Developing a Research Agenda to Improve the Impact of Tobacco Use Quit Lines

United States

NIDA Organizers: Beverly Pringle, Ph.D. and Dionne Jones, Ph.D., Services Research Branch

Co-sponsors:
National Cancer Institute: Scott Leischow, Ph.D., Mary Anne Bright, Ph.D., Glen Morgan, Ph.D.
Centers for Disease Control and Prevention: Corrine Husten, M.D., MPH, Ann Malarcher, Ph.D.
Canadian Tobacco Control Research Initiative: Cheryl Moyer, Ph.D., Oonagh Maley
Health Canada: Carol Sutherland-Brown

Meeting Purpose:

The Division of Epidemiology, Services, and Prevention Research hosted the meeting on February 23-24, 2005 to develop a research agenda to improve the impact of tobacco use quit lines (i.e., accessibility and utilization, promotion and reach, organization and management, quality and outcomes, and financing and costs) in the United States and Canada. The ultimate goal of tobacco use quit lines is to increase smoking cessation rates by improving the reach, delivery, and effectiveness of quit line services.

Meeting Outcome:

Six panels of researchers, clinicians and practitioners presented their work on: 1) Quit Lines: Integrating Clinical and Population-Based Approaches; 2) Design, Organization, and Management of Quit Line Services; 3) Accessibility, Utilization, and Promotion of Quit Line Services; 4) Quality and Outcomes of Quit Line Services; 5) Financing & Costs of Quit Line Services; and 6) Research Method Issues. Each panel was followed by a 45-minute Q&A/discussion session which produced rich information on the state of the science and future research directions.

The first panel provided:

• A broad national perspective on quit lines as part of a comprehensive approach to smoking cessation; a means of delivering evidence-based smoking cessation treatments, efficacy and reach; and public-private partnerships to support quit lines.
• A state perspective was illustrated by describing Wisconsin's quit line program, including the state?s efforts to integrate clinical and population-based approaches, and data on promotion, use, reach, and outcomes.

The second panel discussed:

• Information from the CDC Guide, including a range of quit line practices, proactive vs. reactive services, and levels of service;
• Regional services in Canada and optimal characteristics of effective quit lines;
• The interface between quit lines and the broader health care system; and
• The use of quit line services as an adjunct to dental office services.

The third panel examined:

• A framework for engaging different targeted subpopulations in quit line services;
• Findings on the accessibility, utilization, and promotion of quit line services in California; and
• Some recent "hot off the presses" data on novel experiments to increase quit line call volume in New York State.

The fourth panel discussed:

• Results of a randomized clinical trial of different services offered through the Oregon Quit Line;
• The outcomes of proactive versus reactive quit lines, including the potential for matching client needs with service intensity through an algorithm for proactive quit lines and the potential for the effects of reactive quit lines to extend beyond those who call in for services;
• Fax referral to quit lines;
• The effect of staffing and training on quality and outcomes; and
• The integration of quit lines into broader tobacco control initiatives.

Topics addressed in the fifth panel were:

• Evaluating the cost and cost-effectiveness of the Oregon Quit Line trial;
• Return on investment to smoking cessation services;
• The cost structure of the ACS service, including how "per-quitter" costs are calculated, and potential research directions for studies on cost-effectiveness optimization;
• Costs of the 5-year old Ontario Quit Line compared to an estimate of the economic benefits from heath-care savings and increased productivity; and
• The financing of quit line services within the context of public policy and social equity issues.

Research methods issues discussed in the sixth panel included:

• The North American Quitline Consortium's work on measuring quit line quality and outcomes;
• The Minimal Data Set that is being developed by the North American Quitline Consortium (rationale, compromise measures that fit the needs of researchers and service providers, sample data elements and research questions they might address, and quit lines as a platform for applied community-based research on drug abuse);
• A Medicare study;
• Work on the ESCHER project, a 9-country study - weighting quantitative and qualitative data collection, and research on strategies to increase the use of quit lines (e.g., printing quit line number on cigarette packages); and
• Some concepts and methods from psychotherapy/counseling research that could be applied to cessation phone counseling, which has focused heavily on techniques such as motivational interviewing.

Expected follow-up

NIDA plans to continue to partner with the National Cancer Institute, the Centers for Disease Control and Prevention, Health Canada, and the Canadian Tobacco Control Research Initiative in collaborative research initiatives.

Resulting Publications

No publications are planned or anticipated at this time.