Quitlines and the Expansion of Smoking Cessation Support

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Key Points

  • Smoking remains the single greatest cause of preventable disease and death in the United States and is the leading cause of lung cancer.
  • Lung cancer is the number one cause of cancer death for both men and women.
  • The National Cancer Institute (NCI) helps people quit smoking by championing the research, development, and implementation of smoking cessation quitlines—telephone-based counseling services that offer coaching, referrals, resource materials, provider training, Web-based services, and free or discounted quitting medications.
  • A legacy of research, both conducted and supported by NCI, has shown that quitlines are highly effective in helping tobacco users quit.
  • NCI continues to fund smoking cessation research and, through innovative technological approaches such as text messaging, is testing new ways of delivering smoking cessation counseling and support.

Pathway to Discovery

Smoking’s harmful effect on our nation’s health is a long and tragic story, and it remains the single greatest cause of preventable disease and death in the country. Smoking remains the leading cause of lung cancer with 9 in 10 lung cancer deaths among men and about 8 in 10 lung cancer deaths among women due to smoking. Smoking also causes colorectal cancer, liver cancer, and heart disease, as well as breast, prostate, throat, mouth, nasal cavity, esophagus, stomach, pancreas, kidney, bladder, and cervical cancer.

Photo collage of healthy life road sign, calendar with a note to quit smoking, and hand reaching for phone.

Quitlines are an effective, inexpensive, and personalized option to help people quit smoking.

NCI introduces a dynamic new character to the story of smoking and cancer—quitlines. In the early 1980s, NCI’s Cancer Information Service (CIS) discovered that many people calling its toll-free number were looking for information about how to quit smoking. In response to this need, NCI created the nation’s first free telephone-based smoking cessation service, which has been a model for smoking cessation quitlines in tobacco control programs around the world.

Quitlines are telephone-based counseling services that help tobacco users quit smoking. The counseling involves an in-depth interaction between a smoking cessation counselor and the caller to help motivate the caller to quit. This interaction can occur in a single counseling session or in multiple sessions, and is tailored to the specific needs of each caller.

Photo of Erik Augustson, PhD, MPH, Program Director, Tobacco Control Research Branch, NCI.

Erik Augustson, PhD, MPH, is the Program Director for NCI’s Tobacco Control Research Branch, which houses NCI’s smoking cessation website, smokefree.gov.

Research confirms the role that quitlines play in helping people stop smoking. Dr. Erik Augustson from NCI’s Tobacco Control Research Branch (TCRB) and colleagues studied whether Americans are aware of quitlines. Using data from NCI’s Health Information National Trends Survey, they found that about half of all Americans were aware of quitlines. Of those who were aware, 65% were people who smoke. In addition, NCI’s investment in the first CIS smoking cessation quitline resulted in research to assess its effectiveness. The study findings were so promising that in 1992, the California Health and Human Services Agency created the first state-based quitline, which due to its continued success, still operates today.

Based on NCI’s success, quitlines were rapidly established across the country and in Europe, Australia, and New Zealand in the early 2000s. Researchers simultaneously continued to investigate the effectiveness of quitlines. In 2006, the Cochrane Collaboration—known for promoting evidence-based health care —conducted an independent study to determine whether quitlines were effective in helping smokers quit. The study, updated in 2013,reviewed 77 studies, including NCI-funded studies, and found that telephone counseling was significantly more effective in helping smokers quit (25-50% more likely to quit) than self-help materials or brief telephone support. This reaffirmed NCI’s commitment to and investment in the value of quitlines for smoking cessation support. Thanks to NCI, an exciting new chapter in the story of smoking and cancer was being written.

Enhancing Cancer Prevention

Research, both conducted and supported by NCI, show that quitlines work. Studies have found that compared with minimal counseling or no counseling, quitlines better help people quit smoking. Studies have also found that, quitline counseling plus medications significantly help people avoid smoking compared with use of medications alone. Research also shows that telephone quitline counseling is effective with diverse populations and reaches a broad audience.

Quitlines become a recommended component of smoking cessation efforts. Quitlines are now a key component of CDC’s National Comprehensive Cancer Control Program (NCCCP) and are recommended by the Guide to Community Preventive Services and included in the U.S. Department of Health and Human Services’ (HHS) clinical practice guidelines on Treating Tobacco Use and Dependence. The research findings on quitlines are so strong that the 2008 clinical practice guideline for treating tobacco use and dependence recommends that clinicians and health care systems promote telephone quitlines to their patients who smoke.

