Misleading Statements About "Life of the Mother" Exceptions in Pro-life Laws Require Correction.

Misleading statements in a recent Obstetrics & Gynecology article require correction. No state has an abortion law that is a total ban on abortion. Every state law permits abortion when necessary to save a mother's life. Texas law does not require an "imminent" risk and allows a doctor to use his "reasonable medical judgment" to determine if an abortion is necessary to prevent a "risk" of maternal death. Similarly, Idaho allows a doctor to use his "good faith medical judgment" to determine when to intervene, without need for "immediacy".

The Impact of the COVID-19 Pandemic on Patient Disparities in Long-Term Opioid Therapy.

BACKGROUND: The COVID-19 pandemic disrupted how primary care patients with chronic pain received care. Our study sought to understand how long-term opioid therapy (LtOT) for chronic pain changed over the course of the pandemic overall and for different demographic subgroups. METHODS: We used data from electronic health records of 64 primary care clinics across Washington state and Idaho to identify patients who had a chronic pain diagnosis and were receiving long-term opioid therapy. We defined 10-month periods in 2019 to 2021 as prepandemic, early pandemic and late pandemic and used generalized estimating equations analysis to compare across these time periods and demographic characteristics. RESULTS: We found a proportional decrease in LtOT for chronic pain in the early months of the pandemic (OR = 0.94, P = .007) followed by an increase late pandemic (OR = 1.08, P = .002). Comparing late pandemic to prepandemic, identifying as Asian or Black, having fewer comorbidities, or living in an urban area were associated with higher likelihood of being prescribed LtOT. DISCUSSION: The use of LtOT for chronic pain in primary care has increased from before to after the COVID-19 pandemic with racial/ethnic and geographic disparities. Future research is needed to understand these disparities in LtOT and their effect on patient outcomes.

How to implement a "standard of care" regulatory model for pharmacists.

National pharmacy associations have increasingly explored regulation according to a "standard of care." In such a model, pharmacists can provide a wide range of clinical services aligned with their education and training. Based on Idaho's experience implementing this model, there are five critical steps states must take to enact a standard of care: 1) Adopt a broad definition of "practice of pharmacy;" 2) Allow elasticity for practice innovation over time; 3) Decide which limited instances still necessitate prescriptive regulation; 4) Eliminate all unnecessary regulations; and 5) Strengthen accountability for deviations from the standard of care. States wishing to adopt a standard of care approach can follow this five-step process to enhance patient care and mitigate the lag that is otherwise constant between laws and practice.

Mixed-Methods Assessment of Farmworkers' Perceptions of Workplace Compliance with Worker Protection Standards and Implications for Risk Perceptions and Protective Behaviors.

INTRODUCTION: The Environmental Protection Agency (EPA)'s Worker Protection Standards is the primary set of legislation aimed at protecting farmworkers from occupational pesticide exposure in the United States. Previous studies suggest that worker adoption of Pesticide Protective Behaviors (PPBs) promoted by WPS is associated with lower urinary pesticide concentrations. However, adoption of PPBs is often outside of the control of individual farmworkers and dependent on workplace factors such as employer provisioning of Personal Protective Equipment (PPE) and access to trainings/resources. METHODS: We conducted a mixed-method study including urinary pesticide biomonitoring, surveys, and interviews with 62 Latinx farmworkers in southwestern Idaho from April to July 2022. We integrated findings across the various data sources to identify emergent themes relating to farmworkers' perceptions of workplace compliance with WPS and potential implications for their pesticide risk perceptions, protective behaviors, and urinary pesticide concentrations. RESULTS: Participants reported some indications of poor workplace compliance with WPS regulations, notably inconsistent access to clean handwashing stations and notification of pesticide applications. Some farmworkers, particularly pesticide applicators, viewed herbicides to be categorically safer than other classes of pesticides such as insecticides; these perceptions appeared to influence protective behaviors, such as the relatively low use of PPE while applying herbicides. These findings are underscored by the higher concentrations of biomarkers of herbicides, but not insecticides, among pesticide applicators compared with non-applicators (e.g. median 2,4-D concentrations = 1.40 µg/L among applicators and 0.69 µg/L among non-applicators). Participants further reported concerns regarding the inadequacy of pesticide safety training, pesticide drift, and the lack of communication regarding pesticide applications on and near fields where they are working. DISCUSSION: Participants' perceptions that herbicides are categorically safer than other pesticide classes is in direct conflict with WPS training, raising concerns about discrepancies between WPS instruction and other on-the-job training, as well as the inadequate provisioning of PPE during the application of certain pesticides. Our findings also suggest that current WPS regulations may not sufficiently address farmworkers' concerns, particularly in regard to pesticide drift.

Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the Mainstreaming Addiction Treatment (MAT) Act.

In December 2022, Congress passed the Mainstreaming Addiction Treatment Act, which removed the federal legal barrier to pharmacist buprenorphine prescribing. As a result, each state can now decide whether or not to allow pharmacists to prescribe buprenorphine as an additional access point to reduce fatal opioid overdoses. At least 10 states allow pharmacists to prescribe controlled substances under collaborative practice agreements. Two states (California and Idaho) have also created pathways for independent prescribing of buprenorphine by pharmacists. Additional states should seek to enable pharmacists to prescribe buprenorphine to increase access to a proven beneficial treatment and help reduce fatal opioid overdoses.

The Evolution of Sex is Tempered by Costly Hybridization in Boechera (Rock Cress).

Despite decades of research, the evolution of sex remains an enigma in evolutionary biology. Typically, research addresses the costs of sex and asexuality to characterize the circumstances favoring one reproductive mode. Surprisingly few studies address the influence of common traits that are, in many organisms, obligately correlated with asexuality, including hybridization and polyploidy. These characteristics have substantial impacts on traits under selection. In particular, the fitness consequences of hybridization (i.e., reduced fitness due to interspecific reproductive isolation) will influence the evolution of sex. This may comprise a cost of either sex or asexuality due to the link between hybridity and asexuality. We examined reproductive isolation in the formation of de novo hybrid lineages between 2 widespread species in the ecological model system Boechera. Seventeen percent of 664 crosses produced F1 fruits, and only 10% of these were viable, suggesting that postmating prezygotic and postzygotic barriers inhibit hybrid success in this system. The postmating prezygotic barrier was asymmetrical, with 110 of 115 total F1 fruits produced when Boechera stricta acted as maternal parent. This asymmetry was confirmed in wild-collected lineages, using a chloroplast phylogeny of wild-collected B. stricta, Boechera retrofracta, and hybrids. We next compared fitness of F2 hybrids and selfed parental B. stricta lines, finding that F2 fitness was reduced by substantial hybrid sterility. Multiple reproductively isolating barriers influence the formation and fitness of hybrid lineages in the wild, and the costs of hybridization likely have profound impacts on the evolution of sex in the natural environment.

Reimbursement for pharmacist-provided health care services: A multistate review.

OBJECTIVE(S): To better understand individual state approaches to reimbursement for pharmacist-provided health care services, we sought to (1) review existing statutes and regulations on pharmacist reimbursement from select states (Alaska, California, Idaho, New Mexico, Oregon, and Washington) and (2) suggest approaches to changing state statutes and regulations to allow for reimbursement. METHODS: We reviewed approaches taken by 4 states that currently allow for direct reimbursement of pharmacist-provided health services and 2 states that are in process. Washington requires commercial health plans to credential and privilege pharmacists as health care providers deeming reimbursement and coverage disparities among providers as compensation discrimination. RESULTS: Oregon does not require insurers to provide payment but requires pharmacists to contract and credential with each individual insurer, without the mandate for payment. In California, pharmacists receive 85% of the established fee schedule that physicians receive for equivalent services, and payment is issued to the pharmacy, not the individual pharmacist. California and New Mexico both only allow specified pharmacies or pharmacists to bill (advanced credentials or a tiered licensing model). In Alaska, scope and payor regulations align to allow compensation for covered services; however, insurance credentialing portals are not configured to enroll pharmacists as billing providers. In May 2020, pharmacists were added as nonphysician ordering, referring, and prescribing providers in the Idaho Medicaid basic plan regulations, and licensed pharmacists with national provider identification numbers were auto-enrolled. CONCLUSION: The states we reviewed took different approaches on the basis of their established statutes and regulations (pharmacy, public and private insurance), resulting in variability in compensated services and reimbursement. An intentional alignment of statutes, regulations, and scope of practice is required to support reimbursement and sustainability of services.

Environmental, public health, and economic development perspectives at a Superfund site: A Q methodology approach.

