Tobacco Use: Quitline Interventions

Summary of CPSTF Finding

The The Community Preventive Services Task Force (CPSTF) 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:

  1. Mass-reach health communication interventions that combine cessation messages with a quitline number
  2. Provision of free evidence-based tobacco cessation medications for quitline clients interested in quitting
  3. 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.


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).

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Promotional Materials

Community Guide News

About The Systematic Review

The CPSTF finding on quitline effectiveness is based on evidence from a systematic review published in 2013 (Stead et al., 77 studies, search period through June 2013). Results from the review were converted into Community Guide metrics and additional analyses were performed to determine whether intervention effectiveness diminishes with longer follow-up. This finding updates and replaces the 2000 CPSTF finding on Multicomponent Interventions that Include Telephone Support.

Evidence of effectiveness for quitline promotional efforts is based on a systematic review of 49 studies (search period through July 2012). Three promotional efforts to increase calls to quitlines were evaluated, including mass-reach health communication interventions (23 studies), provision of free cessation medications (12 studies), and quitline referral systems (14 studies).

The systematic reviews were conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.

Summary of Results

Seventy-seven studies were included in the review. Of these, 71 studies evaluated effectiveness of proactive telephone counseling.
  • Quitlines available to the general public
    • Tobacco cessation: median absolute percentage point increase of 3.1 percentage points (Interquartile interval [IQI]: 0.5 to 3.3 percentage points; 12 studies)
  • Quitlines for callers recruited from clinical or research settings
    • Tobacco cessation: median absolute percentage point increase of 1.7 percentage points (IQI:0.0 to 8.5 percentage points; 51 studies)
  • The remaining 8 studies used different outcome measures which could not be compared.

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).

To supplement findings on quitline effectiveness, the Task Force considered additional evidence from 49 studies that evaluated interventions to promote quitline use.

  • 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: mean absolute percentage point increase of 4.2 percentage points compared with callers who were not exposed to media messages (3.0 percentage points and 5.3 percentage points; 2 studies)
    • Increases in campaign intensity resulted in increases in quitline call volume (12 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 percent increase of 396% (IQI: 134% to 1132%; 9 studies)
    • Tobacco cessation rates among quitline callers: median absolute percentage point 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., provider 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 tobacco users: median absolute percentage point increase of 2.4 percentage points compared with non-referred tobacco users (IQI: 1.6 to 12.0 percentage points; 8 studies).

Summary of Economic Evidence

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 2013 U.S. dollars.
  • Cost-effectiveness of providing quitline counseling and cessation information: median estimate of $2,358 per quality-adjusted life year (QALY) saved (IQI: $1,761 to $3,156 per QALY; 6 studies)
  • Cost-effectiveness of adding cessation medications to existing quitline services: median estimate $849 per QALY saved (IQI $369 to $2,426 per QALY; 6 studies)
  • Cost-effectiveness of providing a combination of quitline counseling, nicotine replacement therapy (NRT), and media promotion: $5,965 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.


The CPSTF finding should be applicable to the tobacco users in the U.S. who are interested in quitting and either call quitlines themselves or are recruited to participate.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

Intervention Design

  • Few studies provided information to evaluate the effectiveness of reactive telephone counseling. Since this service format is common, additional studies should examine the effectiveness of single-session counseling when delivered reactively.
  • Studies should examine the relative and combined effectiveness of quitline services and cessation services provided through other digital media formats (like automated text messages on mobile phones, or web-based social support).

Quitline Promotion

  • Only a minority of tobacco users make use of quitline services despite evidence demonstrating effectiveness at population level. Hence, additional research is needed to increase quitline awareness both population-wide and in high-risk populations, including groups with high rates of tobacco use and tobacco-related diseases or limited access to health care and evidence-based cessation treatments.

Intervention Evaluation

  • Studies could attempt to measure or model the impact of quitline services on tobacco-related morbidity and mortality.