Studies have also shown that quitlines are cost-effective and provide smokers easy access to one-on-one smoking cessation counseling by eliminating barriers such as transportation, child care, insurance coverage, and out-of-pocket costs. Other research has shown that smokers are four times as likely to use a quitline compared with traditional face-to-face counseling.

Because they are able to reach and serve tobacco users regardless of their location and because they are effective, quitlines have spread quickly across North America. In the United States, all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, and the Territory of Guam offer quitline services as part of their comprehensive tobacco control programs.

Turning Discovery into Health

Illustration of one-month smokefree milestone message from smokefree.gov.

NCI champions research, development, and use of quitlines to help people stop smoking and prevent cancer.

The journey to quit smoking can be challenging and is often marked by relapse and multiple attempts to quit. Quitlines provide smokers with support that is convenient, flexible, and tailored to their immediate needs and schedule. Quitlines also serve as a gateway to resources such as medications to help quit, broader health information, help with managing chronic diseases, and counseling services that equip smokers with tips, tools and referrals to support their journey to quit and stay smoke-free.

NCI continues to provide free help to anyone who wants to quit smoking through its quitline. Support is offered both byphone and online chat:

  • Smoking Quitline: 1-877-44U-QUIT (1-877-448-7848)
  • LiveHelp online chat

NCI also developed and supports Smokefree.gov which provides smoking cessation information and support. Created by the TCRB, the site utilizes findings from NCI-funded research studies and continue to expand both information and support options for smokers. NCI also has specific sites for women, teens and Spanish-speaking communities that provide tips and supportive information to help smokers prepare for quitting and continue to remain “smokefree” after their quit day. NCI extends its smoking cessation support with text messaging through its SmokefreeTXT program and social media with its SmokeFreeTXT Facebook page and @SmokefreeGov on Twitter.

NCI expands smoking cessation support with text messaging. Today’s quitlines offer a variety of services, including coaching, referrals, mailed materials, training to health care providers, and Web-based services. Most quitlines also offer free or discounted quitting medications, such as nicotine replacement therapy (NRT). The creation of quitlines and the study of their effectiveness have also led researchers to explore innovative ways of providing smoking cessation services.

Not only does NCI offer SmokefreeTXT, NCI continues to explore ways to improve upon text messaging as a smoking cessation support mechanism. NCI funded Dr. Lorien Abroms’ study at George Washington University that investigated the use of text messaging combined with enhanced counseling services. In Dr. Abroms’ study, she and colleagues recruited 503 smokers on the internet and randomized them to receive either a text-messaging program called Text2Quit or self-help material aimed at encouraging smokers to quit. Text2Quit gives smokers advice and invites them to ask for more help or to reset a quit date if they need more time. Smokers who have trouble fighting an urge can also text in and receive a tip or a game that might help curb the craving. The study found that people using text-messaging programs had a higher likelihood of quitting compared to the control group (11% compared to 5%) and that they were more likely to abstain from smoking more often (19.9% compared to 10%). These results suggest that text-messaging programs could be a supporting character in helping someone in their journey to quit smoking.

Proactive approaches take center stage. Other studies are exploring differences in reactive versus proactive approaches in providing quitline services and smoking cessation support. In proactive approaches, the counselor initiates one or more calls. Reactive approaches depend on the smoker, friend or family member to initiate the call. With reactive approaches, some interventions seek to provide better access to the quitline to increase awareness of the service and drive motivation. Other studies have explored the effectiveness of having clinicians fax a referral for a patient to a quitline. This enables quitlines to proactively contact interested patients who smoke and offer smoking cessation support versus waiting for a patient to first contact the quitline.

Research to Practice: NCI’s Role

Because of NCI’s commitment to and success in advancing smoking cessation support services and cancer prevention efforts, in 2004 the Department of Health and Human Services asked NCI to create a telephone portal. This portal would allow callers from anywhere in the United States to connect to a state-based quitline through one number. Responding to the task, NCI collaborated with the Centers for Disease Control and Prevention (CDC) to create 1-800-QUIT-NOW, a national toll-free portal that routes callers directly to their state’s quitline. Developing this universal point of access via a single toll-free number helped to unify state-based quitlines and smoking cessation promotion efforts throughout the country.

