Leveraging Community Pharmacists to Optimize Smoking Cessation Services for Rural Smokers in Appalachia

The goal of this clinical trial is to evaluate the effectiveness and implementation of a pharmacist-delivered MTM (medication therapy management) approach, called QuitAid, to quitting cigarette smoking in rural Appalachia.The main questions it aims to answer are:Is QuitAid, alone or combined with other quitting tobacco treatments, effective?What makes QuitAid easy or hard to carry out? Is it cost effective? Is it easy to maintain?Treatment:All participants will be given at least 4 weeks of the nicotine patch.Some participants will be randomized (like the flip of a coin) to receive additional treatments (listed below).These groups will be compared to each other to see which combination works best to help them quit smoking.Smokefree TXT - a texting program that helps people quit smokingTobacco quitline - 4 phone sessions to help people quit smoking8 weeks of NRT (nicotine replacement therapy in the form of nicotine patches or nicotine patches and lozenge) medication instead of 4 weeksQuitAid - An MTM program given by the patient's pharmacist. This is a quitting smoking coaching programNicotine patch AND nicotine lozenge instead of just nicotine patches

Study participants will be rural cigarette smokers from Virginia, Tennessee, Kentucky and North Carolina who visit one of the participating study pharmacies. Pharmacies will be located in rural geographic areas of the Central and South Central subregions of Appalachia that include Virginia, Tennessee, Kentucky and North Carolina, as defined by the RUCA codes 4-10. No exclusionary criteria are based on race, gender, or age.Inclusion Criteria include:must be 18 years of age and oldermust be able to read, speak, and understand Englishmust report smoking at least 5 cigarettes per day for the past 6 months (regardless of non-cigarette tobacco product use)must be willing to set a quit date within the next 30 daysmust own a cell phonemust be willing and able to use NRT in the form of patch or lozengeNot be pregnant or planning to be pregnant in the next 6 months.Exclusion Criteria include:are pregnant women (self-reported), breastfeeding, planning to become pregnant during the next 6 monthshave a medical contraindication to NRT (e.g., past 30 days, heart attack or stroke; past 6 months, serious or worsening angina, very rapid or irregular heartbeat requiring medication)