Targeted distribution of nicotine patches by mail to rural regions of Canada: Predictors of patch use.

Introduction: Rural regions generally report higher smoking rates than urban centers, which increases the risk of tobacco related harms and consequences, and makes promoting smoking cessation in these areas a priority. Mass distribution of nicotine replacement therapy (NRT) by postal mail has been found to increase the odds of successful cessation attempts. Understanding factors that contribute to the use of NRT could help maximize this intervention's effectiveness.

Methods: People who smoke cigarettes and live in rural areas of Canada were recruited from December 2020 to February 2022 using random digit telephone dialing. Participants were either randomized to be mailed a free, 5-week supply of NRT patches (experimental condition; n=252) or not (control condition; n=246). This secondary analysis used data from this randomized controlled trial to conduct an ordinal regression to determine if any variables measured at baseline predicted which participants in the experimental condition used none, some, or all of the NRT patches.

Results: Greater confidence in ability to quit (AOR=1.07; 95% CI: 1.00-1.15) independently predicted more patch use, while living in more remote places (AOR=0.25; 95% CI: 0.07-0.90) and past substance use (compared to having no history) (AOR=0.68; 95% CI: 0.45-1.04) independently predicted less use.

Conclusions: Understanding what contributes to NRT use in rural mass distribution programs could help maximize the odds of successful cessation attempts, personalize treatment recommendations, and target limited rural resources. Future research focused on rural NRT use and smoking cessation is merited.