FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 347:1087-1093 October 3, 2002 Number 14 Next

	Full Text PDF PDA Full Text Editorial by Schroeder, S. A. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Telephone services that offer smoking-cessation counseling (quitlines) have proliferated in recent years, encouraged by positive results of clinical trials. The question remains, however, whether those results can be translated into real-world effectiveness.

Methods We embedded a randomized, controlled trial into the ongoing service of the California Smokers' Helpline. Callers were randomly assigned to a treatment group (1973 callers) or a control group (1309 callers). All participants received self-help materials. Those in the treatment group were assigned to receive up to seven counseling sessions; those in the control group could also receive counseling if they called back for it after randomization.

Results Counseling was provided to 72.1 percent of those in the treatment group and 31.6 percent of those in the control group (mean, 3.0 sessions). The rates of abstinence for 1, 3, 6, and 12 months, according to an intention-to-treat analysis, were 23.7 percent, 17.9 percent, 12.8 percent, and 9.1 percent, respectively, for those in the treatment group and 16.5 percent, 12.1 percent, 8.6 percent, and 6.9 percent, respectively, for those in the control group (P<0.001). Analyses factoring out both the subgroup of control subjects who received counseling and the corresponding treatment subgroup indicate that counseling approximately doubled abstinence rates: rates of abstinence for 1, 3, 6, and 12 months were 20.7 percent, 15.9 percent, 11.7 percent, and 7.5 percent, respectively, in the remaining subjects in the treatment group and 9.6 percent, 6.7 percent, 5.2 percent, and 4.1 percent, respectively, in the remaining subjects in the control group (P<0.001). Therefore, the absolute difference in the rate of abstinence for 12 months between the remaining subjects in the treatment and control groups was 3.4 percent. The 12-month abstinence rates for those who made at least one attempt to quit were 23.3 percent in the treatment group and 18.4 percent in the control group (P<0.001).

Conclusions A telephone counseling protocol for smoking cessation, previously proven efficacious, was effective when translated to a real-world setting. Its success supports Public Health Service guidelines calling for greater availability of quitlines.

Source Information

From the Department of Family and Preventive Medicine, University of California, San Diego, La Jolla.

Address reprint requests to Dr. Zhu at the University of California, San Diego, 9500 Gilman Dr., Mail Code 0905, La Jolla, CA 92093-0905, or at szhu{at}ucsd.edu.

Full Text of this Article

This article has been cited by other articles:

• Ferrer, R. L., Mody-Bailey, P., Jaen, C. R., Gott, S., Araujo, S. (2009). A Medical Assistant-Based Program to Promote Healthy Behaviors in Primary Care. Ann Fam Med 7: 504-512 [Abstract] [Full Text]  
• Pbert, L. (2009). Enhancing the Effect of Telephone Quitline Counseling Through Proactive Call-Back Counseling. Chest 136: 1199-1200 [Full Text]  
• Tzelepis, F., Paul, C. L., Walsh, R. A., Wiggers, J., Duncan, S. L., Knight, J. (2009). Active telephone recruitment to quitline services: Are nonvolunteer smokers receptive to cessation support?. Nicotine Tob Res 11: 1205-1215 [Abstract] [Full Text]  
• Linder, J. A., Rigotti, N. A., Schneider, L. I., Kelley, J. H. K., Brawarsky, P., Haas, J. S. (2009). An Electronic Health Record-Based Intervention to Improve Tobacco Treatment in Primary Care: A Cluster-Randomized Controlled Trial. Arch Intern Med 169: 781-787 [Abstract] [Full Text]  
• Schroeder, S. A. (2009). A 51-Year-Old Woman With Bipolar Disorder Who Wants to Quit Smoking. JAMA 301: 522-531 [Abstract] [Full Text]  
• Hudmon, K. S., Corelli, R. L. (2009). ASHP Therapeutic Position Statement on the Cessation of Tobacco Use. Am J Health Syst Pharm 66: 291-307 [Full Text]  
• Morris, C. D., Tedeschi, G. J., Waxmonsky, J. A., May, M., Giese, A. A. (2009). Tobacco Quitlines and Persons With Mental Illnesses: Perspective, Practice, and Direction. J Am Psychiatr Nurses Assoc 15: 32-40 [Abstract]  
• Solway, E. (2009). Windows of Opportunity for Culture Change Around Tobacco Use in Mental Health Settings. J Am Psychiatr Nurses Assoc 15: 41-49 [Abstract]  
• An, L. C., Bluhm, J. H., Foldes, S. S., Alesci, N. L., Klatt, C. M., Center, B. A., Nersesian, W. S., Larson, M. E., Ahluwalia, J. S., Manley, M. W. (2008). A Randomized Trial of a Pay-for-Performance Program Targeting Clinician Referral to a State Tobacco Quitline. Arch Intern Med 168: 1993-1999 [Abstract] [Full Text]  
• Tang, K-C, Choi, B C K, Beaglehole, R (2008). Grading of evidence of the effectiveness of health promotion interventions. J. Epidemiol. Community Health 62: 832-834 [Abstract] [Full Text]  
• Chan, S. S. C., Wong, D. C. N., Fong, D. Y. T., Leung, A. Y. M., Lam, D. O. B., Mak, Y.-W., Lam, T.-H. (2008). The Establishment and Promotion of the First Youth Quitline in Hong Kong Challenges and Opportunities. Eval Health Prof 31: 258-271 [Abstract]  
• O'Connor, R. J., Carlin-Menter, S. M., Celestino, P. B., Bax, P., Brown, A., Cummings, K. M., Bauer, J. E. (2008). Using Direct Mail to Prompt Smokers to Call a Quitline. Health Promot Pract 9: 262-270 [Abstract]  
• Levinson, A. H., Glasgow, R. E., Gaglio, B., Smith, T. L., Cahoon, J., Marcus, A. C. (2008). Tailored behavioral support for smoking reduction: development and pilot results of an innovative intervention. Health Educ Res 23: 335-346 [Abstract] [Full Text]  
• Karter, A. J., Stevens, M. R., Gregg, E. W., Brown, A. F., Tseng, C.-W., Marrero, D. G., Duru, O. K., Gary, T. L., Piette, J. D., Waitzfelder, B., Herman, W. H., Beckles, G. L., Safford, M. M., Ettner, S. L. (2008). Educational Disparities in Rates of Smoking Among Diabetic Adults: The Translating Research Into Action for Diabetes Study. AJPH 98: 365-370 [Abstract] [Full Text]  
• Vitale, F. (2007). Brief intervention protocol for assisting patients with tobacco cessation. Am J Health Syst Pharm 64: 2583-2584 [Full Text]  
• Stead, L. F, Perera, R., Lancaster, T. (2007). A systematic review of interventions for smokers who contact quitlines. Tobacco Control 16: i3-i8 [Abstract] [Full Text]  
• Campbell, H S., Ossip-Klein, D., Bailey, L., Saul, J., the Research and Evaluation Working Group*, North, (2007). Minimal dataset for quitlines: a best practice. Tobacco Control 16: i16-i20 [Abstract] [Full Text]  
• Swartz Woods, S., Haskins, A. E (2007). Increasing reach of quitline services in a US state with comprehensive tobacco treatment. Tobacco Control 16: i33-i36 [Abstract] [Full Text]  
• Hollis, J. F, McAfee, T. A, Fellows, J. L, Zbikowski, S. M, Stark, M., Riedlinger, K. (2007). The effectiveness and cost effectiveness of telephone counselling and the nicotine patch in a state tobacco quitline. Tobacco Control 16: i53-i59 [Abstract] [Full Text]  
• Hayward, L. M, Campbell, H S., Sutherland-Brown, C. (2007). Aboriginal users of Canadian quitlines: an exploratory analysis. Tobacco Control 16: i60-i64 [Abstract] [Full Text]  