Environmental remediation and restoration at hazardous waste sites is important for reducing risks and sustaining local economies. Navigating trade-offs between diverse and conflicting stakeholder perspectives to identify practical and affordable ways forward is important for sustaining objectives and goals. Differences in stakeholder perspectives are informed by their affiliations and roles and their views towards environmental, economic development, and public health issues. We used Q methodology, an approach that combines priority sorting and interviews, to elicit and interpret the perspectives of 28 stakeholders, representing government entities, non-profits, and industries at a mining-impacted Superfund site in the Coeur d'Alene Basin of Idaho, USA. Four primary perspectives were distinguished by their prioritization of: 1) government intervention, 2) the Superfund remediation, 3) local concerns, and 4) public-private partnerships. Participants' roles and affiliations played an influential role in informing primary perspectives. Overall, collaboration was viewed more favorably when it was associated with concrete implementation pathways.

Direct patient care services by community and ambulatory care pharmacists in Idaho.

Background Pharmacists are one of the most accessible but unoptimized healthcare providers in the community. They are medication experts and have authority to independently prescribe in Idaho. Through the provision of direct patient care services (i.e., those distinct from traditional prescription dispensing functions), pharmacists have a greater opportunity to impact chronic disease prevention and management across the state. This can be done by filling gaps in community care (e.g., prescribing recommended therapy) and directly managing and preventing chronic diseases. However, current practices surrounding pharmacist-provided direct patient care services are unknown. Objective To characterize direct patient care services provided by Idaho community and ambulatory care pharmacists as well as to assess individual pharmacists' and their work sites' capacity and barriers in providing and expanding services. Setting Community and ambulatory care pharmacists' work sites in Idaho. Method We administered a cross-sectional, electronic, 20-min survey to Idaho community and ambulatory care pharmacists. Main outcome measure The survey focused on collecting data on current practices, capacity, and barriers related to pharmacist-provided direct patient care services. Results The survey was completed by 280 eligible community and ambulatory care pharmacists with the majority of respondents (n = 250) offering pharmacist-provided direct patient care services. Pharmacists most often prescribed therapy for tobacco cessation (nicotine replacement, bupropion, varenicline), naloxone, and devices for patients with diabetes. Top barriers to individual pharmacists providing services were dispensing load and workload while top barriers to work sites (e.g., environment) were reimbursement/billing, number of available staff, and workflow. Conclusion Idaho community and ambulatory care pharmacists currently offer direct patient care services to patients across the state, but face barriers in providing and increasing services offered.

Evaluation of residue management practices on barley residue decomposition.

Optimizing barley (hordeum vulgare L.) production in Idaho and other parts of the Pacific Northwest (PNW) should focus on farm resource management. The effect of post-harvest residue management on barley residue decomposition has not been adequately studied. Thus, the objective of this study was to determine the effect of residue placement (surface vs. incorporated), residue size (chopped vs. ground-sieved) and soil type (sand and sandy loam) on barley residue decomposition. A 50-day(d) laboratory incubation experiment was conducted at a temperature of 25°C at the Aberdeen Research and Extension Center, Aberdeen, Idaho, USA. Following the study, a Markov-Chain Monte Carlo (MCMC) modeling approach was applied to investigate the first-order decay kinetics of barley residue. An accelerated initial flush of residue carbon(C)-mineralization was measured for the sieved (Day 1) compared to chopped (Day 3 to 5) residues for both surface incorporated applications. The highest evolution of carbon dioxide (CO2)-C of 8.3 g kg-1 dry residue was observed on Day 1 from the incorporated-sieved application for both soils. The highest and lowest amount of cumulative CO2-C released and percentage residue decomposed over 50-d was observed for surface-chopped (107 g kg-1 dry residue and 27%, respectively) and incorporated-sieved (69 g kg-1 dry residue and 18%, respectively) residues, respectively. There were no significant differences in C-mineralization from barley residue based on soil type or its interactions with residue placement and size (p >0.05). The largest decay constant k of 0.0083 d-1 was calculated for surface-chopped residue where the predicted half-life was 80 d, which did not differ from surface sieved or incorporated chopped. In contrast, incorporated-sieved treatments only resulted in a k of 0.0054 d-1 and would need an additional 48 d to decompose 50% of the residue. Future residue decomposition studies under field conditions are warranted to verify the residue C-mineralization and its impact on residue management.

Price Changes in Washington Following the 2012 Liquor Privatization: An Update Through 2016 With Comparisons to California, Idaho, and Oregon.

