Article
Quitlines: A Tool for Research and Dissemination of Evidence-Based Cessation Practices

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Abstract

Quitlines in the United States have grown dramatically over the past 15 years, from one state and a handful of health plans to all 50 states and over 200 health plans and employers. Over half a million tobacco users received help from state quitlines alone in 2005. Research to confirm and improve quitline effectiveness also has burgeoned, with multiple meta-analyses confirming a dose-related treatment effect. Quitlines are increasing the depth and breadth of services offered, including the integration of medication support and other electronic communication mediums such as web and e-mail.

Quitlines have the capacity to serve a larger fraction of the population than they currently serve. Accomplishing this is dependent on creating ambitious, multi-institution funding and delivery mechanisms, as well as further research and development to improve reach, effectiveness, and efficiency.

Section snippets

Background

Despite decades of research and dissemination effort, use of evidence-based counseling support by those trying to quit smoking is infrequent. Only around 1% of smokers trying to quit report receiving any behavioral assistance beyond static printed materials.1 One bright spot in this otherwise grim picture is the recent marked increase in the availability and use of a new medium for receiving behavioral support: the telephone.

In 1992, California had the only state-level quitline in the United

Evidence Summary

A strong evidence base supports quitline efficacy and effectiveness.12, 13 The 2006 Cochrane Review found a 1.41 odds ratio (OR) (95% confidence interval [CI]=1.27–1.57) for long-term cessation for people receiving phone counseling compared to people trying to quit without counseling assistance.11 A meta-regression detected a significant association between the maximum number of planned calls and effect size. The Cochrane Review concluded that: “Proactive telephone counseling helps smokers

Benefits of Quitlines

Quitlines help increase the reach of evidence-based services by increasing convenience and anonymity, and by providing multilingual services. They provide extended hours of operation and centralized quality control, and eliminate transportation barriers more easily than many face-to-face cessation services. They can help people gain access to pharmacotherapy as well as the behavioral and adherence support that maximize medication effectiveness. Quitlines provide a centralized triage point for

How Quitline Services Are Delivered and Financed

There is wide variation in the U.S. in the populations that quitlines serve, who delivers the services, and how they are financed. Quitlines have been set up to deliver services to all residents in some municipalities and counties, and in all states. Some limited services for special populations, such as pregnant women, have been provided at the national level. Quitlines also may provide services to health plan members, employees, or union members. Services are delivered by a wide variety of

How Quitlines Promote Services

A broad range of marketing techniques has been used to generate calls to quitlines. State-level quitlines initially relied primarily on mass media ads, especially television. This medium has proven reliable for call generation, but is quite expensive per call generated, sometimes requiring as much investment to generate a call as is spent on providing service for the caller. In addition, the promotional effect tends to be short-lived, tailing off after a few days or weeks. However, many state

Public–Private Partnerships

There are increasingly sophisticated public–private partnerships extending the depth and breadth of services offered. Integration often occurs at the state level, with another layer at the national level. As of July 1, 2006, every state in the U.S. has some form of operational quitline. The National Cancer Institute (NCI) and the Centers for Disease Prevention and Control (CDC) have collaborated with states to create a formal national network of quitlines, with a single number (1–800–QUITNOW)

1. Under-utilization

The biggest current challenge for quitlines is that despite dramatic growth over the past decade, they are under-utilized compared to their potential. This under-utilization is in part related to decisions by sponsoring organizations not to maximize participation, due to lack of sufficient funding to support both promotion and service provision.

The National Action Plan,42 created by the Subcommittee on Cessation of the Interagency Committee on Smoking and Health, convened by former U.S.

Top Ten Development and Research Opportunities for Quitlines

Promising innovations could increase the reach, effectiveness, and efficiency of quitlines even further. However, these need additional development and research. Ten of these are outlined below.

Research Implications

Quitlines are creating a remarkable infrastructure for theoretic and applied research in numerous disciplines. They are collecting uniform minimum datasets on hundreds of thousands of tobacco users who attempt to quit each year. In the U.S., there is wide heterogeneity in recruitment and service strategies from state to state and institution to institution, providing numerous natural experiments. Because of the high volume of participants and computerized coaching support, quitlines also

Conclusion

The new behavioral technology that formed the basis of quitlines easily could have languished in articles growing moldy on the shelves of libraries; instead, individuals in academia, state health departments, healthcare companies, philanthropic organizations, federal agencies, large employers, and service agencies created a vision and over time brought it to life. This has been a messy, sometimes painful process that never would have gotten as big as it has if the individuals involved had not

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    • Specialized tobacco quitline and basic needs navigation interventions to increase cessation among low income smokers: Study protocol for a randomized controlled trial

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      Effective cessation programs and resources are available but underutilized by low-income smokers [2,9,10]. Telephone counseling for smoking cessation is an evidence-based intervention [11–13] that is recommended in both clinical and community practice guidelines [11,14,15]. Because tobacco quitlines offer population-wide free access to smoking cessation support, they have the potential to reach a diverse population of smokers.

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