• Keller, P. A, Koss, K. J, Baker, T. B, Bailey, L. A, Fiore, M. C (2007). Do state characteristics matter? State level factors related to tobacco cessation quitlines. Tobacco Control 16: i75-i80 [Abstract] [Full Text]  
• Anderson, C M, Zhu, S-H (2007). Tobacco quitlines: looking back and looking ahead. Tobacco Control 16: i81-i86 [Abstract] [Full Text]  
• Shiffman, S. (2007). Nicotine replacement therapy for smoking cessation in the "real world". Thorax 62: 930-931 [Full Text]  
• Lee, D. J, Fleming, L. E, McCollister, K. E, Caban, A. J, Arheart, K. L, LeBlanc, W. G, Chung-Bridges, K., Christ, S. L, Dietz, N., Clark, J. D III (2007). Healthcare provider smoking cessation advice among US worker groups. Tobacco Control 16: 325-328 [Abstract] [Full Text]  
• Cummins, S. E., Hebert, K. K., Anderson, C. M., Mills, J. A., Zhu, S.-H. (2007). Reaching Young Adult Smokers Through Quitlines. AJPH 97: 1402-1405 [Full Text]  
• Ebbert, J. O., Carr, A. B., Patten, C. A., Morris, R. A., Schroeder, D. R. (2007). Tobacco use quitline enrollment through dental practices: A pilot study. Journal of the American Dental Association 138: 595-601 [Abstract] [Full Text]  
• Messer, K., Pierce, J. P, Zhu, S.-H., Hartman, A. M, Al-Delaimy, W. K, Trinidad, D. R, Gilpin, E. A (2007). The California Tobacco Control Program's effect on adult smokers: (1) Smoking cessation. Tobacco Control 16: 85-90 [Abstract] [Full Text]  
• Pierce, J. P., Natarajan, L., Sun, S., Al-Delaimy, W., Flatt, S. W., Kealey, S., Rock, C. L., Thomson, C. A., Newman, V. A., Ritenbaugh, C., Gold, E. B., Caan, B. J., for the Women's Healthy Eating and Living Study Gr, (2006). Increases in Plasma Carotenoid Concentrations in Response to a Major Dietary Change in the Women's Healthy Eating and Living Study.. Cancer Epidemiol. Biomarkers Prev. 15: 1886-1892 [Abstract] [Full Text]  
• Christakis, D. A., Zimmerman, F. J., Rivara, F. P., Ebel, B. (2006). Improving Pediatric Prevention via the Internet: A Randomized, Controlled Trial. Pediatrics 118: 1157-1166 [Abstract] [Full Text]  
• An, L. C, Schillo, B. A, Kavanaugh, A. M, Lachter, R. B, Luxenberg, M. G, Wendling, A. H, Joseph, A. M (2006). Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy.. Tobacco Control 15: 286-293 [Abstract] [Full Text]  
• Pan, W. (2006). Proactive telephone counseling as an adjunct to minimal intervention for smoking cessation: a meta-analysis. Health Educ Res 21: 416-427 [Abstract] [Full Text]  
• Cokkinides, V., Bandi, P., Ward, E., Jemal, A., Thun, M. (2006). Progress and opportunities in tobacco control.. CA Cancer J Clin 56: 135-142 [Abstract] [Full Text]  
• Winickoff, J. P., Tanski, S. E., McMillen, R. C., Hipple, B. J., Friebely, J., Healey, E. A. (2006). A National Survey of the Acceptability of Quitlines to Help Parents Quit Smoking. Pediatrics 117: e695-e700 [Abstract] [Full Text]  
• Zhu, S-H, Nguyen, Q B, Cummins, S, Wong, S, Wightman, V (2006). Non-smokers seeking help for smokers: a preliminary study.. Tobacco Control 15: 107-113 [Abstract] [Full Text]  
• An, L. C., Zhu, S.-H., Nelson, D. B., Arikian, N. J., Nugent, S., Partin, M. R., Joseph, A. M. (2006). Benefits of telephone care over primary care for smoking cessation: a randomized trial.. Arch Intern Med 166: 536-542 [Abstract] [Full Text]  
• Erbas, B., Bui, Q., Huggins, R., Harper, T., White, V. (2006). Investigating the relation between placement of Quit antismoking advertisements and number of telephone calls to Quitline: a semiparametric modelling approach. J. Epidemiol. Community Health 60: 180-182 [Abstract] [Full Text]  
• Swartz, L H G, Noell, J W, Schroeder, S W, Ary, D V (2006). A randomised control study of a fully automated internet based smoking cessation programme. Tobacco Control 15: 7-12 [Abstract] [Full Text]  
• Emmons, K. M., Puleo, E., Park, E., Gritz, E. R., Butterfield, R. M., Weeks, J. C., Mertens, A., Li, F. P. (2005). Peer-Delivered Smoking Counseling for Childhood Cancer Survivors Increases Rate of Cessation: The Partnership for Health Study. JCO 23: 6516-6523 [Abstract] [Full Text]  
• Schroeder, S. A. (2005). What to Do With a Patient Who Smokes. JAMA 294: 482-487 [Abstract] [Full Text]  