BACKGROUND: Washington State ended their wholesale and retail monopoly on liquor on June 1, 2012, resulting in a 5-fold increase in liquor outlets in diverse store types. The legislation also included taxes at the wholesale and retail levels. This study seeks to investigate whether prices have changed from 2014 through 2016, as a follow-up to a previous study finding increases in prices from 2012 to 2014, compared to prices in other states. METHODS: We developed an index of 68 brands that were popular in Washington in early 2012. Data on final liquor prices (including taxes) in Washington and California were obtained through store visits and online sources between November 2013 and March 2014, and again between April and May 2016 for Washington only. Pricing data for Idaho and Oregon were obtained from the Statistics for Alcohol Management Database over both sampling periods. Primary analyses were conducted on the utmost brands available in the majority of the stores sampled. RESULTS: Liquor prices in Washington rose an average of 3.9% for 750 ml and 6.5% for 1.75-l containers overall from 2014 to 2016, while bordering states Idaho (+2.9%) and Oregon (+1.5%) experienced smaller increases for 750-ml and declines for 1.75-l containers (Idaho: -2.9%, Oregon: -4.9%). In the analyses of spirits prices in Washington compared to California, prices in California were 24.1% lower for 750-ml containers and 29.6% lower for 1.75-l containers. CONCLUSIONS: Our findings indicate liquor prices in Washington have increased since our 2014 assessment at a larger percentage than prices in the neighboring control states Oregon and Idaho, with varying effects on brands, container sizes, and store types. We demonstrate privatization is associated with a different pattern of prices across store types than seen in California.

Assessment of Factors Associated with Molecular Quantification of Stubby Root Nematode Paratrichodorus allius from Field Soil DNA.

Factors relating to SYBR Green-based quantitative real-time PCR (qPCR) quantification of stubby root nematode Paratrichodorus allius using soil DNA were evaluated in this study. Soils used were loamy sand from potato fields in North Dakota and Idaho. Results showed that the largest nematode individuals (body length >720 µm) produced significant lower Cq values than the smallest individuals (<359 µm), indicating more total DNA amount in the largest nematodes. Soil pre-treatments showed that autoclaved field soil had significantly reduced DNA amount and quality. The air- or oven-dried soil yielded a lower amount of DNA with similar purity, compared with natural field soil. PCR inhibitors were detected in soil DNA substrates targeting pBluescript II SK(+)-plasmid DNA. Al(NH4)(SO4)2 treatment during DNA preparation significantly reduced the inhibitors compared with post-treatment of soil DNA with polyvinylpolypyrrolidone column. The effect of PCR inhibitors on qPCR was suppressed by bovine serum albumin. Quantification results did not significantly change when increasing the number of DNA extractions from three to six per soil sample when soil grinding and grid sampling strategies were used. Two standard curves, generated from serial dilutions of plasmid DNA containing P. allius ITS1 rDNA and soil DNA containing known nematode numbers, produced similar correlations between Cq values and amount of targets. The targets in soil DNA quantified by qPCR using either standard curve correlated well with microscopic observations using both artificially and naturally infested field soils. This is the first study for assessing various factors that may affect qPCR quantification of stubby root nematodes. Results will be useful during the setup or optimization of qPCR-based quantification of plant-parasitic nematodes from soil DNA.

Impact of Critical Illness on Resource Utilization: A Comparison of Use in the Year Before and After ICU Admission.

OBJECTIVES: Increasingly, patients admitted to an ICU survive to hospital discharge; many with ongoing medical needs. The full impact of an ICU admission on an individual's resource utilization and survivorship trajectory in the United States is not clear. We sought to compare healthcare utilization among ICU survivors in each year surrounding an ICU admission. DESIGN: Retrospective cohort of patients admitted to an ICU during one calendar year (2012) in a multipayer healthcare system. We assessed mortality, hospital readmissions (categorized by ambulatory care sensitive conditions and emergency department), and outpatient visits. We compared the proportion of patients with visits during the pre-ICU year versus the post-ICU year. PATIENTS: People admitted to an Intermountain healthcare ICU for greater than 48 hours in the year 2012 INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS: Among 4,074 ICU survivors, 45% had increased resource utilization. Readmission rates at 30-day, 90-day, and 1-year were 15%, 26%, and 43%. The proportion of patients with a hospital admission increased significantly in the post-ICU period (43% vs 29%; p < 0.001). Of patients with a readmission in the post-ICU period, 24% were ambulatory care sensitive condition. Patients with increased utilization differed by socioeconomic status, insurance type, and severity of illness. Sixteen percent of patients had either an emergency department or inpatient admission, but no outpatient visits during the post-ICU period. CONCLUSIONS: An ICU admission is associated with increased resource utilization including hospital readmissions, with many due to an ambulatory care sensitive condition. Lower socioeconomic status and higher severity of illness are associated with increased resource utilization. After an ICU visit patients seem to use hospital resources over outpatient resources. Interventions to improve and coordinate care after ICU discharge are needed.

