Brian Brashears is down to smoking a few cigarettes a day. With city and state help, the Highlandtown resident hopes to quit altogether.
Last week he received a free month's supply of nicotine gum intended to quell his cravings for tobacco. The $38 package comes out of a statewide initiative to encourage smokers to quit by providing a free telephone counseling service and, in the case of city smokers, free nicotine patches and gum.
At least 8,106 Marylanders have called the state-sponsored hot line for advice on kicking tobacco since last July, when the state agreed to a $1 million, one-year contract with Free & Clear, a Seattle-based firm that operates the hot line, said Joan Stine, director of the state Health Department's Center for Health Promotion.
"It's so convenient for anyone who wants to quit," she said. "They don't even have to leave home."
In addition, the city Health Department began offering free nicotine patches or gum in March to any city resident who calls the state hot line and agrees to undergo the recommended counseling, said Dr. Joshua M. Sharfstein, city health commissioner. About 890 people have received a free month's supply of either nicotine gum or patches at a cost of about $45,000 since early March.
The hot line offered a unique opportunity in a city where smoking rates far exceed state and national averages, Sharfstein said. Up to 29 percent of the city's adults smoked in 2005, compared with 19 percent statewide and 21 percent nationwide, according to city and state figures.
Studies have shown that counseling along with nicotine patches or gum is more effective than either counseling or the patches and gum alone, Sharfstein said.
"With a hot line," he said, "you're getting the people who are committed, who have thought it through and at least made that initial call."
The initiative coincides with a bill signed into state law this month requiring bars and restaurants, as well as private clubs such as American Legion and Veterans of Foreign Wars halls, to be smoke-free by Feb. 1. Health experts arguing for the measure said that smoking and secondhand smoke kill about 440,000 people each year in the United States.
"If you get someone to stop smoking, you're not only helping that person, but the people around them," Sharfstein said.
A month's supply of patches costs $62.50, while the gum is $38, the city Health Department says. The city has budgeted $100,000 for the patches and gum this year. Most of the money will come from the state's cigarette restitution fund, which is paid to the states each year by the tobacco industry as part of a legal settlement reached in 1998.
"We're able to do this as long as the money is there to pay for it," Sharfstein said.
Callers from outside the city counseled on the hot line have access to nicotine patches or gum through their local health departments, but they may be charged for them, Stine said.
"The city's really taken the lead on this," she said. "We're hoping other jurisdictions will do likewise."
The hot line's success rate will be assessed sometime in the months ahead and the contracts will probably be renewed next year, if city and state reviews show they are working, Stine and Sharfstein said.
Based on past experience, state officials anticipate that up to 50 percent of the smokers who complete the counseling will be able to quit for at least six months, Stine said.
"We're a little bit early on in the game to have that yet, but the success rate is something we're watching closely," she said.
It has become "increasingly common" for cities and states to offer phone counseling hot lines and free nicotine therapy for smokers trying to quit, said Matt Barry, director of policy research for the Campaign for Tobacco-Free Kids, an anti-smoking group. New York City is credited with starting the trend in 2003 when city officials moved to ban smoking in restaurants, he said.
Phone programs generally double "or even triple" the likelihood that a smoker will be able to quit, Barry said. "One of the things they do a good job at is walking people through the process of what it's like to quit. They're there to lean on."
Free & Clear uses about 100 "quit coaches" who have specialized training, said Jackie Kurle, a company spokeswoman. Some of the callers aren't ready to quit, she said, but just want to know what they should be doing initially to prepare themselves, she said.
Kurle said callers are not automatically given nicotine gum or patches, but have to agree to go through at least some counseling before the nonprescription nicotine medications are mailed out.
She said counselors are trained to offer encouragement and guide callers through a stressful process.
"We're flexible so we can support different people, working on different timelines," she said.
Quitting can be difficult even for a light smoker, said David Salmons, one of the firm's quit coaches.
"There are folks who smoke two or three cigarettes a day and find it incredibly difficult," he said. "They consider it like a friend, something that's become a part of them."
Salmons, who holds a master's degree in counseling, said one of the first tasks is determining whether the caller is ready to set a "quit date," which is sometimes weeks or even months away. "They might need time to prepare and get their mind around it," he said.
Once a quit date is set, he and the caller work on dealing with the times of week or activities that usually trigger craving for a cigarette, such as a cup of coffee or a stressful work day.
"Stress is probably the No. 1 factor that either holds us in smoking or brings us back," Salmons said.
Barry said the average smoker will try to quit six to 10 times before succeeding. "A lot of people don't want to try to quit because they're afraid of failure," he said.
Brashears, 29, who is participating in the city program, said he's optimistic. It's his first attempt at quitting after a 15-year habit.
He was smoking a pack a day until he started cutting back gradually in recent weeks, with some help from the hot line's counselors. The $4-a-pack price of cigarettes is one incentive for quitting -- along with the fact that he's getting winded more often, he said.
"I want to quit while I still have my health," he said.
How to Get Help
The hotline for both city and state residents is: 1-800-QUIT-NOW (1-800-784-8669)
State residents are provided free counseling to quit smoking
City residents are provided free counseling and a free month's supply of nicotine gum or patches