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Issue Papers
Issue papers aim to provide critical knowledge on important quitline topics and guidance for decision-making.

Adoption of Recommended Best Practices among State Quitlines (2018)

This report provides an overview of 21 recommended best practices for state quitlines; providing the adoption rate for each best practice, as well as information on facilitators or barriers to adoption as reported by state quitlines. This report is intended to inform the quitline community about the current landscape for adopting recommended best practices that impact the advancement of state quitlines and their ability to increase reach and improve cessation outcomes for quitline callers. It also provides actions steps for NAQC, state funders, quitline service providers and national organizations to improve the adoption of best practices.

Quitline Services: Current Practice and Evidence Base (2016)

A new Quality Improvement Initiative guidance paper, Quitline Services: Current Practice and Evidence Base, reviews current quitline practice in the U.S., highlights the scientific evidence for each category of service, and discuses major considerations related to implementation and evaluation of the service.

This paper is intended for all consortium members and stakeholders who want to expand their knowledge of quitline services. It provides scientific guidance for decision making on the types of services to offer.

To supplement the Guide, NAQC has created a Checklist for Reviewing Quitline Services and Activities. It serves as a tool for guiding quitline stakeholders (purchasers, service providers, researchers and health care system leaders) in their efforts to review the quality and value of services provided and whether they are evidence-based services.

Guide for Implementing eReferral Using Certified EHRs! (2015)

This guide is a resource for quitlines and other cessation services that would like to establish referral systems with healthcare electronic health record (EHR) systems. It provides recommended standards for implementing eReferral in a straightforward and efficient way.
  • For non-technical program staff, the guide’s introduction, purpose and summary of recommendations will provide useful background on eReferral (see first 5 pages).
  • For technical staff at quitlines, other cessation services and healthcare institutions, the guide’s recommended set of standards provides a roadmap for creating bi-directional eReferrals (read full guide and appendices).
Calculating Quit Rates, 2015 Update (Including Implementation Guide)

The full paper is intended to be a stand-alone document to support efforts to produce a standard NAQC quit rate. While randomized controlled trials have established the efficacy of quitlines, quit rates can assess the effectiveness of quitlines in real-world settings, under certain conditions or with different populations. Standardized quit rates can help quitline managers make better quitline purchasing decisions and provide evidence of program effectiveness; they can also be used to explore trends and facilitate discussion among NAQC members. It is important to have a standard quit rate definition so that when quit rates are compared over time or between quitlines, any differences observed are not due to differences in research methods. To make recommendations in this paper that balance the interests of multiple stakeholders, the authors used the criteria of methodological rigor, real-world feasibility, and the potential for use of findings. Learn about recommendations for decisions in the most important areas with the strongest evidence, and suggestions to consider in areas we think are important but less critical or supported by weaker evidence.

view issue paper (PDF 22MB)
implementation guide (121KB)

This issue paper reviews current service offerings for the three largest quitline service providers and reports on their protocols and strategies to promote engagement and retention of pregnant callers, including using a dedicated coach, incentives for attending counseling sessions, using text messaging to reach clients, engaging partners or spouses, and sending correspondence or reminders about quitline support. A literature review is also included.
view issue paper (PDF 593KB)

The purpose of this NAQC Quality Improvement Initiative Issue Paper is to provide an update on the comprehensive review of the literature and practice related to the integration of tobacco cessation medications and quitline services that reflects additions to the evidence base and improvements in practice since the first publication (2009). The author discusses the major factors that must be considered in deciding if medications should be offered as part of quitline services, including topics such as cost-effectiveness analysis, choice of medication, determination of quantity of medication to provide and the method of distribution of medications that will be used. A new section on e-cigarettes appears in the update, as well as new content related to concurrent use of more than one type of tobacco to reflect the FDA's new warning label regulations. Updated recommendations on key issues related to integration of medications into quitline services are provided by the author.
view issue paper (PDF 645KB)

Quitlines in the U.S.: An Exploration of the Past and Considerations for the Future(2014)

This paper outlines the current status of state quitlines and describes how, as a result of an extremely dynamic political and funding landscape and the opportunity of the Affordable Care Act, quitlines should move forward to improve efficiency and become leverage points for broader cessation initiatives with new and existing partners. The paper illuminates best and promising practices for integrating quitlines into the broader healthcare landscape and informs decisions on strategic planning, determining specific goals and objectives of a state quitline and sustainability planning for the future.

