Nicotine replacement therapy sampling via primary care: Methods from a pragmatic cluster randomized clinical trial.

BACKGROUND: Primary care is the most important point of healthcare contact for smokers. Brief physician advice to quit, based on the 5As/AAR model, offers some efficacy but is inconsistently administered and has limited population impact. Nicotine replacement therapy (NRT) sampling, defined as provision of a brief NRT starter kit, when added to the 5As/AAR, is well-suited to primary care because it is simple, brief, and can be provided to all smokers. This article describes the design and methods of an ongoing comparative effectiveness trial testing standard care vs. standard care + NRT sampling within primary care. METHODS: Smokers were recruited directly from primary care practices between July 2014 and December 2017 within an established network of South Carolina clinics. Interventions were delivered randomly by clinic personnel, and phone-based follow-ups were centrally coordinated by research staff to track outcomes through six months post-intervention. Primary study aims are to examine the impact of NRT sampling on smoking, inclusive of cessation, quit attempts, and uptake of evidence-based treatment. RESULTS: Twenty-two clinics were recruited. Across clinics, patient census ranged from 985 to 10,957 and number of providers ranged from 1 to 63. Average patient age across clinics was 52.9 years and smoking prevalence across ranged from 10.6% to 28.5%. CONCLUSION: Improving the effectiveness and reach of brief interventions within primary care could have a considerable impact on population quit rates. We consider the advantages and disadvantages of key methodological decisions relevant to the design of future primary care-based cessation trials.

'Closet' quit attempts: prevalence, correlates and association with outcome.

AIMS: To examine the (i) prevalence, (ii) predictors and (iii) cessation outcomes of smokers who engage in undisclosed quit attempts. DESIGN: Online survey (n = 524), with balanced recruitment of current smokers (55%) and past-year quitters (45%). Participants were daily smokers (current or previous) who had at least one quit attempt in the past year. MEASUREMENTS: Respondents were grouped on whether they did versus did not make advanced disclosure to others of their most recent quit attempt. FINDINGS: Almost half (n = 234; 45%) reported that their most recent quit attempt was undisclosed to anyone in advance. Those who planned their quit attempt in advance [odds ratio (OR) = 0.10; 95% confidence interval (CI): 0.05-0.23] and those who used behavioral treatment (OR = 0.14; 95% CI: 0.05-0.43) were less likely to make 'closet quit attempts', while those who rated their attempt as being serious (OR = 2.52; 95% CI: 1.16-5.46) and those who deemed social support to be unhelpful (OR = 1.91; 95% CI: 1.24-2.95) were more likely to make such attempts. Closet quit attempters were more likely to achieve 30 days of abstinence than were those who made advanced disclosure (67% versus 58%; adjusted OR 1.8; 95% CI: 1.1-2.8), but there were no differences for achieving 6 months of abstinence (52% versus 49%; adjusted OR 1.2; 95% CI: 0.7-2.0). CONCLUSIONS: Attempting to quit smoking without telling anyone in advance is common, and does not appear to impede success. These findings do not support blanket advice to smokers to tell others about pending quit attempts.