In 2012, NCI supported the first federally funded national tobacco media campaign. The campaign, called Tips from Former Smokers (TIPS), was a collaborative effort with CDC and showed former smokers talking about their experiences living with diseases caused by smoking, including cancer. The TIPS campaign encouraged adult smokers to quit by making them aware of the harm caused by smoking. The main call-to-action featured in the campaign was letting people who smoke know that they could call NCI’s quitline or access NCI’s free, smoking cessation resources online. The TIPS campaign increased calls to NCI’s quitline, 1-800-QUIT-NOW, by 136% compared with the volume of calls in the same period the year before.

NCI also holds a seat on the advisory committee of the North American Quitline Consortium (NAQC), which was established in 2004 to create standards for the operation and evaluation of quitlines. NAQC provides leadership, case studies, and forums to help advance smoking cessation science that can be applied by health departments, quitline service providers, researchers, and national organizations to maximize the access, use, and effectiveness of quitlines across North America. This collaborative approach is helping NCI to rewrite the story of smoking and cancer using evidence and lessons learned to create a smokefree and cancer free future.

Key Takeaway

Smoking is the leading cause of cancer and death from cancer. Quitlines offer a variety of services and support to help smokers quit and stay quit.

Selected Resources

Abroms L. Using Text Messaging & Email to Enhance Counseling Services at NCI’s Smoking Cessation Quitline.

Anderson CM, Zhu SH. Tobacco quitlines: looking back and looking ahead. Tob Control. 2007;16(1):i81-i86. [PubMed Central]

Anderson DM, Duffy K, Hallet CD, Marcus AC. Cancer prevention on telephone helplines. Public Health Rep. 1992;107(3):278-289. [PubMed Central]

Augustson E, Bright MA. Increases in quitline calls and smoking cessation website visitors during a national tobacco education campaign. MMWR. 2012;61(34):669-670.

Barry MB, Saul J, Bailey LA. U.S. Quitlines at a Crossroads: Utilization, Budget and Service Trends 2005-2010. Phoenix, AZ: North American Quitline Consortium; 2010.

Campbell SH, Ossip-Klein DJ, Bailey L, et al. Minimal dataset for Quitlines: a best practice. Tob Control. 2007;16(suppl 1):i16-i20. [PubMed Central]

Cobb NK, Graham AL, Abrams DB. Social network structure of a large online community for smoking cessation. Am J Pub Health. 2010;100(7):1282-1289. [PubMed Central]

Community Preventive Services Task Force. Increasing Tobacco Use Cessation. Atlanta, GA: Task Force on Community Preventive Services; 2011.

Community Preventive Services Task Force. Reducing Tobacco Use and Secondhand Smoke Exposure: Quitline Interventions. Atlanta, GA: Task Force on Community Preventive Services; 2012.

Fiore MC, Jaén 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; 2008.

Kaufman A, Augustson E, Davis K, et al. Awareness and use of tobacco quitlines: evidence from the Health Information National Trends Survey. J Health Comm. 2010;15(3):264-278. [PubMed Central]

McAfee T, Sofian NS, Wilson J, Hindmarsh M. The role of tobacco intervention in population-based health care: a case study. Am J Prev Med. 1998;14(suppl 3):46-52. [PubMed]

Ossip-Klein DJ, McIntosh S. Quitlines in North America: evidence base and applications. Am J Med Sci. 2003;326(4):201-205. [PubMed Abstract]

Sarna L, Bialous S, Wewers ME, et al. Nurses trying to quit smoking using the Internet. Nurs Outlook. 2009;57(5):246-256. [PubMed Abstract]

Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Syst Rev. 2013;8:CD002850. [PubMed Abstract]

U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General—Smoking Among Adults in the United States: Cancer. Atlanta, GA: 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; 2004.

U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Executive Summary. Atlanta, GA: 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; 2014.

Zhu SH, Anderson CM, Tedeschi GJ. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med. 2002;347(14):1087-1093. [PubMed Abstract]

Zhu SH, Stretch V, Balabanis M, et al. Telephone counseling for smoking cessation: effects of single-session and multiple-session interventions. J Consult Clinical Psychol. 1996;64(1):202-211. [PubMed Abstract]

  • Posted: December 5, 2014