Economic Evaluation

  • Future economic studies should include the combined costs for both quitline promotion and quitline services
  • Additional studies should examine the economic costs and outcomes of quitline referral systems

Study Characteristics

  • All of the included studies were randomized controlled trials and assessed self-reported (47 studies) or biochemically verified (26 studies) cessation outcomes 6 months or more after the intervention.
  • Fifty-three of the 72 included studies were conducted in the United States; the remaining studies were conducted in Australia, Canada, Germany, Hong Kong, Norway, Spain, and the United Kingdom.
  • Although most included studies collected information about age, gender, race/ethnicity, and socioeconomic status (SES), cessation outcomes were not generally analyzed on these client characteristics.

Analytic Framework

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Included Studies

The Community Preventive Services Task Force recommendation for quitline interventions is based on evidence from two systematic reviews.
  • 7 studies published between March 2009 July 2012 (Community Guide review of updated evidence)
  • 65 studies published through March 2009 (Stead LF, Perera R, Lancaster T. Telephone counseling for smoking cessation. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub2.)

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Studies from The Community Guide Updated Review (search period March 2009 July 2012)

Bullock L, Everett KD, Mullen PD, Geden E, Longo DR, Madsen R. Baby BEEP: a randomized controlled trial of nurses’ individualized social support for poor rural pregnant smokers.Maternal & Child Health Journal 2009;13:395-406.

Ellerbeck EF, Mahnken JD, Cupertino AP, Cox LS, Greiner KA, et al. Impact of varying levels of disease management on smoking cessation: a randomized trial. Annals of Internal Medicine 2009;150(7):437-46.

Girgis S, Adily A, Velasco M, Zwar NA, Jalaludin BB, Ward JE. Feasibility, acceptability and impact of a telephone support service initiated in primary medical care to help Arabic smokers quit. Australian Journal of Primary Health 2011;17:274-81.

Graham AL, Cobb NK, Papandonatos GD, Moreno JL, Kang H, Tinkelman DG et al. A randomized trial of internet and telephone treatment for smoking cessation. Archives of Internal Medicine 2011;171(1):46-53.

Swan GE, McClure JB, Jack LM, Zbikowski SM, Javitz HS, Catz SL, et al. Behavioral counseling and varenicline treatment for smoking cessation. American Journal of Preventive Medicine 2010;38(5):482-90.

Tzelepis F, Paul CL, Wiggers J, Walsh RA, Knight J, Duncan SL, et al. A randomised controlled trial of proactive telephone counselling on cold-called smokers’ cessation rates. Tobacco Control 2011;20:40-6.

Zhu SH, Cummins SE, Wong S, Gamst AC, Tedeschi GJ, Reyes-Nocon J. The effects of a multilingual telephone quitline for Asian smokers: a randomized controlled trial. Journal of National Cancer Institute 2012;104:299-310.

Studies from Stead et al. (search period through March 2009)

Abdullah ASM, Mak YW, Loke AY, Lam TH. Smoking cessation intervention in parents of young children: a randomised controlled trial. Addiction 2005;100:1731 40.

An LC, Zhu S-H, Nelson DB, Arikian NJ, Nugent S, Partin MR, et al. Benefits of telephone care over primary care for smoking cessation. Archives of Internal Medicine 2006;166:536 42.

Aveyard P, Griffin C, Lawrence T, Cheng KK. A controlled trial of an expert system and self-help manual intervention based on the stages of change versus standard self-help materials in smoking cessation. Addiction 2003;98(3):345 54.

Borland R, Segan CJ, Livingston PM, Owen N. The effectiveness of callback counselling for smoking cessation: a randomized trial. Addiction 2001;96:881 9.

Borland R, Balmford J, Segan C, Livingston P, Owen N. The effectiveness of personalized smoking cessation strategies or callers to a Quitline service. Addiction 2003;98(6):837 46.

