Put It Out Rockland: Improving cessation rates using tailored NRT dosing as part of a comprehensive intiative to reach the HP 2010 tobacco goals

The Rockland County Department of Health Put It Out Rockland (PIOR) program has contributed to reducing smoking rates to nearly 12% countywide. A foundation of the comprehensive program is an intensive cessation series offering free NRT. The PIOR program uses trained cessation specialists; at worksites, community centers, schools, hospitals and clinics. Rigorous, ongoing evaluation among 743 program participants, has shown quit rates of 57%, 44% and 46% at 3, 6, and 12 months. More conservative estimates, where all people lost to follow-up were assumed to be smokers, one year quit rates were 52%, 37%, and 29%, respectively. The program uses a unique tailored NRT approach in which specialists monitor NRT need and use throughout the program. Participants can receive up to 10 weeks of NRT, in addition to nicotine gum or lozenges. Dosing is adjusted each week, based on initial Fagerstrom scores, and weekly assessment of difficulty and success. Formative evaluation suggested that a 10 week course of NRT produced better 3 month quit rates than the standard 8 week dose. The four year evaluation has demonstrated that quit rates at six month follow-up are significantly higher for participants using NRT for 10 weeks as compared to those using the standard 8 week course (47.3% vs. 38.5%, p<.005), with a trend at 12 months (46.6% vs. 38.9%, p=.079). A county-funded cessation program with tailored NRT can decrease tobacco use at a cost per person that is far less than that born by the county in health care costs.