general quitline information, cessation information, self-directed quit plans, automated e-mail messages, chat rooms, and interactive counseling. About one-third of the quitlines mailed free medications to callers, and 23% provided vouchers for medications. Although many of the quitlines had specialized protocols for pregnant women, smokeless-tobacco users, ethnic populations, and people 12–17 years old, far fewer offered protocols for multiple addictions, people 18–24 years old, those with mental illness, or older adults. Most of the quitlines had some criteria for receiving free medications, such as lack of insurance coverage.

The North American Quitline Consortium (NAQC) was established to help federal and state health departments, quitline service providers, researchers, and service providers, such as the American Cancer Society, to improve quitline services. In addition to the state quitlines and the service providers, NAQC members include CDC, the Robert Wood Johnson Foundation, the American Legacy Foundation, ClearWay Minnesota, and several Canadian organizations. NAQC is one resource for information about current quitline services, improving quitline quality, and assessing quitline efficacy and research.

Although quitlines are acknowledged to be effective in reaching a large number of tobacco users and can be tailored to reach specific audiences, they do have limitations. Quitlines typically reach only a small proportion of their target populations and are chronically underfunded. The 2003 National Action Plan for Tobacco Cessation (Fiore, 2003) recommended that state quitlines use at least four person-to-person proactive calls, that there be no cost to insurers for the use of the quitline by eligible tobacco users, and that all NRTs be made available to quitline users free of charge or that users receive vouchers for prescription medications. The plan also called for states to receive earmarked grants to maintain their quitlines and for quitlines to meet national performance standards. Zhu and Anderson (2004) noted that the promotion of a quitline may prompt tobacco users to attempt to quit on their own even if they did not contact the quitline (Zhu and Anderson, 2004). Quitlines therefore may reach a broader audience than only tobacco users who are seeking counseling, including their friends and family who may call to request information on how to support or initiate quit attempts by tobacco users.



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