Free Samples for Health (FreSH) Study on Smoking Cessation in Dental Offices

• Studies

FreSH Study: Evaluating Free Nicotine Replacement Therapy in Dental Settings (2023–2025)

From January 2023 to June 2025, the Network conducted the Free Samples for Health (FreSH) Study, led by Dr. Sandra Japuntich, Clinician Investigator at Hennepin Healthcare and Associate Professor at the University of Minnesota Medical School. The study evaluated whether offering free nicotine replacement therapy (NRT) in dental practices could increase smoking cessation among adult patients.

Study Goals

The FreSH study aimed to:

• Test the effectiveness of free NRT samples combined with Ask-Advise-Refer (AAR) counseling on long-term smoking abstinence.
• Compare this approach to enhanced usual care, which included AAR plus an electric toothbrush (ET).
• Evaluate implementation outcomes such as feasibility, acceptability, and appropriateness of delivering NRT in dental settings.

Recruitment Targets

• The goal was to recruit 1,200 adult smokers across 50 dental practices.
• Practices were randomized to either the NRTS or ET condition.
• Final enrollment included 1,196 patients from 59 practices, with 89 practitioners participating across the Midwestern and Northeastern Network regions.

Key Findings

• Short-Term Impact:
  • NRTS patients had significantly higher quit attempts and NRT use than ET patients.
  • 12.8% of NRTS patients reported abstinence at 1 month vs. 9.0% in the ET group (p<0.05).
  • 50% of NRTS patients used NRT at some point, compared to 13% in the ET group.
• Long-Term Abstinence:
  • No significant difference in 6-month CO-confirmed abstinence between groups (NRTS: 8.4%, ET: 8.0%).
• Implementation Outcomes:
  • Practitioners rated NRTS as feasible (4.3/5), acceptable (4.5/5), and appropriate (4.5/5).
  • Patients found the intervention helpful, with 24% obtaining additional NRT after receiving samples.
• Practitioner Experience:
  • NRTS was easier to deliver during preventive visits.
  • Some practitioners expressed discomfort offering NRT to unmotivated patients, which may have impacted recruitment and uptake.

Practice Implications

The FreSH study demonstrated that offering free NRT in dental settings is feasible and well-received by both patients and providers. While it increased short-term cessation behaviors, it did not significantly improve long-term abstinence. These findings suggest a need for strategies that enhance practitioner confidence and patient engagement, especially among those not actively seeking to quit.

FreSH Results Webinar September 26, 2025

Dr. Sandra Japuntich and Dr. Sarah Helseth joined the National Dental PBRN on September 26, 2025, to present findings from the Free Samples for Health (FreSH) Study. The webinar also featured practitioner panelists Dr. Dhanya Narasimhan and Dr. Sangeeta Gajendra, who shared their experiences implementing the control intervention in practice. Practitioners and patients rated the intervention highly in terms of feasibility and acceptability. Panelists discussed how the study changed their approach to smoking cessation conversations and highlighted the value of offering support to patients for smoking cessation during dental visits.

FreSH Best Practices Webinar January 30, 2024

The webinar was led by Dr. Sandra Japuntich, a clinical psychologist and the principal investigator of the study; and Dr. Matthew Carpenter, a Professor in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina. Dr. Carpenter’s research focuses on tobacco control, smoking cessation, nicotine dependence, cancer prevention, and control, and behavioral medicine. Dr. Japuntich and Dr. Carpenter were joined by four FreSH practitioners for a panel discussion, Dr. Michael Romano,  Dr. Peggy Richardson, Dr. Scott Durand, and dental hygienist, Rhonda Bravick. Their combined expertise provided a rich learning experience for all attendees. The primary aim of this one-hour session was to equip FreSH study practitioners with effective strategies for recruiting and treating cigarette smokers. The experts shared their knowledge and experiences, providing practical tips and advice that practitioners can apply in their work.

FreSH Webinar January 27, 2023

WHAT DENTISTS ARE SAYING ABOUT THIS STUDY

Dr. Louis from HealthPartners participated in the pilot study.