Recommendations found in the Executive Summary express NAQC’s priorities for moving toward the future vision for quitlines defined by NAQC in collaboration with its members, leadership and partners. As NAQC celebrates its 10 year anniversary, the quitline community remains committed to ensuring that tobacco users are encouraged to quit, that high-quality cessation services are readily available to all who want to quit, and that we stand ready to move collectively toward a future vision of the role we will play in this critical effort.
view issue paper (PDF 881KB)
view executive summary (PDF 346KB)

Quality Improvement Initiative Issue Paper: Quitline Referral Systems (2013)

This issue paper aims to explore the current landscape of quitline referral systems with healthcare and other providers and to examine in detail the critical operational and outcome-related components of these referral systems. While the primary focus of the paper is on the U.S. experience, the authors have incorporated critical aspects of the Canadian systems where appropriate. In addition to providing a review of the evidence, authors address the fundamental processes that underlie all referral systems, regardless of the referral method (e.g., phone, fax or electronic) and make recommendations for quality referral systems practices.
view issue paper (PDF 1,487KB)

Quitline Service Offering Models: A Review of the Evidence and Recommendations for Practice in Times of Limited Resources


This paper aims to present evaluation and research data used to guide decision-making on ways to invest limited funding for quitline services most effectively in an easy-to-use format and to make recommendations for most effectively using limited resources when determining quitline service offering options. Specifically, the paper addresses the following questions:

1) How effective are different service offering models regarding quitline utilization, tobacco abstinence rates, and costs? Are there points at which the return on investment diminishes in terms of amount of counseling (attempted and completed) and medication provided?
2) What impact does the provision of medications through quitlines have on reach and quit rates? Which mechanisms for dosing and delivery of medications are most cost-effective and/or provide other efficiencies?
3) Is there evidence to support the use of advanced technologies (web, interactive voice response [IVR] and texting) to expand quitline service offerings? Are these approaches cost-effective? What other efficiencies are achieved?

view issue paper(PDF 717KB)
view executive summary(PDF 464KB)
view recommendations for research(PDF 383KB)
view options table(PDF 323KB)

The Use of Quitlines Among Priority Populations in the U.S.: Lessons from the Scientific Evidence (2011)

This issue paper is is a systematic review of the scientific evidence regarding cessation services to priority populations (African Americans/blacks (AA/B), American Indian and Alaska Natives (AI/AN), Asian American and Native Hawaiian and Pacific Islanders (API), Hispanic/Latinos (H/L), the lesbian, gay, bisexual and transgender (LGBT) community, and individuals of low socioeconomic status (low SES)) with a specific focus on the use, effectiveness and promotion of quitlines. The review attempts to provide lessons learned from the scientific evidence in order to better inform decision making within quitlines.
view issue paper (PDF 216KB)

Assessing the Cost-Effectiveness of Quitline Programs (2010)

Performing cost-effectiveness analyses is an essential element of any quitline’s quality improvement process. This is especially true as budgetary constraints become more important to determining all aspects of service delivery. This issue paper aims to:

· document the facts related to the cost of tobacco use;
· provide an overview of methods currently used for cost-effectiveness analysis of quitlines; and
· in general terms, describe approaches and considerations for conducting cost-effectiveness analysis on a specific quitline program.