Borland R, Balmford J, Bishop N, Segan C, Piterman L, McKay-Brown L, et al. In-practice management versus quitline referral for enhancing smoking cessation in general practice: A cluster randomized trial. Family Practice 2008;25(5):382 9.

Boyle RG, Solberg LI, Asche SE, Maciosek MV, Boucher JL, Pronk NP. Proactive recruitment of health plan smokers into telephone counseling. Nicotine & Tobacco Research 2007;9:581 9.

Brown S, Hunt G, Owen N. The effect of adding telephone contact to self-instructional smoking-cessation materials. Behavior Change 1992;9:216 22.

Chouinard MC, Robichaud-Ekstrand S. The effectiveness of a nursing inpatient smoking cessation program in individuals with cardiovascular disease. Nursing Research 2005;54(4):243 54.

Curry SJ, McBride C, Grothaus LC, Louie D, Wagner EH. A randomized trial of self-help materials, personalized feedback, and telephone counselling with nonvolunteer smokers.Journal of Consulting and Clinical Psychology 1995;63:1005 14.

Duffy SA, Ronis DL, Valenstein M, Lambert MT, Fowler KE, Gregory L, et al. A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiology, Biomarkers & Prevention 2006;15(11):2203 8.

Ebbert JO, Carr AB, Patten CA, Morris RA, Schroeder DR. Tobacco use quitline enrollment through dental practices: a pilot study. Journal of the American Dental Association 2007; 138(5):595 601.

Emmons KM, Puleo E, Park E, Gritz ER, Butterfield RM, Weeks JC, et al. Peer-delivered smoking counseling for childhood cancer survivors increases rate of cessation: The Partnership for Health Study. Journal of Clinical Oncology 2005;23:6516 23.

Fiore MC, McCarthy DE, Jackson TC, Zehner ME, Jorenby DE, Mielke M, et al. Integrating smoking cessation treatment into primary care: An effectiveness study. Preventive Medicine 2004;38(4):412 20.

Gilbert H, Sutton S. Evaluating the effectiveness of proactive telephone counselling for smoking cessation in a randomized controlled trial. Addiction 2006;101:590 8.

Halpin HA, McMenamin SB, Rideout J, Boyce-Smith G. The costs and effectiveness of different benefit designs for treating tobacco dependence: results from a randomized trial. Inquiry 2006;43(1):54 65.

Hanssen TA, Nordrehaug JE, Eide GE, Hanestad BR. Improving outcomes after myocardial infarction: a randomized controlled trial evaluating effects of a telephone follow-up intervention. European Journal of Cardiovascular Prevention & Rehabilitation 2007;14(3):429 37.

Hennrikus DJ, Jeffery RW, Lando HA, Murray DM, Brelje K, Davidann B, et al. The SUCCESS Project: The effect of program format and incentives on participation and cessation in worksite smoking cessation programs. American Journal of Public Health 2002;92:274 9.

Hollis JF, McAfee TA, Fellows JL, Zbikowski SM, Stark M, Riedlinger K. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control 2007;16 Suppl 1:i53 9.

Holmes-Rovner M, Stommel M, Corser WD, Olomu A, Holtrop JS, Siddiqi A, et al. Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?. Journal of General Internal Medicine 2008;23(9):1464 70.

Joyce GF, Niaura R, Maglione M, Mongoven J, Larson-Rotter C, Coan J, et al. The effectiveness of covering smoking cessation services for medicare beneficiaries. Health Services Research 2008;43:2106 23.

Katz DA, Muehlenbruch DR, Brown RL, Fiore MC, Baker TB. Effectiveness of implementing the Agency for Healthcare Research and Quality smoking cessation clinical practice guideline: a randomized, controlled trial. Journal of the National Cancer Institute 2004;96(8):594 603.

Lando HA, Hellerstedt WL, Pirie PL, McGovern PG. Brief supportive telephone outreach as a recruitment and intervention strategy for smoking cessation. American Journal of Public Health 1992;82:41 6.

