2005 Model Practice Application (Public)

Bureau of Tobacco Control

New York City Department of Health and Mental Hygiene

New York City residents who were eligible to participate in the New York City Department of Health and Mental Hygiene’s Free Nicotine Patch Program of 2003 were over 18 years of age, were moderate to heavy smokers, had no medical contraindications for NRT patch use, were not currently using any other forms of NRT, indicated a readiness to quit, and agreed to be contacted by phone for follow-up.

The program reached 34,090 New York City residents. A six-month outcome evaluation of the program showed that more than 87% of participants reported a quit attempt after enrolling and 33% reported quitting smoking for 7 days or longer compared to 6% who did not receive the intervention. Participants who received one or more counseling calls were about one-third more likely to quit than those who received no counseling calls.

A toll free number was needed for participants to request patches and an intake screening protocol was utilized to determine eligibility. A storage, packaging and distribution company was contracted to handle delivery of program materials. Essential resources mailed to participants included a six-week supply of NRT (two-weeks each of generic 21mg, 14mg and 7mg patches), a patch use instruction sheet, patient information from the NRT manufacturer, smoking cessation tips and other cessation resources available in New York City. Trained staff were needed to provide brief, proactive counseling and follow up calls (i.e., 5 minutes or less) by phone to each participant. Phone calls were used to ensure correct patch use, address questions and concerns, inquire about side effects, troubleshoot delivery problems and ask about participant’s experiences in using the patches.

The program was designed to direct-mail a free, six-week course of treatment to eligible callers, thereby increasing access and reducing cost to people who wanted to stop smoking and improve their health.

Tobacco use is still the most preventable cause of morbidity and mortality in the United States. Annually 440,000 deaths and $157 billion dollars in health-related costs can be attributed to smoking. In New York City, one New Yorker dies every hour from a smoking related illness and annually 1000 residents die from second hand smoke exposure.

A major incentive for developing and implementing the Free Nicotine Patch Program of 2003 was the passage of Local Law 47, also known as the Smoke Free Air Act of 2002. This law banned smoking in virtually all public indoor areas in New York City, most notably amending prior laws which permitted smoking in bars and restaurants – a core industry of the City.

With the advent of such important legislation, it was imperative to increase cessation opportunities and resources for New Yorkers. Mailing the patches to the participants allows the program to reach smokers with busy schedules (e.g., workers, housewives), individuals with limited mobility (e.g. seniors), individuals with limited access to pharmacies and drug stores, individuals with no health insurance or inadequate health insurance and individuals who could not afford to pay for cessation services out-of-pocket. The brief telephone counseling sessions not only provide a way to ensure that the nicotine patches are being correctly used and that side effects are being addressed, but also offer needed encouragement and support for individuals making a difficult lifestyle change. Receiving cessation treatment via the mail and phone also supports the privacy and confidentiality needs for participants.

Prior mass distribution efforts in the United States had used vouchers or required travel to a specified NRT pick-up location; however, this program screened participants by phone and direct mailed resources by UPS which saved time, increased access and efficiency in serving the needs of thousands of people at one time.

To meet its goals the Free Nicotine Patch Program of 2003 was done in collaboration with the expertise of other State and City agencies including the New York State Smoker’s Quitline’s management and staff who conducted the program intake and eligibility screenings. The Bureau of Tobacco Control also collaborated with the New York City Information Line (311) management and staff as well as an outside agency contracted for the purpose of making thousands of essential follow up counseling calls to support thousands of people receiving these cessation services.

The estimated cost of the intervention per person who successfully quit smoking was about $250.00. All staff time and resources were covered through New York City tax levy funds and additional costs were paid through Roswell Park Research Institute/New York State. Commitment to future programs is ensured through the current Mayoral administration, the shared resources of other city agencies (such as 311) as well as through the development of a new partnership with a pharmaceutical company that has since agreed to donate NRT for this type of program.

The Free Nicotine Patch Program of 2003 was developed and implemented with the New York State Quiteline in less than five months. Once the program began, it took approximately one month to screen the callers. Call backs were conducted at 3 and 14 weeks and each wave of call backs took approximately 2 weeks to complete.

A six-month follow-up was conducted with a smaller random sample of participants to assess program implementation and outcomes. A group of smokers who did not receive patches was used for comparison. The study was conducted by phone. Non-responders to the third call were asked to complete a mailed evaluation survey. Participants who completed the surveys were mailed $20.00 MetroCards to compensate them for their time and participation in the study. The evaluation component was completed entirely by DOHMH staff.

The study results are based on a 61% response rate. Outcome data collected were compared to the baseline information collected during intake. Differences between the participants and the comparison group were also assessed. Results showed that a diverse group of participants were enrolled in the program including residents of all New York City boroughs, women, young adults, low-income individuals and people of various race and ethnicities. Seventy-eight percent of the participants smoked more than 20 cigarettes (one pack) per day.

In contrast to the comparison group, participants were about 1.6 times more likely to report a quit attempt and more than five times as likely to stop smoking for a week or longer. In addition to the 33% 7-day quit rate, participants who received one or more counseling calls were about one-third more likely to quit than those who received no counseling calls. Participants who were not successful in quitting reported a significant decrease in cigarette consumption.

The marked differences in findings for the participant and comparison groups attests to the efficacy of the program. In addition, the program proved to be a cost-effective way to treat nicotine addiction.