Strategy 3.2 - Improving the Accessibility, Reach and Use of Proven Cessation Services: Quitlines and Other Cessation Service Delivery Innovations

    • May 25, 2010

What Is Known About Increasing Access to Cessation Treatment Services

As part of its efforts to widen the demand for and use of evidence-based tobacco-cessation treatments, RWJF supported several efforts to bring tobacco-cessation treatment directly to consumers in ways that enhanced their appeal, reach and use, especially among underserved smokers. RWJF funded efforts to expand the availability of telephone and Web-based tobacco-cessation counseling (called "quitlines") and also encouraged the availability of nicotine-replacement therapy.

  • Quitlines have been found to be an effective way to deliver tobacco-cessation services. The U.S. Public Health Service clinical practice guidelines recommend proactive telephone quitline counseling (including structured outgoing follow-up calls to smokers) as an effective, high-reach cessation treatment with the potential to reduce or eliminate disparities in treatment access. All states offer quitline counseling in multiple languages, most provide counseling tailored to the needs of pregnant and young smokers, and many provide free nicotine-replacement therapy and access to Web sites for ongoing counseling and support. Many have created fax-to-quit services allowing health care providers to easily refer patients for follow-up quitline counseling and many offer referral to community-based cessation programs. A study in the New England Journal of Medicine concluded: "A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting." [Zhu S-H, Anderson CM, Teceschi GJ et. al. (347): 1087–1093, 2002.]
  • Online cessation programs are effective. Research at the University of California, Berkeley, found that computer- or Web-based smoking-cessation programs can effectively aid smokers in their efforts to quit. The study analyzed results from 22 randomized controlled trials.
  • Over-the-counter nicotine-replacement therapy has increased use and quit rates. In 1996 the U.S. Food & Drug Administration permitted the sale of certain nicotine replacement therapies (NRTs) over the counter to increase their accessibility. Research supported by the Substance Abuse Policy Research Program (SAPRP) found that the switch increased NRT use and population quit rates. (See journal article and Program Results.)


Key RWJF-Sponsored Initiatives: Research

RWJF sponsored independent research projects on quitlines and NRTs. These projects included:

  • A national survey of quitlines showing that as of 2004, every state in the country plus the District of Columbia operated a quitline providing a variety of quitting information, referrals and products. (See the journal article, plus a summary of the results.)
  • A controlled trial that found that smokers offered free NRTs were more likely to quit. (See Program Results.)
  • An evaluation of the Massachusetts Quitline, which looked at differences between smokers calling the quitline, their attempts to quit, their use of other services and other variables. (See Program Results.)


Key RWJF-Sponsored Initiatives: Action to Put Research Into Practice


  • Substance Abuse Policy Research Program (SAPRP) (1994–2010) and its predecessor, the Tobacco Policy Research and Evaluation Program (TPREP) (1992–96) have supported policy relevant, peer-reviewed research that increases understanding of policies for reducing the harm of tobacco use. These programs provided seminal findings showing the beneficial quitting effects from reducing smoker's out-of-pocket costs for tobacco-dependence treatments and creating smoke-free hospitals and hospital campuses. Results are summarized in SAPRP knowledge assets and reports, including "Increasing the Use of Smoking Cessation Treatments" and "A Research Agenda to Achieve a Smoke-Free Society." (See Program Results on SAPRP, Program Results on TPREP and SAPRP Knowledge Assets.)
  • The National Action Plan for Tobacco Cessation was a federal committee that made six recommendations to reduce tobacco use. Michael C. Fiore, M.D., M.P.H., chaired the committee and received a 2003 Innovator Combating Substance Abuse award from RWJF to implement key components of the plan. The major recommendation of this plan, implemented in 2004 by Secretary of Health and Human Services Tommy Thompson, was to create a network of government-funded state tobacco quitlines. (See his Programee Profile.) Fiore was the lead author on a seminal article in the February 2004 American Journal of Public Health, "Preventing 3 Million Premature Deaths and Helping 5 Million Smokers Quit: A National Action Plan for Tobacco Cessation."
  • North American Quitline Consortium. This national membership organization of quitline service providers, funders of quitlines, researchers and strategic partners promotes evidence-based quitline services. RWJF funded activities to evaluate quitline capacity and ways to expand reach and use, especially among underserved populations.


Key RWJF-Sponsored Initiatives: Advocacy & Communications Around What Works


  • The Consumer Demand Initiative (2005–08), co-funded by the American Cancer Society, American Legacy Foundation, CDC, NCI, NIDA and RWJF and conducted under the auspices of the National Tobacco Cessation Collaborative, developed six core strategies for increasing consumer demand for and use of evidence-based tobacco-cessation products and services. This initiative focused specifically on reaching traditionally underserved, low-income smokers See their website for summaries and products of each consumer demand roundtable session and a Content Alert for a podcast and video on smoking-cessation tools.
    • The March 2010 Special Issue of the American Journal of Preventive Medicine focuses on increasing consumer demand for cessation services.
  • With two grants from RWJF, AED and IDEO teamed up to create a toolkit, Designing for Innovation: A Toolkit for Creating Solutions to Build Consumer Demand for Tobacco Cessation Products and Services. It can assist tobacco-control organizations in applying consumer demand design principles to tobacco-cessation products and services. The process to thinking differently about smoking-cessation products and services has five main steps: observe, look for patterns, brainstorm, prototype and get feedback.
  • IDEO also produced a booklet, Consumer Demand Design Principles: 8 Design Principles for Redesigning Tobacco Cessation Products and Services. The principles are:
    • Allow them to kick the tires
    • Lower the bar
    • Make it look and feel good
    • Facilitate transitions
    • Make progress tangible
    • Foster community
    • Connect the dots
    • Integrate with their lives
    For more information see the article in the American Journal of Preventive Medicine.


Other Related Resources Funded by RWJF


  • The North American Conference of Smoking Cessation Quitlines considered strategies to advance quitlines. (See Program Results.)
  • A survey by the North American Quitline Consortium on the organization, financing, promotion and cost of state quitlines. (See journal article.)
  • A survey by the North American Quitline Consortium to determine the factors related to the presence or absence of a state quitline. (See journal article.)