Lando HA, Rolnick S, Klevan D, Roski J, Cherney L, Lauger G. Telephone support as an adjunct to transdermal nicotine in smoking cessation. American Journal of Public Health 1997;87:1670 4.

Lichtenstein E, Andrews JA, Lee ME, Glasgow RE, Hampson SE. Using radon risk to motivate smoking reduction: evaluation of written materials and brief telephone counselling. Tobacco Control 2000;9:320 6.

Lichtenstein E, Boles SM, Lee ME, Hampson SE, Glasgow RE, Fellows J. Using radon risk to motivate smoking reduction II: randomized evaluation of brief telephone counseling and a targeted video. Health Education Research 2008;23(2):191 201.

Lipkus IM, Lyna PR, Rimer BK. Using tailored interventions to enhance smoking cessation among African-Americans at a community health center. Nicotine & Tobacco Research 1999; 1:77 85.

Lipkus IM, McBride CM, Pollak KI, Schwartz-Bloom RD, Tilson E, Bloom PN. A randomized trial comparing the effects of self-help materials and proactive telephone counseling on teen smoking cessation. Health Psychology 2004;23:397 406.

Macleod ZR, Charles MA, Arnaldi VC, Adams IM. Telephone counselling as an adjunct to nicotine patches in smoking cessation: a randomised controlled trial. Medical Journal of Australia 2003;179:349 52.

McBride CM, Scholes D, Grothaus LC, Curry SJ, Ludman E, Albright J. Evaluation of a minimal self-help smoking cessation intervention following cervical cancer screening. Preventive Medicine 1999;29:133 8.

McBride CM, Curry SJ, Lando HA, Pirie PL, Grothaus LC, Nelson JC. Prevention of relapse in women who quit smoking during pregnancy. American Journal of Public Health 1999; 89:706 11.

McBride CM, Baucom DH, Peterson BL, Pollak KI, Palmer C, Westman E, et al. Prenatal and postpartum smoking abstinence A partner-assisted approach. American Journal of Preventive Medicine 2004;27:232 8.

McClure JB, Westbrook E, Curry SJ, Wetter DW. Proactive, motivationally enhanced smoking cessation counseling among women with elevated cervical cancer risk. Nicotine & Tobacco Research 2005;7:881 9.

McFall SL, Michener A, Rubin D, Flay BR, Mermelstein RJ, Burton D, et al. The effects and use of maintenance newsletters in a smoking cessation intervention. Addictive Behaviors 1993;18:151 8.

Metz K, Floter S, Kroger C, Donath C, Piontek D, Gradl S. Telephone booster sessions for optimizing smoking cessation for patients in rehabilitation centers. Nicotine & Tobacco Research 2007;9(8):853 63.

Miguez MC, Vazquez FL, Becona E. Effectiveness of telephone contact as an adjunct to a self-help program for smoking cessation: a randomized controlled trial in Spanish smokers.Addictive Behaviors 2002;27:139 44.

Miguez MC, Becona E. Evaluating the effectiveness of a single telephone contact as an adjunct to a self-help intervention for smoking cessation in a randomized controlled trial.Nicotine & Tobacco Research 2008;10(1):129 35.

Miller NH, Smith PM, DeBusk RF, Sobel DS, Taylor CB. Smoking cessation in hospitalized patients – Results of a randomized trial. Archives of Internal Medicine 1997;157:409 15.

Ockene JK, Kristeller J, Goldberg R, Amick TL, Pekow PS, Hosmer D, et al. Increasing the efficacy of physician-delivered smoking interventions: a randomized clinical trial. Journal of General Internal Medicine 1991;6:1 8.

Orleans CT, Schoenbach VJ, Wagner EH, Quade D, Salmon MA, Pearson DC, et al. Self-help quit smoking interventions: effects of self-help materials, social support instructions, and telephone counseling. Journal of Consulting and Clinical Psychology 1991;59:439 48.

