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Nicotine Tob Res. 2020 Mar 21. pii: ntaa050. doi: 10.1093/ntr/ntaa050. [Epub ahead of print]

Proactively offered text messages and mailed nicotine replacement therapy for smokers in primary care practices: A pilot randomized trial.

Author information

Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital.
Tobacco Research and Treatment Center, Massachusetts General Hospital.
Harvard Medical School.
Department of Psychiatry, Massachusetts General Hospital.
Center for Global Health, Massachusetts General Hospital.
Milken Institute School of Public Health, George Washington University.



Proactive, population health cessation programs can guide efforts to reach smokers outside of the clinic to encourage quit attempts and treatment use. This study aimed to measure trial feasibility and preliminary effects of a proactive intervention offering text messages and/or mailed nicotine replacement therapy (NRT) to smokers in primary care clinics.


From 2017-2019 we performed a pilot randomized trial comparing brief telephone advice (control: BA), text messages (TM), 2-weeks of mailed NRT, or both interventions (TM+NRT). Patients were identified using electronic health records and contacted proactively by telephone to assess interest in the study. We compared quit attempts, treatment use, and cessation in the intervention arms with BA.


Of 986 patients contacted, 153 (16%) enrolled (mean age 53 years, 57% female, 76% white, 11% black, 8% Hispanic, 52% insured by Medicaid) and 144 (94%) completed the 12-week assessment. On average, patients in the TM arms received 159 messages (99.4% sent, 0.6% failed), sent 19 messages and stayed in the program for 61 days. In all groups, a majority of patients reported quit attempts (BA 67% versus TM 86% [p=0.07], NRT 81% [p=0.18], TM+NRT 79% [p=0.21]) and NRT use (BA 51% versus NRT 83% [p=0.007], TM 65% [p=0.25], TM+NRT 76% [p=0.03]). Effect estimates for reported 7-day abstinence were BA 10% versus TM 26% (p=0.09), NRT 28% (p=0.06), and TM+NRT 23% (p=0.14).


Proactively offering text messages or mailed nicotine medications was feasible among primary care smokers and a promising approach to promote quit attempts and short-term abstinence.


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