The initial and ongoing effect of the COVID-19 pandemic on the reach and impact of a US state tobacco quitline

INTRODUCTION: This study examines the long-term effect of the COVID-19 pandemic on the reach and impact of one US state tobacco quitline while taking into account quitline offers of free nicotine replacement therapy (NRT). METHODS: This is a pre-post analysis from January 2017 through June 2023 of the reach and impact of Michigan's tobacco quitline after the start of the COVID-19 pandemic. We assess quitline reach (number of callers per month), effectiveness (self-reported 30-day abstinence at 6 months), and impact (number of new ex-tobacco users per month). We examine the main effects and interactions between pandemic status (i.e. pre vs post March 2020) and quitline offers of free NRT. RESULTS: The COVID-19 pandemic had a persistent negative effect on quitline reach (p=0.002) and impact (p<0.001). Abstinence rates decreased transiently during the first year of the pandemic. Offering free NRT had a positive effect on quitline reach (p<0.001) and impact (p<0.001) before and after the start of the pandemic. For quitline reach, we found a significant interaction between pandemic and free NRT effects with a substantial decrease in the mean number of callers per month after the pandemic during months when free NRT is being offered (750; 95% CI: 545-1033, pre-pandemic vs 302; 95% CI: 233-392, post-pandemic) compared to months when free NRT is not being offered (247; 95% CI: 187-327, pre-pandemic vs 159; 95% CI: 114-221, post-pandemic). CONCLUSIONS: There is a critical need to assess and address the ongoing effects of the COVID-19 pandemic on tobacco quitline reach and impact.