NAQC recently asked Dr. Tim McAfee,
Director, Office on Smoking and Health, National Center for Chronic Disease Prevention and
Health Promotion, CDC, what are the lessons-learned over the
past 20 years that quitlines MUST carry forward into the next 20 years?
Here are his thoughts…
"Effectiveness is important. Reach
and impact are REALLY important.
The promotion of quitlines may play
as important a role in contributing to cessation as the increase in quit rates
among callers. This is because most smokers motivated by promotion to try to
quit, still quit without formal assistance. Knowing that help is just a phone
call away if they need it may encourage them to act on quitting messages they
hear from media campaigns or their health care providers, and thus increase
their chances of succeeding. Quitlines may also have this effect by helping
normalize quitting. This important secondary benefit of quitlines was
demonstrated in one of the very first quitline studies (by Debbie Ossip at
University of Rochester in New York)!
We should keep thinking about ways
that we can leverage quitlines to increase quit attempts and quit success among
the general population of smokers, as well as to help smokers who call quitlines
successfully quit. We also need to keep working to ensure quitlines expand on
their impressive track record of use by populations experiencing tobacco-related
The reach of quitlines is highly
dependent on how heavily they are promoted. Since most quitlines are funded at
modest levels, states often make the difficult choice of under-promoting their
quitlines and quitline services in order to avoid generating more calls than
they can serve. This may inadvertently lend plausibility to skeptics who argue
that quitlines should not be funded at all because they "only” reach 1-2% of the
population. The reality is that this limited reach is due more to limited
funding and promotion than to a lack of interest or an intrinsic ceiling on
Quitlines can come in many different
shapes and sizes, including state-funded, federal-funded, and community-funded,
as well as employer- and health care system-funded quitlines. There are also
hybrid arrangements where one system triages callers to other systems.
To be effective, quitlines need to
pay close attention to the caller experience from start to finish. Quitlines
have been successful because the researchers who developed them did so
thoughtfully based on science, and because practitioners have paid close
attention to training, protocol fidelity, and continuous improvement.
Regardless of the level of funding
available to promote quitlines and provide service to callers, it’s critical
that quitlines constantly strive to improve efficiency in order to maximize
their reach without sacrificing caller success.
When they emerged in the 1980s and
1990s, quitlines were a dramatic innovation. Today they are one medium among a
burgeoning array of electronic communication technologies being used to extend
access to many types of health care services. Within this rapidly changing
environment, it is important that quitlines evolve and redefine themselves to
maximize reach and success (while retaining their commitment to evidence and
evaluation). This includes exploring potential linkages and synergies with other
new communications media like text messaging and web-based counseling. It may
also involve potential paradigm shifts such as the creation of registries for
longer-term interaction with quitters, as along the lines of the databases of
tobacco users being compiled by the tobacco
Any of your own lessons learned that
you’ll be sure to carry forward? What else have we learned over time that is
important not to forget?