Overcoming barriers to smoking cessation in Ontario

Providing free nicotine replacement therapy (NRT) by mail is an effective strategy to help a large number of smokers who are attempting to quit, according to a recent study conducted by Dr. Peter Selby and Dr. Laurie Zawertailo from the Smoking Treatment for Ontario Patients (STOP) Program at the Centre for Addiction and Mental Health (CAMH). The STOP Program is an ongoing research project that aims to discover the most effective methods of delivering free smoking cessation medication and counselling support to smokers across Ontario.

The new study, published in Tobacco Control, found that 1 in 5 smokers reported that they were not smoking six months after receiving the intervention by mail.

The study addressed two common barriers often faced by people who attempt to quit smoking: unequal access to clinic-based services and the cost of purchasing NRT medication. The intervention was made available to all those who registered with the STOP helpline. Eligible participants were couriered a kit containing five weeks of NRT (patches or gum), self-help materials, a toll-free telephone hotline for questions and concerns, and the provincial telephone quitline number to access additional counselling if desired. To be considered eligible, participants had to be Ontario residents 18 years of age and older who smoked at least 10 cigarettes per day and were willing to make a quit attempt within 30 days.

Participants also completed an assessment questionnaire that served as a modified ‘5A tobacco use intervention.’ The 5A intervention approach is a clinical best-practice guideline developed by U.S. Public Health designed to help people quit smoking. In the STOP study, participants were asked about their smoking; assessed with respect to stage of change, motivations and importance of quitting smoking and advised on the type of NRT to use.

After six months, participants were contacted to complete a follow-up interview. Of the 2,601 participants who completed the interview, 67.4 per cent reported having made at least one serious attempt to quit smoking after receiving NRT; 21.4 per cent said they had quit smoking at the time of the interview, and 17.8 per cent were neither smoking at the time of the six month interview nor had smoked within the previous 30 days.

These outcomes were compared to a separate group of individuals who did not receive an intervention or any free NRT, materials or advice to quit. The comparison demonstrated that an initial brief intervention plus five weeks of free NRT to motivated smokers in Ontario significantly increased self-reported six month abstinence rates.

Since the CAMH STOP study launched in October 2005, more than 80,000 smokers have enrolled to use NRT in combination with counselling. For more information on the STOP Program, visit the CAMH Nicotine Dependence Clinic webpage.

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