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Case Studies

The Impact on Quitlines When Graphic Warning Labels Include a Quitline Number: Australia  and New Zealand Case Studies

As of August 2012, 56 countries in the Americas, Eastern Mediterranean, Europe, South-East Asia and Western Pacific regions require pictures or images on cigarette packs (some of these are still being implemented).1 Graphic Warning Labels (GWLs) on tobacco packaging in countries like Canada, Australia and New Zealand include concrete information on ways to quit such as quitline numbers and website addresses and their experiences to-date indicate that including cessation resources on the label are an effective way to encourage tobacco users to quit. In fact, approximately 20 nations currently require a quitline number on their tobacco package labeling, including Finland, the Netherlands, Denmark, Iceland, Malta, the U.K., France, Sweden, Hungary, Poland, Germany, Belgium, South Africa, Brazil, Singapore, Australia, Switzerland, New Zealand and Norway.2

While the evidence on the impact of GWLs is clear and the evidence for the effectiveness of the inclusion of a quitline number on warning labels growing, less is known about the impact of GWLs on quitline operations when labels first begin to include a quitline number. What is the immediate impact on call volume when these labels are first announced and how are spikes in volume best addressed operationally? Does volume become increasingly steady over time? Do the types of callers to the quitline change as a result and hence, counseling protocols? In an attempt to answer these and other questions related to implementation and impact of GWLs that include a quitline number, the Global Quitline Network (GQN) has published two case studies that focus on four areas:

  • Preparing for implementation
  • Promoting the new warning labels
  • Impact on quitline service delivery and utilization
  • Evaluation of outcomes
Highlighting Australia and New Zealand, the purpose of the case studies is to describe implementation of warning labels that include a quitline number within a real-world quitline setting, noting the programmatic and operational issues that emerged and how they were addressed. GQN’s aim is to provide quitline service providers and quitline funders with valuable information to support successful preparation and implementation.

Australia Case Study (PDF 735KB)
New Zealand Case Study (PDF  711 KB)

A Case Study to Support Gaining Federal Medicaid Match for State Tobacco Cessation Quitlines: Maryland

With the goal to inspire, support, encourage and direct states in their cost-sharing efforts, this resource offers quick-to-read yet detailed guidance from one successful state, with broader lessons learned through NAQC’s Medicaid Learning Community woven throughout. Important things to consider before moving forward in partnership with Medicaid are highlighted, as well as building blocks for success. The case study includes the following sections:

1. Background
2. Building the Relationship
3. Challenges to the Relationship
4. Building the Agreements: Memorandum of Understanding and Cost Allocation Plan
5. Building the Infrastructure
6. Challenges to the Process
7. Final Thoughts
8. Resources

Maryland Case Study (PDF 663 KB)

Innovative Approaches and Proven Strategies for Maximizing Reach

In an effort to improve the reach across all quitlines in North America, and as part of an overall focus on critical quality measures including quit rates and reach to specific populations, NAQC has developed a Web repository of case studies on states that have achieved a reach that is at least three times higher than the median reach of all state quitlines.1 The information shared in this resource will help other members identify mechanisms and approaches for increasing the reach of their quitlines and is intended to compliment NAQC’s 2009 publication, Increasing Reach of Tobacco Cessation Quitlines (2009).

While it is important to remember that reach is not the only or most important measure of quitline value, the following case studies focus on experiences with various strategies intended to increase the reach of a state quitline. Each case study highlights the methods employed to maximize reach, opportunities, challenges, and lessons learned by states and their partners. These case studies can assist other states and provinces working to increase the reach of their quitline services by providing information about key outreach and promotional strategies and approaches and the potential impact on reach.

Each case study includes:
  • An overview of the strategic objectives of the quitline and the services offered
  • The promotional and outreach strategies employed to maximize reach
  • Key elements of success
  • Evaluation efforts for various strategies
  • Sustaining strategies over time
  • Lessons learned and key opportunities

Iowa Case Study(PDF 925KB)
New York Case Study(PDF 1MB)
Oklahoma Case Study (PDF 467KB)
South Dakota Case Study (PDF 205KB)


Providing Cessation Services during the Implementation of Smoke-Free Policies

The following case studies focus on experiences of states providing cessation services during the implementation of new statewide smoke-free policies. Each case study highlights the main issues, opportunities, challenges, and lessons learned by quitlines and their partners. These case studies can assist other states with plans to promote their quitlines during policy implementation by providing information about implementation strategies and approaches and the potential impact on quitline services. Learn more about this group of case studies.

Arizona Case Study (PDF 258KB)
Colorado Case Study (PDF 330KB)
Nevada Case Study (PDF 277KB)
North Carolina Case Study (PDF 791KB)




1 In these case studies reach refers to promotional reach, calculated using 2008 NAQC Annual Survey data, and based on the total number of unique tobacco users calling the quitline. Please note this is not NAQC’s standard calculation of treatment reach, counting only those who receive at least some evidence-based treatment, but rather is based on the number of unique smokers calling the quitline divided by the total number of smokers in each state.
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