Tobacco Quitlines

There is ample evidence that tobacco quitlines are efficacious (Borland et al., 2001; Stead et al., 2006; Zhu and Anderson, 2004), particularly when combined with other interventions (CDC, 2009b). Quitlines offer the advantage of generally being available when needed and free of charge for counseling. No appointments are necessary to access them, and patients can call them for individual counseling in privacy. Quitlines also help patients to overcome barriers to treatment, such as living at a considerable distance from a clinic or other treatment locations, being unable to attend counseling sessions because of work or social commitments, and waiting for the next tobacco-cessation program to begin.

The statewide use of a quitline as part of a comprehensive tobacco-use cessation program began in California in the early 1990s and was followed in Massachusetts. Now all 50 states and the District of Columbia have tobacco quitlines (http://www.smokefree.gov/). Any adult in need of tobacco-use cessation services can call a national telephone number (1-800-QUIT-NOW), which will route the caller to his or her state tobacco quitline; this referral service is sponsored by NCI. NCI also has a toll-free quitline at 1-877-44U-QUIT that has a smoking-cessation counselor available during the day for help in quitting and to provide answers to smoking-related questions in English or Spanish.

Although quitline access is available to all adults across a broad demographic spectrum, quitlines vary greatly in quality, intensity, and duration. Three factors increase their efficacy: proactive quitlines (participant may initiate call with proactive follow-up by quitline or a telephone counselor may initiate the call to the participant) rather than reactive quitlines (the participant initiates all calls to the quitline) (Stead et al., 2006); counseling that lasts longer (for example, at least four sessions) and that includes booster sessions (Hollis et al., 2007; Stead et al., 2006); and quitlines that provide NRTs (Fiore et al., 2008; Rabius et al., 2007).

Cummins et al. (2007) surveyed 62 publicly available quitlines in North America (all 50 states, the District of Columbia, Puerto Rico, and 10 Canadian provinces) in 2004–2005. Most of the US quitlines had trained counselors available for a mean of 85 hours/week, many of them offering counseling in 2 languages, and a few offering as many as 8 languages. All the quitlines offered multisession (generally 5 sessions) proactive telephone counseling, and some offered follow-up reactive sessions; the first session was usually 30 minutes long, and the follow-up sessions were shorter. In addition to their telephone counseling services, about 50% of the quitlines offered Internet-based services, including



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