Wow! We are already on the fifth question of 20…and this can only mean one
thing. Okay, maybe it can mean two things. We are getting closer to the NAQC Conference (call for abstracts open now!) and
we are ready to start moving away from questions related to our history and
toward questions focused on our future.
To help us make this shift NAQC asked
Cummings, PhD, MPH, Professor in the Department
of Psychiatry & Behavioral Sciences at the Medical University of South
Carolina and former Chairman of the Department of Health
Behavior at Roswell Park Cancer Institute how do we make quit lines make a
difference in lowering smoking rates?
How can quit lines be significant to population-based tobacco control?
"Tobacco control interventions that have the greatest
chance of reducing tobacco use in the population are those that reach the most
smokers. Highly efficacious
interventions that reach only a tiny fraction of the target population will not
have a sizeable impact on rates of tobacco use in the population at large. This is one of the reasons that past research
has shown that the most potent demand-reducing influences on tobacco use on a
population level (albeit relatively weak in terms of efficacy) have been
interventions that impact virtually all smokers repeatedly, such as higher
taxes on tobacco products, comprehensive advertising bans, pack warnings, mass
media campaigns, and smoke-free policies.
Similarly, despite the promising evidence on the efficacy of different
stop smoking treatments (including quit lines), there is not compelling
evidence to support the idea that any of these therapies have dramatically
influenced rates of tobacco use in the population at large, mainly because too
few smokers use them when they try to quit.
Quit lines have a huge potential to contribute to
population based tobacco control efforts, but this potential has not been
effectively exploited so far. The
challenge for quit lines is how they can expand their recruitment of smokers
while also providing a service that effectively helps someone overcome their
nicotine addiction. Resource
limitations have forced many quit lines to trade off reach against maintaining
elements of an effective tobacco cessation intervention. However, as the research evidence suggests
reach is a necessary condition for impacting population level tobacco use
behaviors. A quit line that reaches only
a tiny fraction of the smokers in its catchment area cannot expect to have a
measurable impact on smoking rates at the population level, and thus is
probably not worth the investment. Quit
lines that reach large numbers of smokers in the population at least have a
chance to impact smoking rates.
The advantage that quit lines have is the
opportunity to engage smokers directly at relatively low costs, capture
information about their smoking behaviors, and re-engage with them repeatedly
over months, years, and even decades.
Relapse is part of the smoking cessation business and we ought to accept
it and build this directly into our treatment programs. The fact that most smokers who call a quit
line will quit and return back to smoking means our treatments should be
offered repeatedly over a longer time frame than is currently the case for most
quit lines. Much like the cigarette
marketer who continually sends out coupons to a customer in hopes to get them
to switch to their brand eventually, quit lines need to think of smokers in the
population as their customers and repeatedly interact with them in hopes that
some will switch to their "Quit”
In my opinion, quit lines need to stop worrying
about delivering the perfect evidenced-based, highly resource intense,
cessation intervention each time they interact with a smoker. We would be far better off if quit lines
focused more effort on recruiting as many smokers as possible into their
service and then designing low cost interventions that track, prompt, and
triage smokers to services over many years.
Taking advantage of things that prompt smokers to think about changing
their smoking behavior such as higher taxes on cigarettes, a new clean indoor
air law, new warning labels, and mass media all can motivate smokers to contact
a quit line service. The offer of free
nicotine patches has also been shown to increase call volume and should not be
discounted as a recruitment tool.
Working together state quit lines could make a
real dent in the smoking rates in this country if they all focused more
attention on recruiting larger numbers of smokers into a national registry of
smokers. The national registry could
then offer low cost interventions such as online cessation support, e-mail and
text messaging and triage those in need of greater support back to state run
services. In 10 years there is no reason
why 80% or more of smokers in the population could not be recruited into a
common database for cessation service delivery.
Such a data base would offer an inexpensive way to deliver target
messages to smokers to prompt them to change their smoking behavior. Since the vast majority of smokers desire not
to smoke anyway, developing this voluntary registry should be feasible.
Quit lines need to evolve to ensure greater
relevance to population-based tobacco control which simply means the focus
needs to be on recruitment of smokers into a common database. Intervention services need to be tailored to
the evolving needs of smokers and designed for low-cost delivery. The metrics by which quit lines are evaluated
in the future also need to be changed to emphasize reach and low-cost delivery
of services over the current emphasis on short-term cessation outcomes.”
What are your thoughts on the quitline
community’s role in population-based tobacco control? Has your quitline changed
its approach over time in order to increase your reach? Share with us! We want
to hear your thoughts!