Reducing Tobacco Use and Secondhand Smoke Exposure: Quitline Interventions
Quitlines use the telephone to provide evidence-based behavioral counseling and support to help tobacco users who want to quit. Counseling is provided by trained cessation specialists who follow standardized protocols that may include several sessions delivered over one or more months.
Quitline counseling is widely accessible, convenient to use, and generally provided at no cost to users. Content may be adapted for specific populations, and tailored for individual clients. Counseling may be:
- Reactive (tobacco user or recent quitter initiates contacts), or
- Proactive (tobacco user or cessation specialist makes initial contact, and the cessation specialist schedules follow-up calls).
Quitlines may provide additional interventions such as mailed self-help materials, integrated web-based and text-messaging support, and evidence-based, FDA-approved medications for tobacco cessation (Fiore et al., 2008).
Summary of Task Force Recommendations and Findings
The Community Preventive Services Task Force recommends quitline interventions, particularly proactive quitlines (i.e. those that offer follow-up counseling calls), based on strong evidence of effectiveness in increasing tobacco cessation among clients interested in quitting. Evidence was considered strong based on findings from 60 trials of proactive telephone counseling when provided alone or in combination with additional interventions.
Three interventions effective at increasing use of quitlines are:
- Mass-reach health communication interventions that combine cessation messages with a quitline number
- Provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting
- Quitline referral interventions for health care systems and providers.
Evidence also indicates that quitlines can help to expand the use of evidence-based services by tobacco users in populations that historically have had the most limited access to and use of evidence-based tobacco cessation treatments.
Results from the Systematic Review
The Task Force finding is based on evidence from a systematic review published in 2009 (Stead et al., search period through March 2009) combined with more recent evidence (search period March 2009 - July 2012). It updates and replaces a previous Task Force finding on Multicomponent Interventions that Include Telephone Support.
Seventy-two studies were included in this review (65 from Stead et. al., 2009 and 7 from the more recent search). Of these studies, 60 evaluated effectiveness of proactive telephone counseling.
- Quitlines available to the general public
- Tobacco cessation: median absolute increase of 3.1 percentage points (Interquartile interval [IQI]: 1.5 to 3.3 percentage points; 11 studies)
- Quitlines for callers recruited from clinical or research settings
- Tobacco cessation: median absolute increase of 1.7 percentage points (IQI:0.0 to 8.4 percentage points; 49 studies)
Six studies evaluated effectiveness of reactive telephone counseling.
- Different counseling approaches showed inconsistent effects on cessation (3 studies).
- Providing a quitline number to tobacco users showed inconsistent effects on cessation (3 studies).
Six studies used different outcome measures that could not be compared.
To supplement findings on quitline effectiveness, the Task Force considered additional evidence from 49 studies that evaluated interventions to promote quitline use (search period January 2000 – July 2012).
- Mass-reach health communication interventions that used messages tagged with the quitline number were evaluated in 23 studies
- Quitline call volume: median relative increase of 132% (IQI: 39% to 379%; 11 studies)
- Tobacco cessation rates among quitline callers: absolute increases in cessation rates of 3.0 and 5.3 percentage points compared with callers who were not exposed to media messages (2 studies)
- Increases in campaign intensity resulted in increases in quitline call volume (10 studies).
- Quitline promotions offering free evidence-based tobacco cessation medications (primarily nicotine replacement therapy) to callers were evaluated in 12 studies.
- Quitline call volume: median relative increase of 396% (IQI: 134% to 1132%; 9 studies)
- Tobacco cessation rates among quitline callers: median absolute increase of 9.8 percentage points compared with callers who were not offered nicotine replacement therapy (IQI: 7.4 to 15.7 percentage points; 11 studies)
- Health system-based quitline referral interventions (e.g., physician referrals) were evaluated in 14 studies.
- Rather than examine overall changes in quitline call volume, most of these studies found increases in the number of quitline referrals from participating clinical settings. In one study from Wisconsin, fax referrals accounted for 30% of the 12,000 annual quitline callers (Perry et al. 2005).
- Tobacco cessation rates for referred callers: median absolute increase of 2.4 percentage points compared with non-referred callers (IQI: 1.6 to 12.0 percentage points; 8 studies)
Twenty-seven studies were included in the economic review. Twelve studies provided 13 estimates of cost-effectiveness measurements of different quitline services. All monetary values from studies are reported in 2010 U.S. dollars.
- Cost-effectiveness of providing quitline counseling and cessation information: median estimate of $2,012 per quality-adjusted life year (QALY) saved (range of values: $439/QALY to $2,627/QALY; 6 studies)
- Cost-effectiveness of adding cessation medications to existing quitline services: median estimate $795 per QALY saved (range of values: $272/QALY to $4,110/QALY; 6 studies)
- Cost-effectiveness of providing a combination of quitline counseling, nicotine replacement therapy (NRT), and media promotion: $7,813 per QALY saved (1 study)
Estimates of cost-effectiveness were assessed in comparison to a conservative threshold of $50,000 per QALY saved. Overall, the economic evidence indicates that quitline services are cost-effective across a range of different treatments and promotional approaches.
These results were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to tobacco use and secondhand smoke exposure.
- Analytic Framework [PDF - 104 kB]
- Evidence Gaps
- Included Studies
- Search Strategy
- Summary Evidence Tables
- Updated Search Period (March 2009 - July 2012) [PDF - 99 kB]
- Mass-Reach Health Communication Interventions to Promote Quitline Use [PDF - 166 kB]
- Quitline Promotions Offering Fee Evidence-Based Tobacco Cessation Medications [PDF - 118 kB]
- Health System-Based Quitline Referral Interventions [PDF - 135 kB]
Full peer-reviewed articles of this systematic review will be posted on the Community Guide website when published. Subscribe to be notified when we post these publications or other materials. See our library for previous Community Guide publications on this and other topics.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Perry RJ, Keller PA, Fraser D, Fiore MC. Fax to quit: a model for delivery of tobacco cessation services to Wisconsin residents. Wisconsin Medical Journal 2005;104(4):37-40.
Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub2.
The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.
The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Reducing tobacco use and secondhand smoke exposure: quitline interventions. www.thecommunityguide.org/tobacco/quitlines.html. Last updated: MM/DD/YYYY.
Review completed: August 2012
- Page last reviewed: December 11, 2013
- Page last updated: December 11, 2013
- Content source: The Guide to Community Preventive Services