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 disparities.

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 reach.

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 industry.”

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?