Orleans CT, Boyd NR, Bingler R, Sutton C, Fairclough D, Heller D, et al. A self-help intervention for African American smokers: tailoring cancer information service counseling for a special population. Preventive Medicine 1998;27(5):S61 S70.

Osinubi OY, Moline J, Rovner E, Sinha S, Perez-Lugo M, Demissie K, et al. A pilot study of telephone-based smoking cessation intervention in asbestos workers. Journal of Occupational and Environmental Medicine 2003;45(5):569 74.

Ossip Klein DJ, Giovino GA, Megahed N, Black PM, Emont SL, Stiggins J, et al. Effects of a smoker’s hotline: results of a 10-county self-help trial. Journal of Consulting and Clinical Psychology 1991;59:325 32.

Ossip Klein DJ, Carosella AM, Krusch DA. Self-help interventions for older smokers. Tobacco Control 1997;6:188 93.

Prochaska JO, Di Clemente CC, Velicer WF, Rossi JS. Standardized, individualized, interactive, and personalized self- help programs for smoking cessation. Health Psychology 1993;12(5):399 405.

Prochaska JO, Velicer WF, Fava JL, Ruggiero L, Laforge RG, Rossi JS, et al. Counselor and stimulus control enhancements of a stage-matched expert system intervention for smokers in a managed care setting. Preventive Medicine 2001;32(1):23 32.

Rabius V, McAlister AL, Geiger A, Huang P, Todd R. Telephone counseling increases cessation rates among young adult smokers. Health Psychology 2004;23(5):539 41.

Rabius V, Pike KJ, Hunter J, Wiatrek D, McAlister AL. Effects of frequency and duration in telephone counselling for smoking cessation. Tobacco Control 2007;16 Suppl 1:i71 4.

Reid RD, Pipe A, Dafoe WA. Is telephone counselling a useful addition to physician advice and nicotine replacement therapy in helping patients to stop smoking? A randomized controlled trial. Canadian Medical Association Journal 1999;160:1577 81.

Reid RD, Pipe AL, Quinlan B, Oda J. Interactive voice response telephony to promote smoking cessation in patients with heart disease: A pilot study. Patient Education & Counseling 2007;66(3):319 26.

Rigotti NA, Park ER, Regan S, Chang Y, Perry K, Loudin B, et al. Efficacy of telephone counseling for pregnant smokers: a randomized controlled trial. Obstetrics & Gynecology 2006;108:83 92.

Rimer BK, Orleans CT, Fleisher L, Cristinzio S. Does tailoring matter? The impact of a tailored guide on ratings and short-term smoking-related outcomes for older smokers. Health Education Research 1994;9:69 84.

Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C, et al. The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Preventive Medicine 2003;36(3):291 9.

Smith PM, Cameron R, McDonald PW, Kawash B, Madill C, Brown KS. Telephone counseling for population-based smoking cessation. American Journal of Health Behavior 2004;28(3):231 41.

Solomon LJ, Scharoun GM, Flynn BS, Secker-Walker RH, Sepinwall D. Free nicotine patches plus proactive telephone peer support to help low-income women stop smoking. Preventive Medicine 2000;31:68 74.

Solomon LJ, Marcy TW, Howe KD, Skelly JM, Reinier K, Flynn BS. Does extended proactive telephone support increase smoking cessation among low-income women using nicotine patches? Preventive Medicine 2005;40(3):306 13.

Sood A, Andoh J, Verhulst S, Ganesh M, Edson B, Hopkins-Price P. “Real-World” Effectiveness of Reactive Telephone Counseling for Smoking Cessation: A Randomized Controlled Trial.Chest 2009; 136(5):1229-36.

Sorensen G, Barbeau EM, Stoddard AM, Hunt MK, Goldman R, Smith A, et al. Tools for health: the efficacy of a tailored intervention targeted for construction laborers. Cancer Causes & Control 2007;18(1):51 9.

