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Does Offering More Support Calls to Smokers Influence Quit Success?

Carlin-Menter, Shannon PhD; Cummings, K. Michael MPH, PhD; Celestino, Paula BS; Hyland, Andrew PhD; Mahoney, Martin C. PhD, MD; Willett, Jeffrey PhD; Juster, Harlan R. PhD

Journal of Public Health Management and Practice: May/June 2011 - Volume 17 - Issue 3 - p E9–E15
doi: 10.1097/PHH.0b013e318208e730
Original Article

Background: Previous studies have found that offering additional callback counseling support to smokers calling a telephone quit line increases quit rates. However, what is less certain is the most cost-efficient protocol for offering such a service.

Objective: This study compares the efficacy of offering 2 versus 4 counseling callbacks after an initial call from Medicaid/uninsured adult smokers contacting the New York State Smokers' Quit Line (NYSSQL). Outcomes compared are the 7- and 30-day nonsmoker prevalence rates measured at 3-month follow-up and the cost per quit.

Design: A 2-group randomized trial was conducted.

Setting and Participants: The study population included 1923 adult (18+ years) Medicaid/uninsured current smokers (10+ cigarettes per day) who called the NYSSQL between February and March 2009 seeking help to stop smoking. At the time of the study, the NYSSQL provided Medicaid/uninsured callers with up to 6 weeks of free nicotine medications and up to 4 counseling callbacks. Half the subjects were randomized to standard care with up to 4 counseling callbacks with the remaining subjects offered only 2 counseling callbacks. All participants were sent a minimum of a 2-week supply of nicotine replacement therapy, with some receiving up to 6 weeks. Participants were recontacted 3 months after enrollment in the study to assess smoking status.

Main Outcome Measures: Quit rates, total counseling callbacks completed, reductions in cigarette consumption, and cost per quit measures.

Results: There was not a significant difference between study groups in the number of callbacks completed. There was also no difference in 7- or 30-day nonsmoker prevalence rates measured after 3 months' follow-up or reported use of the free nicotine replacement therapy between those assigned to either the 2- or 4-callback protocols. The cost per quit was essentially the same in both groups (2 callbacks—$442 per quit vs 4 callbacks—$445 per quit).

Conclusion: There was no advantage in terms of quit success or cost to offering up to 4 callbacks instead of 2 callbacks.

This study compares the efficacy of offering 2 vs 4 counseling callbacks after an initial call from Medicaid/uninsured adult smokers contacting the New York State Smokers' Quit Line.

New York State Smokers' Quitline, Roswell Park Cancer Institute (Drs Carlin-Menter and Mahoney and Ms Celestino) and Department of Health Behavior, Roswell Park Cancer Institute (Drs Cummings and Hyland), Buffalo; and New York State Tobacco Control Program (Dr Willett) and New York State Department of Health, Tobacco Surveillance, Evaluation, & Research (Dr Juster), Albany.

Correspondence: K. Michael Cummings, MPH, PhD, Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton St, Buffalo, NY 14263 (

Funding for this study was provided by the New York State Department of Health.

Authors Contributions: Conception and design—K.M.C., A.H., S.C.M., P.C., M.H., H.J.; acquisition of data—A.H., S.C.M., P.C., J.W.; data analysis and interpretation—K.M.C., A.H., S.C.M., M.C.M.; and drafting the article and/or revising it critically for important intellectual content—K.M.C., A.H., S.C.M., M.C.M., P.C., J.W., H.J.

© 2011 Lippincott Williams & Wilkins, Inc.