{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:59:59Z","timestamp":1792166399588,"version":"4.4.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Smoking cessation interventions could ultimately offer greater impact to the extent that they are brief, concrete, and face valid (to the individuals presenting and receiving the intervention), which would then make these interventions scalable across a broad spectrum of adults who smoke (AWS). Medication sampling is one potential strategy to meet that need.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine outcomes of varenicline sampling in a fully powered randomized clinical trial (RCT), conducted from February 2021 to April 2025.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This decentralized RCT included non\u2013treatment seeking AWS with varying levels of motivation to quit who were recruited throughout South Carolina.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n Participants were randomized to receive a 4-week sample of varenicline, nicotine replacement therapy (NRT; active control), or quitline referral (inactive control) in a 2:1:1 ratio. Accompanying 4-week medication supply, intervention messaging in both sampling groups emphasized naturalistic use, ie, a participant-driven experience with self-determined uptake, use, and goals for use.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was self-reported 7-day point prevalence abstinence (PPA) at 6-month follow-up. Secondary outcomes included carbon monoxide (CO)\u2013verified abstinence, floating abstinence (any 7-day period of not smoking throughout follow-up), quit attempts, and smoking reduction.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study sample included 651 AWS (mean [SD] age, 52 [11] years; 431 (66%) female), with 161 randomized to the no-sampling control, 172 randomized to NRT, and 318 randomized to varenicline. Compared with the no-sampling control, AWS receiving varenicline samples had higher rates of self-reported PPA at month 6 (16 of 161 [10%] vs 53 of 318 [17%];\n P<\/jats:italic>\n \u2009=\u2009.048), floating abstinence throughout follow-up (33 [20%] vs 108 [34%];\n P<\/jats:italic>\n \u2009=\u2009.003); and greater incidence of 50% or greater reduction in cigarettes per day (CPD) by 6 months (31 [19%] vs 106 [33%];\n P<\/jats:italic>\n \u2009=\u2009.002); however, rates of CO-verified abstinence at 6 months were not significantly different. Varenicline sampling was superior to NRT sampling for 6-month self-reported abstinence (53 [17%] vs 14 of 172 [8%];\n P<\/jats:italic>\n \u2009=\u2009.01); floating abstinence through 6 months (108 [34%] vs 43 [25%];\n P<\/jats:italic>\n \u2009=\u2009.04); and incidence of 50% or greater reduction in CPD at week 8 (111 [35%] vs 38 [22%];\n P<\/jats:italic>\n \u2009=\u2009.005) but not at 6 months.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this RCT of 651 AWS, varenicline sampling was efficacious, with potentially superior outcomes compared with NRT. Results provide additional evidence in support of medication sampling as a pragmatic option to engage AWS in cessation, worth further evaluation within an applied settings.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04525755<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.11418","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:30:18Z","timestamp":1778254218000},"page":"e2611418","source":"Crossref","is-referenced-by-count":2,"title":["Medication Samples and Smoking Cessation Among Adults"],"prefix":"10.1001","volume":"9","author":[{"given":"Matthew J.","family":"Carpenter","sequence":"first","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston"},{"name":"Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy T.","family":"Smith","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston"},{"name":"Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy E.","family":"Wahlquist","sequence":"additional","affiliation":[{"name":"Center for Rural Health and Research, East Tennessee State University, Johnson City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin A.","family":"Toll","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston"},{"name":"Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, South Carolina"},{"name":"Department of Public Health Sciences, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen L.","family":"Cropsey","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily C.","family":"Ware","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M.","family":"Kaczmar","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston"},{"name":"Department of Medicine, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Dahne","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston"},{"name":"Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin M.","family":"Gray","sequence":"additional","affiliation":[{"name":"Hollings Cancer Center, Medical University of South Carolina (MUSC), Charleston"},{"name":"Department of Psychiatry & Behavioral Sciences, MUSC, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"issue":"29","key":"zoi260345r1","doi-asserted-by":"publisher","first-page":"633","DOI":"10.15585\/mmwr.mm7329a1","article-title":"Adult smoking cessation\u2014United States, 2022.","volume":"73","author":"VanFrank","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"zoi260345r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.addbeh.2022.107523","article-title":"Differences in cessation attempts and cessation methods by race\/ethnicity among US adult smokers, 2016-2018.","volume":"137","author":"Lee","year":"2023","journal-title":"Addict Behav"},{"issue":"4","key":"zoi260345r3","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1037\/0893-164X.22.4.472","article-title":"Over-the-counter nicotine replacement therapy: can its impact on smoking cessation be enhanced?","volume":"22","author":"Amodei","year":"2008","journal-title":"Psychol Addict Behav"},{"issue":"21","key":"zoi260345r4","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1001\/archinternmed.2011.492","article-title":"Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: a randomized clinical trial.","volume":"171","author":"Carpenter","year":"2011","journal-title":"Arch Intern Med"},{"issue":"7","key":"zoi260345r5","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1093\/ntr\/ntu025","article-title":"Evaluating the effect of access to free medication to quit smoking: a clinical trial testing the role of motivation.","volume":"16","author":"Jardin","year":"2014","journal-title":"Nicotine Tob Res"},{"issue":"7","key":"zoi260345r6","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1111\/add.14953","article-title":"Nicotine replacement therapy sampling for smoking cessation within primary care: results from a pragmatic