Stotts AL, Diclemente CC, Dolan-Mullen P. One-to-one A motivational intervention for resistant pregnant smokers. Addictive Behaviors 2002; 27(2):275 92.

Swan GE, McAfee T, Curry SJ, Jack LM, Javitz H, Dacey S, et al. Effectiveness of bupropion sustained release for smoking cessation in a health care setting: a randomized trial. Archives of Internal Medicine 2003;163:2337 44.

Thompson B, Kinne S, Lewis FM, Wooldridge JA. Randomized telephone smoking-intervention trial initially directed at blue-collar workers. Journal of the National Cancer Institute. Monographs 1993;14:105 12.

Velicer WF, Friedman RH, Fava JL, Gulliver SB, Keller S, Sun X, et al. Evaluating nicotine replacement therapy and stage-based therapies in a population-based effectiveness trial.Journal of Consulting & Clinical Psychology 2006;74(6):1162 72.

Young JM, Girgis S, Bruce TA, Hobbs M, Ward JE. Acceptability and effectiveness of opportunistic referral of smokers to telephone cessation advice from a nurse: a randomised trial in Australian general practice. BMC Family Practice 2008;9:16.

Zhu SH, Stretch V, Balabanis M, Rosbrook BP, Sadler G, Pierce JP. Telephone counseling for smoking cessation – effects of singlesession and multiple-session interventions. Journal of Consulting and Clinical Psychology 1996;64:202 11.

Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, Byrd M, et al. Evidence of real-world effectiveness of a telephone quitline for smokers. New England Journal of Medicine 2002;347(14):1087 93.

Economic Review

Updated Search Period (January 2000-January 2012)

An LC, Schillo BA, Kavanaugh AM, Lachter RB, Luxenberg MG, Wendling AH, et al. Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tobacco Control 2006;15(4):286-93.

Ayadi MF, Adams EK, Melvin CL, Rivera CC, Gaffney CA, Pike J, et al. Costs of a smoking cessation counseling intervention for pregnant women: Comparison of three settings. Public Health Reports 2006;121(2):120-6.

Bauer JE, Carlin-Menter SM, Celestino PB, Hyland A, Cummings KM. Giving away free nicotine medications and a cigarette substitute (Better Quit (R)) to promote calls to a quitline. Journal of Public Health Management and Practice 2006;12(1):60-7.

Bentz CJ, Bayley KB, Bonin KE, Fleming L, Hollis JF, McAfee T. The feasibility of connecting physician offices to a state-level tobacco quit line. American Journal of Preventive Medicine 2006;30(1):31-7.

Burns EK, Levinson AH. Reaching Spanish-speaking smokers: state-level evidence of untapped potential for QuitLine utilization. Am J Public Health 2010 April; 100(Suppl 1): S165 S710.

Cummings KM, Fix B, Celestino P, Carlin-Menter S, O’Connor R, Hyland A. Reach, efficacy, and cost-effectiveness of free nicotine medication giveaway programs. Journal of Public Health Management and Practice 2006;12(1):37-43.

Cummings KM, Hyland A, Carlin-Menter S, Mahoney MC, Willett J, Juster HR. Costs of giving out free nicotine patches through a telephone quit line. Journal of Public Health Management and Practice 2011;17(3):E16-23.

Deprey M, McAfee T, Bush T, McClure JB, Zbikowski S, Mahoney L. Using free patches to improve reach of the oregon quit line. Journal of Public Health Management and Practice 2009;15(5):401-8.

Ellerbeck EF, Mahnken JD, Cupertino AP, Cox LS, Greiner KA, Mussulman LM, et al. Impact of varying levels of disease management on smoking cessation: a randomized trial. Annals of Internal Medicine 2009;150(7):437-46.

Farrelly MC, Hussin A, Bauer UE. Effectiveness and cost effectiveness of television, radio and print advertisements in promoting the New York smokers’ quitline. Tobacco Control 2007;16(Suppl 1):i21-3.

