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Tobacco quitlines

Evidence Rating
Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Disparity Rating
No impact on disparities likely
Community Conditions
Tobacco use
Authors
Lead: Naiya Patel
Contributor(s): Jessica Rubenstein
Acknowledgements: Alison Bergum, Jennifer Russ, Jessica Solcz
Date Last Updated
December 10, 2021

Quitlines provide behavioral counseling to tobacco users who want to quit. Cessation specialists schedule follow-up calls after the specialist or tobacco user makes initial contact using a proactive quitline; reactive quitlines rely solely on tobacco users to make future contact. Some quitlines provide additional interventions such as mailed materials, web-based support, text messaging, or tobacco cessation medications (CG-Tobacco). Many quitlines offer services in multiple languages (NAQC-US).

Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased quit rates

What does the research say about effectiveness? -+

There is strong evidence that proactive quitlines increase tobacco cessation (CG-Tobacco, West 2015, Cochrane-Matkin 2019, Klesges 2015, AHA-Mozaffarian 2012, Mottillo 2009). State- (CG-Tobacco) and community-sponsored quitlines have demonstrated effects on cessation (Russo 2018, AHA-Mozaffarian 2012).

Proactive counseling is more effective than reactive counseling and three to five counseling sessions appear more effective than one session alone (Cochrane-Matkin 2019). Combining quitlines with other interventions such as mass communication campaigns, texting apps, and efforts to encourage health care providers to refer patients to quitlines, increases quitline use and tobacco cessation (CG-Tobacco). Combining quitlines with technology-based efforts such as internet- or cell phone-based services like texting (Abroms 2016, Danielsson 2014) and providing counseling in multiple languages (Cummins 2015) can also support cessation. Referrals from providers based in community health centers may increase participation among minority populations (Russo 2018). Text-based outreach to patients may connect smokers to quitlines (Krebs 2020).

Providing tobacco cessation medication such as nicotine replacement therapy (NRT) with quitline services increases quit rates (CG-Tobacco, Smith 2013a) and call volume (CG-Tobacco). Telephone counseling with NRT increases smoking quit rates more than medication alone (Cochrane-Stead 2015). Quitlines combined with NRT have been shown to increase quit rates for active military personnel, veterans, and their dependents (Klesges 2015), and smokers with low incomes (Bernstein 2016).

Telephone counseling may increase smokeless tobacco cessation (Nethan 2018, Cochrane-Ebbert 2015). Experts suggest quitline services expand to include and recruit e-cigarette users (Vickerman 2021).

Quitlines are considered cost effective (Wilson 2019, CG-Tobacco).

Implementation Examples -+

All fifty states have quitlines. Most quitlines proactively call and counsel clients multiple times and offer free tobacco cessation medication (NAQC-Quitline facts).

The American Indian Commercial Tobacco Program (AICTP) is a culturally tailored quitline focusing on cessation of commercial tobacco use for men, women, and elders of all ages and tribal nations (AICTP).

Implementation Resources -+

AICTP - American Indian Commercial Tobacco Program. Quit commercial tobacco for good with the American Indian Commercial Tobacco Program (AICTP).

NAQC-Quitline - North American Quitline Consortium (NAQC). Promoting evidence based quitline services across diverse communities in North America.

NAQC-US - North American Quitline Consortium (NAQC). Promoting evidence based quitline services across diverse communities in North America. United States profiles.

Smokefree.gov-Quitline - U.S. Department of Health and Human Services (U.S. DHHS). Smokefree.gov. Speak to an expert.

Citations -+

* Journal subscription may be required for access.

Abroms 2016* - Abroms LC, Carroll P, Boal AL, Mendel JA, Carpenter KM. Integrated phone counselling and text messaging services at quitlines: An acceptability study. Journal of Smoking Cessation. 2016;11(1):5-11.