cluster randomized clinical trial.","volume":"115","author":"Carpenter","year":"2020","journal-title":"Addiction"},{"key":"zoi260345r7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/jsc.2019.17","article-title":"Pilot trial of nicotine replacement therapy sampling in a dental care clinic.","volume":"15","author":"Bloom","year":"2020","journal-title":"J Smok Cessat"},{"issue":"1","key":"zoi260345r8","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1186\/s12903-024-04758-w","article-title":"A national dental practice-based research network phase II, cluster-randomized clinical trial assessing nicotine replacement therapy sampling in dental settings: study protocol for the Free Samples for Health (FreSH) study.","volume":"24","author":"Fang","year":"2024","journal-title":"BMC Oral Health"},{"issue":"4","key":"zoi260345r9","doi-asserted-by":"publisher","first-page":"543","DOI":"10.3390\/ijerph22040543","article-title":"Gain-framed text messages and nicotine replacement therapy for smoking cessation among lung cancer screening patients: a brief report of a pilot randomized controlled trial.","volume":"22","author":"Pebley","year":"2025","journal-title":"Int J Environ Res Public Health"},{"issue":"3","key":"zoi260345r10","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1001\/jama.2020.23541","article-title":"Interventions for tobacco cessation in adults, including pregnant persons: updated evidence report and systematic review for the US Preventive Services Task Force.","volume":"325","author":"Patnode","year":"2021","journal-title":"JAMA"},{"issue":"2","key":"zoi260345r11","doi-asserted-by":"publisher","first-page":"e5","DOI":"10.1164\/rccm.202005-1982ST","article-title":"Initiating pharmacologic treatment in tobacco-dependent adults: an official American Thoracic Society clinical practice guideline.","volume":"202","author":"Leone","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"issue":"6","key":"zoi260345r12","doi-asserted-by":"publisher","first-page":"983","DOI":"10.1093\/ntr\/ntaa241","article-title":"A pilot randomized clinical trial of remote varenicline sampling to promote treatment engagement and smoking cessation.","volume":"23","author":"Carpenter","year":"2021","journal-title":"Nicotine Tob Res"},{"issue":"22","key":"zoi260345r13","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1001\/jama.2025.4347","article-title":"CONSORT 2025 Statement: updated guideline for reporting randomized trials.","volume":"333","author":"Hopewell","year":"2025","journal-title":"JAMA"},{"issue":"5","key":"zoi260345r14","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1037\/0278-6133.10.5.360","article-title":"The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation.","volume":"10","author":"Biener","year":"1991","journal-title":"Health Psychol"},{"key":"zoi260345r15","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.drugalcdep.2017.01.047","article-title":"Development and initial validation of a cessation fatigue scale.","volume":"176","author":"Mathew","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"zoi260345r16","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1093\/ntr\/ntae172","article-title":"Varenicline over-the-counter trial on efficacy and safety.","volume":"27","author":"Pearson","year":"2024","journal-title":"Nicotine Tob Res"},{"issue":"6","key":"zoi260345r17","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1093\/ntr\/ntq045","article-title":"Characteristics and abstinence outcomes among tobacco quitline enrollees using varenicline or nicotine replacement therapy.","volume":"12","author":"Biazzo","year":"2010","journal-title":"Nicotine Tob Res"},{"key":"zoi260345r18","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/s13012-015-0329-7","article-title":"Empowering smokers with a web-assisted tobacco intervention to use prescription smoking cessation medications: a feasibility trial.","volume":"10","author":"Selby","year":"2015","journal-title":"Implement Sci"},{"issue":"5","key":"zoi260345r19","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.amepre.2010.01.024","article-title":"Behavioral counseling and varenicline treatment for smoking cessation.","volume":"38","author":"Swan","year":"2010","journal-title":"Am J Prev Med"},{"issue":"10","key":"zoi260345r20","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1093\/ntr\/ntr103","article-title":"Efficacy of varenicline to prompt quit attempts in smokers not currently trying to quit: a randomized placebo-controlled trial.","volume":"13","author":"Hughes","year":"2011","journal-title":"Nicotine Tob Res"},{"issue":"7","key":"zoi260345r21","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1001\/jama.2015.280","article-title":"Effect of varenicline on smoking cessation through smoking reduction: a randomized clinical trial.","volume":"313","author":"Ebbert","year":"2015","journal-title":"JAMA"},{"issue":"6","key":"zoi260345r22","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1177\/15598276221103476","article-title":"Nudging as a support for behavioral change in lifestyle medicine.","volume":"17","author":"Matthews","year":"2022","journal-title":"Am J Lifestyle Med"},{"issue":"3","key":"zoi260345r23","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.3390\/ijerph20031675","article-title":"Nudging interventions on alcohol and tobacco consumption in adults: a scoping review of the literature.","volume":"20","author":"Nurchis","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"zoi260345r24","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1016\/j.ahj.2021.11.001","article-title":"Behavioral nudges as patient decision support for medication adherence: the ENCOURAGE randomized controlled trial.","volume":"244","author":"Horne","year":"2022","journal-title":"Am Heart J"},{"key":"zoi260345r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2023.110902","article-title":"Comparison of the Bluetooth iCOquit, piCO, and Vitalograph for the assessment of breath carbon monoxide among adults initiating smoking cessation and standardized canisters.","volume":"250","author":"Tonkin","year":"2023","journal-title":"Drug Alcohol Depend"},{"issue":"6","key":"zoi260345r26","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1093\/ntr\/ntad230","article-title":"Remote carbon monoxide capture via REDCap: evaluation of an integrated mobile application.","volume":"26","author":"Dahne","year":"2024","journal-title":"Nicotine Tob Res"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2848777\/carpenter_2026_oi_260345_1777989001.47356.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T15:30:19Z","timestamp":1778254219000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2848777"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.11418","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]}}}