Study Finds Smokers’ Quitlines Work
Does talking to a smoking cessation counselor on the phone help smokers quit? Research from controlled clinical trials suggests that the telephone counseling provided through these quitlines is effective in helping smokers quit. But researchers at the University of California, San Diego (UCSD) wanted to find out if the success seen in clinical trials was borne out in smokers’ real world experiences with quitlines. Their research, published in the October 2, 2002 New England Journal of Medicine , suggests that quitline counseling does help smokers quit and remain smoke free.
About the Study
The UCSD researchers enrolled people who called the California Smokers’ Helpline between July 1995 and November 1996. During times of high call volume, when counselors were unable to counsel all callers, they randomly assigned some callers to receive counseling (up to six sessions) and others to be in a control group who would not receive counseling. However, because it would be unethical not to provide counseling to a smoker who wanted it, those assigned to the control group (1309 callers) were simply asked to call back for counseling and those in the treatment group (1973 callers) were called back by the counselors. All callers were sent self-help materials in the mail. Callers under age 18 and those who did not speak English or Spanish were excluded from this study.
Because counseling was offered to everyone, some members of the control group did call back and receive counseling, but some did not. So the control group actually contained two subgroups: one that received counseling and one that did not. Likewise, the treatment group consisted of two subgroups: (1) those who would have called back (even if a counselor had not called them) and therefore received counseling, and (2) those who would not have called back and therefore not received counseling. The researchers used a mathematical calculation to determine how many callers in the treatment group would have called back and how many would not have called back.
Interviewers called participants at 1, 3, 6, and 12 months to ask whether or not they were smoking. The researchers compared the abstinence (non-smoking) rates in the treatment group with the abstinence rates in the control group. They also compared the abstinence rates of the control subgroup that did not call back and receive counseling with the treatment subgroup that would not have called back for counseling.
Compared with the control group as a whole, the treatment group as a whole had slightly higher abstinence rates at 1, 3, 6, and 12 months.
However, abstinence rates in the treatment subgroup that would not have called back for counseling were two times higher than the rates in the control subgroup that did not receive counseling. This second comparison provides stronger evidence that telephone counseling is more effective than only sending people self-help materials. Unfortunately, because the abstinence rates at 12 months were quite low for both groups (7.5% vs. 4.1%), the absolute difference in abstinence rates after one year was only 3.4%.
Although these results suggest that telephone counseling is effective in helping smokers quit, this study has its limitations. First, the treatment subgroup that “would not have called back and received counseling” is a theoretical group, which exists only as a percentage of the overall treatment group. This group does not contain any specific people to compare with their counterparts in the control subgroup who did not call back for counseling. Second, the study participants reported whether they were smoke free or had relapsed. This method of self-reporting is prone to error because people may feel compelled to say they are smoke free even if they have relapsed. Third, this study was conducted in California where there is a strong antismoking culture. Smokers in California may receive more social support to quit and more encouragement to quit through local smoking ordinances than smokers in other states. Finally, smokers who call a quitline are quite likely to differ in significant ways (such a motivation) than smokers who don’t call a quitline.
How Does This Affect You?
Should you call a quitline if you want to stop smoking? Sure. The results of this study confirm the findings of clinical trials that telephone counseling along with self-help materials can help smokers quit successfully. But keep in mind that on the whole, only a small percentage of smokers in this study were still smoke free after 12 months. Although counseling seems to help, quitting smoking is still a real challenge.
Other options to help you quit smoking include face-to-face counseling, smoking cessation classes, nicotine replacement therapies (patches and gums), and certain antidepressant drugs. For more information on how to quit smoking, talk to your health care provider and check out the resources below.
“Freedom From Smoking” Smoking Cessation Program
American Lung Association
Tobacco Information and Prevention Resource
Centers for Disease Control and Prevention
Zhu SH, Anderson CM, Tedeschi GJ, et al. Evidence of real-world effectiveness of a telephone quitline for smokers. NEJM. 2002;347:1087-1093.
Schroeder SA. Conflicting dispatches from the tobacco wars. NEJM. 2002;347:1106-1109.
Last reviewed Oct 4, 2002 by ]]>Richard Glickman-Simon, MD]]>
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