This paper is intended to present general information useful for a wide variety of stakeholders and not to serve as a guide for performing cost-effectiveness analyses.
view issue paper (PDF 125KB)
view table 1 (PDF 7.36KB)
view table 2 (PDF 7.14KB)
view table 3 (PDF 6.67KB)

Call Center Metrics: Best Practices in Performance Measurement and Management to Maximize Quitline Efficiency and Quality (2010)

This issue paper defines the most critical operational, service performance and efficiency-related call center metrics for establishing and maintaining quitline quality. The paper, authored by Penny Reynolds of The Call Center School (, makes recommendations on important metrics to measure (including why they are important for funders, service providers and callers); recommendations on how to measure and report these metrics; and describes how these reports may be used by both the service providers and funders to improve quality.
view resource (PDF 184KB)

Call Center Metrics Glossary of Terms

This glossary was developed to support an increased understanding of call center operations-related terms and to continue building a shared language between quitline service providers, funders and researchers. 
view resource (PDF 68KB)

A Framework for Improving Tobacco Quitline Quality in North America (2009)

The purpose of this paper is to propose a framework for improving the quality of quitlines and to describe the major elements of the framework. The framework highlights the shared responsibilities of funders and service providers alike and makes recommendations that encourage collaborative efforts to move quality improvement forward.

Integration of Tobacco Cessation Medications in State and Provincial Quitlines:A Review of the Evidence and the Practice with Recommendations (2009)

This paper provides a comprehensive review of the current literature and practice related to the integration of tobacco cessation medications and quitline services. The authors discuss the major factors that must be considered in deciding if medications should be offered as part of quitline services including such topics as cost-effectiveness analysis, choice of medication, determination of quantity of medication to provide and the method of distribution of medications that will be used. Recommendations on key issues related to integration of medications into quitline services are also highlighted.
This paper provides a comprehensive review of the current literature on a wide variety of strategies to increase reach of tobacco cessation quitlines. Additionally, several examples from practice are included. The paper also highlights recommendations for quitline reach and funding levels from key government and health agencies, highlighting the need to increase reach to more tobacco users to save lives and direct medical costs.

Measuring Reach of Quitline Programs (2009)

This paper recommends a standard definition of "reach” and provides recommendations for standard measuring and reporting of the reach of quitline programs. Recommendations that are necessary in order to implement the standard are found in bold-print and recommendations that are viewed as important but not critical to implementation are italicized.

Measuring Quit Rates (2009)

This paper provides a standard formula for measuring quit rates for quitline programs and recommends standard reporting methods as well. Recommendations that are necessary in order to implement the standard are found in bold-print and recommendations that are viewed as important but not critical to implementation are italicized.

Tobacco Cessation Quitlines - A Good Investment to Save Lives, Decrease Direct Medical Costs and Increase Productivity (2009)

Tobacco use is the single most preventable cause of death and disease in the U. S., causing approximately 438,000 deaths each year. Quitlines are telephone-based tobacco cessation services that help tobacco users quit through a variety of services, including counseling, medications, information and self-help materials. Quitline effectiveness is documented by numerous research studies. Through the leadership of state and federal governments, quitlines have become increasingly popular in the U.S. due to their centralization, cost-effectiveness and ability to reach tobacco users in rural and urban areas. With state budget cuts on the rise, the ability of quitlines to provide evidence-based tobacco cessation services is under threat. Yet, without adequate, sustained funding for quitlines, tobacco use prevalence is unlikely to decline. This NAQC Issue Paper makes the case for quitline investment and sustainability.

The Role of Reimbursement and Third Party Financial Support in Sustaining Quitlines (2008)

An emerging issue related to quitline sustainability is third-party reimbursement for quitline services. As part of a grant from the Robert Wood Johnson Foundation (RWJF), NAQC developed an issue paper on third-party reimbursement of quitlines to serve as a resource to NAQC members and tobacco control partners. Due to differences in healthcare financing in the U.S. and Canada, this project focuses solely on U.S. quitlines. This paper assesses the current practices of quitlines with regard to third-party reimbursement and other forms of financial support, provides an overview of the opportunities for obtaining third party support and sets next steps for garnering third-party financial support for quitlines.
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