Financial Strain, Suicidal Thoughts, and Suicidal Behavior Among US Military Personnel in the National Guard.

Background: Although financial strain is an identified risk factor for suicide among US military personnel, research is limited regarding the specific dimensions of financial strain that confer the greatest risk. Aims: The present study examined the associations among multiple indicators of financial strain, suicide ideation, and suicide attempts in a sample of US National Guard personnel, a high-risk subgroup of the US military. Method: National Guard personnel from Utah and Idaho (n = 997) completed an anonymous online self-report survey. Weighted univariate and multivariate logistic regression was used to test hypothesized associations. Results: Lifetime history of suicide ideation was significantly more common among participants reporting recent income decrease, credit problems, and difficulty making ends meet, even when adjusting for other covariates. Lifetime history of suicide attempt was significantly associated with recent foreclosure or loan default, credit problems, and difficulty making ends meet, but only in univariate analyses. Recent credit problems were the only financial strain indicator that significantly predicted a history of suicide attempt among participants with a history of suicide ideation. Limitations: The present study includes self-report methodology and cross-sectional design. Conclusion: Although multiple indicators of financial strain are associated with increased risk for suicidal thinking among National Guard military personnel, credit problems had the strongest association with suicide attempts.

Spatial Clustering of Suicide and Associated Community Characteristics, Idaho, 2010-2014.

INTRODUCTION: In 2015, Idaho had the fifth highest suicide rate in the United States. Little is known about the characteristics of areas in Idaho with high suicide rates. To aid suicide prevention efforts in the state, we sought to identify and characterize spatial clusters of suicide. METHODS: We obtained population data from the 2010 US Census and the 2010-2014 American Community Survey, analyzed data on suicides from death certificates, and used a discrete Poisson model in SaTScan to identify spatial clusters of suicide. We used logistic regression to examine associations between suicide clustering and population characteristics. RESULTS: We found 2 clusters of suicide during 2010-2014 that accounted for 70 (4.7%) of 1,501 suicides in Idaho. Areas within clusters were positively associated with the following population characteristics: median age ≤31.1 years versus >31.1 years (multivariable-adjusted odds ratio [aOR] = 2.4; 95% confidence interval [CI], 1.04-5.6), >53% female vs ≤53% female (aOR = 2.7; 95% CI, 1.3-5.8; P = .01), >1% American Indian/Alaska Native vs ≤1% American Indian/Alaska Native (aOR = 2.9; 95% CI, 1.4-6.3), and >30% never married vs ≤30% never married (aOR = 3.4; 95% CI, 1.5-8.0; P = .004). CONCLUSION: Idaho suicide prevention programs should consider using results to target prevention efforts to communities with disproportionately high suicide rates.

Economic Evaluation of Concussion Programs in the State of Idaho: The Collective Potential of Prevention and Clinical Care.

Concussion, or mild traumatic brain injury, especially among young children, teenagers, and young adults, is a significant problem in Ada County, Idaho, and the United States. Although much has been learned about concussion, considerable controversy and gaps in knowledge still exist in many areas of research, leading to variation in concussion assessment, treatment, and management protocols. Health systems can positively impact concussion outcomes through community education and outreach, and provision of timely, coordinated, evidence-based clinical care. Collectively, these measures serve to reduce concussion incidence (primary prevention), enable more timely recognition of concussion by parents, coaches, and teachers of youth athletes (secondary prevention), and improve treatment of concussion after it has occurred (tertiary prevention). Using the concussion prevention and clinical care coordination activities of St. Luke's Health System in Idaho as a benchmark, this analysis estimates the economic value of these preventive measures, in particular those preventive measures that target the pediatric population, for Ada County and the state of Idaho, and includes both year of injury and long-term costs of concussion. This study adopts a societal perspective, incorporating savings in direct medical, indirect, and quality of life costs.

State Approaches to Therapeutic Interchange in Community Pharmacy Settings: Legislative and Regulatory Authority.