• Barnoya, J., Bialous, S. A., Glantz, S. A. (2005). Effective Interventions to Reduce Smoking-Induced Heart Disease Around the World: Time to Act. Circulation 112: 456-458 [Full Text]  
• Schroeder, S. A. (2005). An Agenda To Combat Substance Abuse. Health Aff (Millwood) 24: 1005-1013 [Abstract] [Full Text]  
• Frieden, T. R., Mostashari, F., Kerker, B. D., Miller, N., Hajat, A., Frankel, M. (2005). Adult Tobacco Use Levels After Intensive Tobacco Control Measures: New York City, 2002-2003. AJPH 95: 1016-1023 [Abstract] [Full Text]  
• Dell, J. L., Whitman, S., Shah, A. M., Silva, A., Ansell, D. (2005). Smoking in 6 Diverse Chicago Communities--A Population Study. AJPH 95: 1036-1042 [Abstract] [Full Text]  
• Walsh, M. M., Ellison, J. A. (2005). Treatment of Tobacco Use and Dependence: The Role of the Dental Professional. J Dent Educ 69: 521-537 [Abstract] [Full Text]  
• Winickoff, J. P., Berkowitz, A. B., Brooks, K., Tanski, S. E., Geller, A., Thomson, C., Lando, H. A., Curry, S., Muramoto, M., Prokhorov, A. V., Best, D., Weitzman, M., Pbert, L., for the Tobacco Consortium, Center for Child Healt, (2005). State-of-the-Art Interventions for Office-Based Parental Tobacco Control. Pediatrics 115: 750-760 [Abstract] [Full Text]  
• Abdullah, A S M, Lam, T-H, Chan, S S C, Hedley, A J (2004). Which smokers use the smoking cessation Quitline in Hong Kong, and how effective is the Quitline?. Tobacco Control 13: 415-421 [Abstract] [Full Text]  
• Borowsky, I. W., Mozayeny, S., Stuenkel, K., Ireland, M. (2004). Effects of a Primary Care-Based Intervention on Violent Behavior and Injury in Children. Pediatrics 114: e392-e399 [Abstract] [Full Text]  
• Abdullah, A S M, Husten, C G (2004). Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax 59: 623-630 [Abstract] [Full Text]  
• Katz, D. A., Muehlenbruch, D. R., Brown, R. L., Fiore, M. C., Baker, T. B. (2004). Effectiveness of Implementing the Agency for Healthcare Research and Quality Smoking Cessation Clinical Practice Guideline: A Randomized, Controlled Trial. JNCI J Natl Cancer Inst 96: 594-603 [Abstract] [Full Text]  
• Bottorff, J. L., Johnson, J. L., Moffat, B., Fofonoff, D., Budz, B., Groening, M. (2004). Synchronizing Clinician Engagement and Client Motivation in Telephone Counseling. Qual Health Res 14: 462-477 [Abstract]  
• Mokdad, A. H., Marks, J. S., Stroup, D. F., Gerberding, J. L. (2004). Actual Causes of Death in the United States, 2000. JAMA 291: 1238-1245 [Abstract] [Full Text]  
• Fiore, M. C., Croyle, R. T., Curry, S. J., Cutler, C. M., Davis, R. M., Gordon, C., Healton, C., Koh, H. K., Orleans, C. T., Richling, D., Satcher, D., Seffrin, J., Williams, C., Williams, L. N., Keller, P. A., Baker, T. B. (2004). Preventing 3 Million Premature Deaths and Helping 5 Million Smokers Quit: A National Action Plan for Tobacco Cessation. AJPH 94: 205-210 [Abstract] [Full Text]  
• Schroeder, S. A. (2004). Tobacco Control in the Wake of the 1998 Master Settlement Agreement. NEJM 350: 293-301 [Full Text]  
• Winickoff, J. P., Buckley, V. J., Palfrey, J. S., Perrin, J. M., Rigotti, N. A. (2003). Intervention With Parental Smokers in an Outpatient Pediatric Clinic Using Counseling and Nicotine Replacement. Pediatrics 112: 1127-1133 [Abstract] [Full Text]  
• Carroll, T, Rock, B (2003). Generating Quitline calls during Australia's National Tobacco Campaign: effects of television advertisement execution and programme placement. Tobacco Control 12: ii40-44 [Abstract] [Full Text]  
• Car, J., Sheikh, A. (2003). Telephone consultations. BMJ 326: 966-969 [Full Text]  
• (2003). OTHER ARTICLES NOTED (25 Oct 02 to 17 Jan 03). Evid. Based Nurs. 6: e1-7 [Full Text]  
• Franzon, M., Gustavsson, G., Korberly, B. H., Antonuccio, D. O., Cadore, J. M., Stead, L. F., Davis, R. M., Fiore, M. C., Hatsukami, D. K., Raw, M., West, R., Pierce, J. P. (2002). Effectiveness of Over-the-Counter Nicotine Replacement Therapy. JAMA 288: 3108-3110 [Full Text]  
• (2002). Quitline for Smokers -- Effective?. Journal Watch Cardiology 2002: 5-5 [Full Text]  
• Schroeder, S. A. (2002). Conflicting Dispatches from the Tobacco Wars. NEJM 347: 1106-1109 [Full Text]  
• Ong, M. K., Glantz, S. A. (2005). Free Nicotine Replacement Therapy Programs vs Implementing Smoke-Free Workplaces: A Cost-Effectiveness Comparison. AJPH 95: 969-975 [Abstract] [Full Text]