Fellows JL, Bush T, McAfee T, Dickerson J. Cost effectiveness of the Oregon quitline “free patch initiative”. Tobacco Control 2007;16(Suppl 1):i47-52.

Feenstra TL, Hamberg-van Reenen HH, Hoogenveen RT, Rutten-van M lken MP. Cost-effectiveness of face-to-face smoking cessation interventions: a dynamic modeling study. Value in Health 2005;8(3):178-90.

Hollis JF, McAfee TA, Fellows JL, Zbikowski SM, Stark M, Riedlinger K. The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control 2007;16(Suppl 1):i53-9.

Keller PA, Bailey LA, Koss KJ, Baker TB, Fiore MC. Organization, financing, promotion, and cost of US quitlines, 2004. American Journal of Preventive Medicine 2007;32(1):32-7.

Maher JE, Rohde K, Pizacani B, Dent C, Stark MJ, Dilley JA, et al. Does free nicotine replacement therapy for young adults prompt them to call a quitline? Tobacco Control 2007;16(5):357-8.

McAlister A, Rabius V, Geiger A, Glynn T, Huang P, Todd R. Telephone assistance for smoking cessation: one year cost effectiveness estimations. Tobacco Control 2004;13(1):85-6.

Miller N, Frieden TR, Liu SY, Matte TD, Mastashari F, Deitcher DR, et al. Effectiveness of a large-scale distribution programme of free nicotine patches: a prospective evaluation. Lancet 2005;35(9474):1849 54.

Mosbaek CH, Austin DF, Stark MJ, Lambert LC. The association between advertising and calls to a tobacco quitline. Tobacco Control 2007;16(Suppl 1):i24-9.

O’Dea D. An economic evaluation of the Quitline nicotine replacement therapy (NRT) service. Wellington: Ministry of Health; 2004.

Parker DR, Windsor RA, Roberts MB, Hecht J, Hardy NV, Strolla LO, et al. Feasibility, cost, and cost-effectiveness of a telephone-based motivational intervention for underserved pregnant smokers. Nicotine & Tobacco Research 2007;9(10):1043-51.

Saul JE, Lien R, Schillo B, Kavanaugh A, Wendling A, Luxenberg M, et al. Outcomes and Cost-Effectiveness of Two Nicotine Replacement Treatment Delivery Models for a Tobacco Quitline. International Journal of Environmental Research and Public Health 2011;8:1547-9.

Shearer J, Shanahan M. Cost effectiveness analysis of smoking cessation interventions. Australian and New Zealand Journal of Public Health 2006;30(5):428-34.

Swartz SH, Cowan TM, Klayman JE, Welton MT, Leonard BA. Use and effectiveness of tobacco telephone counseling and nicotine therapy in Maine. American Journal of Preventive Medicine 2005; 29(4):288 94.

Tomson T, Helgason AR, Gilljam H. Quitline in smoking cessation: a cost-effectiveness analysis. International Journal of Technology Assessment in Health Care 2004;20(4):469-74.

Tzelepis F, Paul CL, Walsh RA, Wiggers J, Knight J, Lecathelinais C, et al. Telephone recruitment into a randomized controlled trial of quitline support. American Journal of Preventive Medicine 2009;37(4):324.

Wilson N, Grigg M, Graham L, Cameron G. The effectiveness of television advertising campaigns on generating calls to a national Quitline by M ori. Tobacco Control 2005;14(4):284-6.

Additional Materials

Implementation Resource

Rural Health Information Hub, Tobacco Control and Prevention Toolkit
This toolkit compiles information, resources, and best practices to support development and implementation of tobacco control and prevention programs in rural communities. Modules include program models, implementation and evaluation resources, and funding and dissemination strategies.

Search Strategies

To update the evidence, the following databases were searched from January 2000 to January 2012 to identify English-language studies that assessed the effectiveness of interventions to reduce tobacco use and secondhand smoke exposure: Cochrane database, Embase, Medline, PsycINFO, PubMed. Intervention studies specific to this review were subsequently identified during the screening process.