Therapeutic interchange is the act of switching a prescribed drug for another drug in the same therapeutic class that is believed to be therapeutically similar but may be chemically different. Therapeutic interchange is different from generic substitution in that it does not occur between therapeutically equivalent products; instead, products are substituted for those that are likely to have a substantially equivalent therapeutic effect generally at a lower cost. Therapeutic interchange is common in institutional settings across the United States but rarely occurs in community pharmacy settings without a pharmacist first contacting the original prescriber and requesting a new prescription in order to facilitate a change. As of 2018, Arkansas, Idaho, and Kentucky have passed laws to enable therapeutic interchange in community pharmacy settings. In general, these laws require the original prescriber to opt-in to allow therapeutic interchange, and the pharmacist generally must leverage the formulary of the patient's health plan to guide decision making within the same therapeutic class. These 3 states require that the pharmacist notify the original prescriber of any interchange in order to ensure a complete and accurate medication record. When appropriately structured, state laws enabling therapeutic interchange in community pharmacy settings allow pharmacists to use their medication expertise to save valuable time and enhance patient care while reducing health care costs. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.

Idaho's Actions Continue Challenges For ACA.

The Trump administration proposed liberalizing rules governing non-ACA-compliant, short-term coverage; responding to state guidance, Blue Cross of Idaho filed health plans not meeting ACA requirements.

An evaluation of a school-based dental sealant programme.

OBJECTIVES: To evaluate the effectiveness of Bengal Smiles, a school-based dental sealant programme and assess outcomes related to the U.S. Healthy People 2020 oral health objectives. METHODS: A needs assessment identified high caries prevalence in Idaho children and supported the need for a school-based dental sealant programme at a local Title 1 school. Children (n=54) ages 6-12 were screened by dental hygiene students for suspected dental caries, sealant placement and need for referral for dental treatment. Sealant retention and sealant caries rates were computed at 12 months (n=32) using descriptive statistics. Caries rates were analysed with a t test for paired samples, while a chi-square test was used to determine a difference in referral treatment rates before and after the intervention of administrative staff who contacted parents of children in need of dental treatment. RESULTS: Bengal Smiles participants had a 16% decrease in suspected dental caries; however, there was no statistically significant difference in caries rates (P=.21) at baseline and 12 months. Sealant prevalence increased 370%. Sealant retention outcomes were 74% fully retained with 0% caries, 13% partially retained with 25% caries and 13% no retention with 25% caries. At 12 months, 50% of participants referred for dental treatment accessed care. The intervention of contacting parents had no statistically significant effect on increasing dental treatments (P=.75). CONCLUSIONS: School-based sealant programmes eliminate disparities in accessing oral health care and contribute to attaining U.S. Healthy People 2020 oral health objectives.

Impact of a Temporary NRT Enhancement in a State Quitline and Web-Based Program.

PURPOSE: To examine the impact of a nicotine replacement therapy (NRT) enhancement on quit outcomes. DESIGN: Observational study using an intent to treat as treated analysis. SETTING: Not available. PARTICIPANTS: A total of 4022 Idaho tobacco users aged ≥18 years who received services from the Idaho Tobacco Quitline or Idaho's web-based program. INTERVENTION: One-call phone or web-based participants were sent a single 4- or 8-week NRT shipment. Multiple-call participants were sent NRT in a single 4-week shipment or two 4-week shipments (second shipment sent only to those completing a second coaching call). MEASURES: North American Quitline Consortium recommended Minimal Data Set items collected at registration and follow-up. Thirty-day point prevalence quit rates were assessed at 7-month follow-up. ANALYSIS: Multiple logistic regression models were used to examine the effects of program type and amount of NRT sent to participants while controlling for demographic and tobacco use characteristics. RESULTS: Abstinence rates were significantly higher among 8-week versus 4-week NRT recipients (42.5% vs 33.3%). The effect was only significant between multiple-call program participants who received both 4-week NRT shipments versus only the first of 2 possible 4-week shipments (51.1% vs 31.1%). Costs per quit were lowest among web-based participants who received 4 weeks of NRT (US$183 per quit) and highest among multiple-call participants who received only 1 of 2 possible NRT shipments (US$557 per quit). CONCLUSION: To better balance cost with clinical effectiveness, funders of state-based tobacco cessation services may want to consider (1) allowing tobacco users to choose between phone- and web-based programs while (2) limiting longer NRT benefits only to multiple-call program participants.