follow-up 35% of NRT recipients report not smoking for one month or longer. By comparison, 30-day abstinence among Helpline registrants not receiving NRT was 22% at the 4-month follow-up and 20% at the 7-month follow-up. Thirteen month follow-up is not yet available for these NRT recipients.
FIG 3 - 30-Day Abstinence for NRT Recipients at 4- and 7-Month Follow-Ups, May - December 2005
At the 4-month follow-up evaluation, the 30-day abstinence rates were influenced by the duration of NRT use. Among NRT recipients who reported using the products less than four weeks, only 24% reported not using tobacco for a month or more, compared to 60% among those who used the NRT for 5-8 weeks (Figure 4).
FIG 4 - 30-Day Abstinence by Duration of NRT Use at 4-Month Follow-Up, May - December 2005
Conclusions - These utilization and follow-up data demonstrate the success of the Oklahoma Tobacco Helpline's NRT initiative. Tobacco users responded to the initiative with record high call volumes to the Helpline. Consistently, more than 50% of registrants are eligible for the free NRT each month. Tobacco users who receive the NRT are reporting high rates of utilization and satisfaction. More importantly, 30-day abstinence rates are 95% higher at the 4-month follow-up when registrants receive NRT, and participants who use the NRT longer, have greater success quitting. Although most smokers want to quit, only 4-5% are successful when they try to quit on their own. The Oklahoma Tobacco Helpline, which provides proactive counseling and NRT for eligible registrants, markedly increases the probability of successfully quitting tobacco.
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