Effectiveness Review

Limit to 2000 current (July 2012)

English language articles only

Tobacco cessation [MeSH]


((Title words: quit or quitting or quit line(s) or quitline(s) or abstinence or abstinent or stop or stopped or stopping or cessation or telephone or hotline(s)


telephone[MeSH] or hotlines[MeSH])


(Smoking[MeSH] or tobacco[MeSH] or tobacco, smokeless[MeSH] or tobacco use disorder[MeSH]


Title words: cigar(s) or cigarette(s) or tobacco or tobaccos or hookah(s) or hubble-bubble or narghile or shisha or smokeless or snuff or snuffs or (waterpipe(s) and (tobacco or smoking or smoke)) or (pipe(s) and (smoke or smoking or tobacco)) )

Economic Review

To conduct the economic review, the review team also searched the following economics databases using the search strategies noted below.

Database: Centre for Reviews and Dissemination at the University of York

(tobacco or smoking or cigarette or cigarettes) AND (cost or costs or model* or benefit or utility or qaly or efficiency or dollar* or model* or reimburse* or price or pricing or priced or prices or economic* or tax or taxes or taxed) RESTRICT YR 2000-2012

Database: Web of Science – Social Science Citation Index

Title=(tobacco or smoking or cigarette*) AND Title=(economic* or model* or taxes or tax or taxed or price* or pricing or cost or costs or utility or qaly or dollar* or efficiency or reimburse*) AND Language=(English) Timespan 2000-2012

Database: EconLit

(Tobacco or cigarette* or smoking)


(economics or cost or costs or benefit or benefits or utility or qaly or “quality-adjusted life year” or efficiency or dollar or dollars or “dynamic modeling” or “dynamic modelling” or reimbursement* or “simulation model*” or “price elasticity” or “economic impact” or media or television or broadcast* or radio or tv or “motion picture*” or films or movies or magazine* or newspaper* or “multimedia” or “multi media” or “mass communications*” or audiovisual or telecommunications or televised or campaign* or marketing or advertis* or label or labels or labeling or labeled or labeled or labeling or communit* or policy or policies or telephone or twitter or facebook or “social media” or access* or increase* or increasing or price* or prohibit* or assist* or restaurant or pub or pubs or disco or discos or bars or nightclub* or clubs or “public places” or “quality adjusted” or youth or child* or school* or student* or adolescent* or teen* or juvenile* or girls or boys or kids or minors or prevention or intervention* or program* or promotion or promoting or cessation or quitline* or helpline* or “quit line*” or workplace * or occupation* or psychology or reduc* or stop or stopping or quit or quitting or contest* or uptake or onset or start* or occupational or smokeless or “smoke-free” or smokefree or law or laws or ordinance* or regulat* or tax or taxed or taxes or taxing or fee or fees or jurisprudence or control* or legislat* or free or legal or model* or politic* or war or kick or habit* or coalition* or initiat*) Limit to English, 2000-2012

Database: JSTOR

(tobacco or smoking or cigarette or cigarettes) AND (cost or costs or model* or benefit or utility or qaly or efficiency or dollar* or model* or reimburse* or price or pricing or priced or prices or economic* or tax or taxes or taxed) RESTRICT YR 2000-2012

Review References

Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Control Programs-2007. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; October 2007.

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, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD002850. DOI: 10.1002/14651858.CD002850.pub3.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.
  • Quitline services are available to most tobacco users in the United States through 1-800-QUIT-NOW. There is some variation in the treatments offered; some state services do not include proactive counseling.
  • Obstacles to quitline use may include clients’ lack of awareness about the services available, uncertainties about service costs, concerns about confidentiality, and barriers related to language and cultural issues.
  • Quitline use and benefits are likely to be amplified when provided as part of a comprehensive approach to tobacco control and prevention and coordinated with other national, state, and local interventions (CDC, 2007).