AHA-Mozaffarian 2012 - Mozaffarian, D., Afshin, A., Benowitz, N.L., Bittner, V., Daniels, S.R., Franch, H.A., Jacobs, D.R., Kraus, W.E., Kris-Etherton, P.M., Krummel, D.A., Popkin, B.M., Whitsel, L.P., & Zakai, N.A. (2012). Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation, 126(12), 1514-1563.

AICTP - American Indian Commercial Tobacco Program. Quit commercial tobacco for good with the American Indian Commercial Tobacco Program (AICTP).

Bernstein 2016* - Bernstein SL, Weiss J-M, Toll B, Zbikowski SM. Association between utilization of quitline services and probability of tobacco abstinence in low-income smokers. Journal of Substance Abuse Treatment. 2016;71:58-62.

CG-Tobacco - The Guide to Community Preventive Services (The Community Guide). Tobacco.

Cochrane-Ebbert 2015* - Ebbert J, Elrashidi M, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews. 2015;(2):CD004306.

Cochrane-Matkin 2019 - Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews. 2019;(5):CD002850.

Cochrane-Stead 2015* - Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews. 2012;(12):CD009670.

Cummins 2015* - Cummins SE, Wong S, Bonnevie E, et al. A multistate Asian-language tobacco quitline: Addressing a disparity in access to care. American Journal of Public Health. 2015;105(10):2150-2155.

Danielsson 2014* - Danielsson AK, Eriksson AK, Allebeck P. Technology-based support via telephone or web: A systematic review of the effects on smoking, alcohol use and gambling. Addictive Behaviors. 2014;39(12):1846-1868.

Klesges 2015 - Klesges RC, Ebbert JO, Talcott GW, et al. Efficacy of a tobacco quitline in active duty military and TRICARE beneficiaries: A randomized trial. Military Medicine. 2015;180(8):917-925.

Krebs 2020* - Krebs P, Sherman SE, Wilson H, et al. Text2Connect: A health system approach to engage tobacco users in quitline cessation services via text messaging. Translational Behavioral Medicine. 2018;10(1):292-301.

Mottillo 2009 - Mottillo S, Filion KB, Bélisle P, et al. Behavioural interventions for smoking cessation: A meta-analysis of randomized controlled trials. European Heart Journal. 2009;30(6):718-30.

NAQC-Quitline facts - North American Quitline Consortium (NAQC). What is a Quitline: Factsheets, materials, and world quitline map.

NAQC-US - North American Quitline Consortium (NAQC). Promoting evidence based quitline services across diverse communities in North America. United States profiles.

NAQC-Wisconsin - North American Quitline Consortium (NAQC). Wisconsin.

Nethan 2018 - Nethan ST, Sinha DN, Chandan K, Mehrotra R. Smokeless tobacco cessation interventions: A systematic review. Indian Journal of Medical Research. 2018;148(4):396-410.

Russo 2018 - Russo ET, Reid M, Taher R, Sharifi M, Shah SN. Referral strategies to a tobacco quitline and racial and/or ethnic differences in participation. Pediatrics. 2018;141(Suppl 1):e20171026.

Smith 2013a - Smith SS, Keller PA, Kobinsky KH, et al. Enhancing tobacco quitline effectiveness: Identifying a superior pharmacotherapy adjuvant. Nicotine Tob Res. 2013;15(3):718-728.

UW-CTRI WTQL - University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI). Wisconsin tobacco quit line (WTQL).

Vickerman 2021 - Vickerman KA, Carpenter KM, Raskob MK, et al. Vaping and e-cigarettes within the evolving tobacco quitline landscape. American Journal of Preventive Medicine. 2021;60(3 Suppl 2):S142-S153.

West 2015 - West R, Raw M, McNeill A, et al. Health-care interventions to promote and assist tobacco cessation: A review of efficacy, effectiveness and affordability for use in national guideline development. Addiction. 2015;110(9):1388-1403.

Wilson 2019 - Wilson DK, Lorig K, Klein WMP, et al. Efficacy and cost-effectiveness of behavioral interventions in nonclinical settings for improving health outcomes. Health Psychology. 2019;38(8):689-700.