Quitline FAQs for Health Care Providers

Quitlines are effective, evidence-based tobacco cessation interventions that help tobacco users quit through a variety of service offerings, including counseling, practical information on how to quit, referral to other cessation resources, and mailed self-help materials.¹

Quitlines:

• Are free
• Can be easily accessed by calling 1-800-QUIT-NOW
• Are confidential
• Overcome some of the barriers to seeking tobacco treatment, such as transportation, child care, financial or geographical barriers
• Tailor their help to meet the needs of individual callers
• Increase a tobacco user's chances of successfully quitting (the 2008 update to the Public Health Service's Clinical Practice Guideline Treating Tobacco Use and Dependence determined that quitlines increased the odds of 6-month abstinence by approximately 60%)²
• Are staffed by counselors who are highly trained health care professionals

Quitlines may offer a variety of other services, such as Web-assisted tobacco interventions and text messaging. They also offer information and support for family, friends, and health care professionals who want to help tobacco users quit.

Some state quitlines offer free cessation medications or provide tobacco users with vouchers or discounts to receive these medications at reduced cost. Most quitlines also offer counseling protocols and materials designed for specific populations, such as pregnant women or smokers with chronic diseases. For information on your state's quitline services, visit http://map.naquitline.org. Simply click on your state to view the quitline profile page.

Quitlines are effective, evidence-based treatments for smoking cessation. The evidence base for tobacco cessation quitlines was established through numerous clinical trials and meta-analyses. After an exhaustive review of the randomized clinical trial research literature, the 2008 update to the Public Health Service's Clinical Practice Guideline Treating Tobacco Use and Dependence concluded that quitlines increase 6-month smoking cessation quit rates compared with no intervention (the Guideline reported quit rates among quitline users of 12.7% for counseling alone and 28.1% for counseling plus medication) and therefore recommended the use of quitlines to help tobacco users quit.² Quitlines have been shown to be a highly cost-effective intervention that deliver high value relative to their cost when compared with other common disease prevention interventions and medical treatments.³

Yes. All 50 U.S. states, the District of Columbia, Puerto Rico, and Guam operate quitlines that can be accessed through the 1-800-QUIT-NOW quitline (operated by the National Cancer Institute). This toll-free number automatically transfers callers to their state quitline. This easy-to-remember number allows for national promotion of quitline services. Health care professionals can refer patients who are interested in quitting to 1-800-QUIT-NOW.

When patients call the quitline they will be asked about their tobacco use, previous quit attempts, how they heard about the quitline, and some basic demographic questions, including gender, age, race/ethnicity, and education level. Citizenship documentation is not asked. This initial process usually takes about 10 minutes. All information collected is kept strictly confidential and is treated as protected health information.

Callers then receive information about the services the quitline offers. If a caller is interested in receiving mailed self-help materials, an address is taken and materials are typically shipped within 24 hours. If a caller would like referrals to local cessation services or information on Web-based cessation help, that information is provided. If a caller is interested in receiving cessation counseling, he/she is typically transferred to a tobacco cessation counselor. Cessation counselors are highly trained professionals who are skilled in motivational interviewing and delivering client-centered interventions. The counseling session, typically lasting about 30 minutes,⁴ may focus on creating a tailored quit plan, providing medication or decision support in choosing medications, and discussing tips and tools for overcoming everyday urges to smoke.

It is important to note that during times of heavy call volume (especially during national media campaigns that promote 1-800-QUIT-NOW), a cessation counselor may not be immediately available. In these cases, the quitline will schedule an appropriate call-back time with the caller.

The majority of states do not have eligibility criteria for providing quitline counseling beyond being a state resident. Many states also require that callers be interested in quitting tobacco in the next 30 days. However, some states may have more detailed eligibility criteria or may prioritize multiple call services or free medications for those meeting specific criteria (e.g., uninsured, Medicaid insured, etc.). For specific details on your state quitline's eligibility criteria, visit http://map.naquitline.org. Click on your state to view the quitline profile page.

After asking if a patient uses tobacco and advising them to quit if they do, you will need to determine if they are ready to quit. For those patients who are not ready to quit, remind them that you have resources to help them quit when they are ready.

If a patient is ready to quit, you can refer them to your state quitline in one of two ways:

• Provide your patient with the 1-800-QUIT-NOW number and briefly explain what will happen when they call. This referral method requires your patient to make the initial call to the quitline. For example, you might say:
  "I am happy to hear you are ready to quit and I want you to know that help is available. Our state has a telephone-based tobacco quitline that is free and offers help to people who want to quit. When you call you will be asked a few questions about yourself and your tobacco use and then you will have the opportunity to talk to a person who has been trained to help you develop a quit plan."
  
• Use your state quitline's proactive referral system. This referral method prompts the quitline to call your patient directly to start services. In most states, health care providers can send a referral with the patient's contact information to the state quitline through a fax or an electronic health record. This typically involves briefly explaining to the patient what will happen when the quitline calls, obtaining the patient's written consent to be contacted by the quitline, and faxing or electronically submitting the referral form. Many quitline referral programs offer feedback to referring providers to track patients' progress. To learn more about the health care provider referral program in your state, visit http://map.naquitline.org. Click on your state to view the quitline profile page.

To learn more about conducting brief tobacco interventions, visit http://www.medscape.com/viewarticle/776542.

Quitlines play an important role in statewide comprehensive tobacco control programs. The majority of funding for state quitlines comes from state Master Settlement Agreement funds, state general funds, and state tobacco taxes.⁴ In addition, some quitlines have partnerships with health insurance plans and/or employers to offer qualifying callers with expanded quitline and cessation services. To learn more about how your state quitline is funded, visit http://map.naquitline.org/reports/administration.

You can refer Spanish-speaking patients who want to quit to 1-855-DÉJELO-YA (1-855-335-3569), which means "Quit it now." This Spanish-language quitline, which is operated by the National Cancer Institute, functions similarly to 1-800-QUIT-NOW, with callers being automatically routed to their state quitline where they can receive services in Spanish.

The Asian Smokers' Quitline (www.asiansmokersquitline.org), which is operated by the Moores Cancer Center at the University of California, San Diego, with funding from the Centers for Disease Control and Prevention, offers free nationwide telephone assistance for Chinese, Korean, and Vietnamese speakers who want to quit smoking. For more information, visit www.asiansmokersquitline.org.

To learn more about languages supported by your state's quitline, including services provided to those who are deaf and hard-of-hearing, visit http://map.naquitline.org. Simply click on your state to view the quitline profile page.

1. Ossip-Klein D, McIntosh S. Quitlines in North America: evidence base and applications. The American Journal of the Medical Sciences 2003;326(4):201–5.
2. Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. April 2009.
3. Kahende JW, et al. A review of economic evaluations of tobacco control programs. International Journal of Environmental Research and Public Health 2009;6(1);51–68.
4. North American Quitline Consortium. Results from the 2011 NAQC annual survey of quitlines [Powerpoint presentation] http://c.ymcdn.com/sites/www.naquitline.org/resource/resmgr/2011_survey/naqc_2011_final_report_final.pdf[PDF - 1.20MB] [accessed 2013 March 8].