Ending the Tobacco Problem - Resources for Local Action
Institute of Medicine of The National Academies

Call To Action


 

Smoking Cessation Programs

 

Research shows that the best way for people to quit smoking is through evidence-based smoking cessation technologies and programs. Such services include, among others, prescription drugs, insurance programs, nicotine over-the-counter products, and quit lines. Smokers who take part in cessation programs are more likely to successfully quit smoking—defined as abstinence for six months or more—than those who attempt quitting on their own. However, less than 50 percent of the 44.5 million current smokers make an attempt to quit annually. Seventy percent of smokers who attempt to quit do so without the use of evidence-based programs, and, of those, 90 percent will relapse. Cessation programs are available to smokers, yet they are underutilized, frequently because smokers are unaware of them. In order to expand cessation program use and ultimately increase cessation rates, smokers must know that safe, effective, and accessible cessation programs are available.


To reach out to those smokers who want to quit and to ensure maximum use of cessation programs, federal and state health agencies need to establish an integrated, multi-level approach. Nearly 90 percent of smokers surveyed in 2004 wanted to know how to quit smoking and wanted additional information on where to get help. State tobacco control agencies, in collaboration with health care partners, can provide smokers with the much needed program assistance they seek. In addition, volunteer organizations such as the American Cancer Society can play a critical role in providing smokers with cessation services and programs. Health practitioners also can be strong advocates, encouraging smokers to quit and directing them to the proven cessation programs to assist with the process.

 

A Promising Approach: Quit Lines


One type of cessation program that has been found to be effective is the telephone quit line. For many years, state and local telephone quit lines have helped people who have called for assistance in their efforts to quit smoking. In particular, national quit line networks have been found to be effective; they have shown a higher rate of smoking abstinence by as much as 30 to 50 percent more than the rate achieved under control conditions [1]. Providing smokers with a national quit line can potentially reach an additional five million quitters per year, saving three million lives within two decades [2].  


As of February 2004, approximately 31 states had smoking quit lines, but no national network existed and there was no coordination between states. An Intergovernmental Agency on Smoking Cessation convened in 2004 recommended the creation of a national smoking quit line to address this fragmented solution. The Secretary of Health and Human Services called on the NCI and CDC to implement the recommendation. 


The NCI and CDC held five regional meetings to meet with representatives from each state to implement the plan. While representatives were wary at first, all fifty states had established smoking quit lines by June 2006. Twenty states used the national number, 1-800-QUITNOW, and the remaining thirty states connected their state number to the national number [3]. Each state quit line provides different services. Some refer callers to local cessation programs, while counselors may answer the phone in other states, offering advice to callers. In some states, the quit line is part of the state’s tobacco control program, while in other states it might simply be affiliated or partnered with the state’s efforts.


Funding for state quit lines comes from a variety of sources including federal funds, state funds, Master Settlement Agreement funds, and tobacco tax revenues, as well as private sources such as foundations and grants. The CDC provides some of this funding through the National Tobacco Control Program’s Funding Opportunity Announcement (FOA).  Each state can submit funding requests and the CDC will evaluate that state’s application and budget against the FOA’s criteria and then award the money accordingly.  Many states received funding from the CDC to set up their quit lines, and many still receive funding to keep them going. However, none of these sources provides a stable, constant flow of funds. State and federal budgets differ each year and quit line funding often is cut when other issues take higher priority. When budgets are tight, states have seen their funding for quit lines reduced, and some are in danger of being shut down altogether.

 

Further Information


One way to increase the overall impact of cessation within the population is to increase the reach of current interventions using social marketing to enhance smokers’ motivation and interest in cessation. The Internet is proving to be a cost-effective vehicle for reaching smokers, but few programs have been thoroughly evaluated. 


Every level of the health care system must be supportive of smoking cessation efforts through policies and incentives. Public and private health care systems should organize and provide smokers with comprehensive cessation programs by demonstrating an assortment of successful cessation methods and management models. Although the initial financial investment for institutions to provide comprehensive cessation programs may be high, they will receive a significant return in their investment within a few short years [4]. Quitters gained an average of 7.1 years of life, with an average cost of $3,417 for each year of life saved. With the costs of health care expenditures for smokers and productivity losses from smoking estimated to be more than $167 billion per year [5], the expected savings from the implementation of effective cessation programs could be substantial.


Cessation from smoking is a long and arduous journey for many smokers, even though for a majority of the time the smoker is not actively attempting to quit. Thus, there are multiple opportunities to enhance cessation success rates at many points of the smoker’s journey. However, there is substantial room to improve the overall cessation outcome rate through strengthening and developing policies that support a comprehensive smoking cessation care management system that addresses each and every step in the process from current smoker to abstinence.




[1] Fiore, M.C., Bailey, W.C., Cohen, S.J. (2000). Treating Tobacco Use and Dependence (Clinical Practice Guideline). Rockville, MD: U.S. Department of Health Human Services. Public Health Service.
[2] 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. American Journal of Public Health, 94(2):205-310.
[3] 1-800-QUIT-NOW is a free smoking cessation service for the general public
.
[4] AHIP (America’s Health Insurance Plans). 2004. Making the Business Case for Smoking Ces¬sation.

[5] CDC. 2005. Annual smoking-attributable mortality, years of potential life lost, and pro¬ductivity losses—United States, 1997–2001. MMWR (Morbidity and Mortality Weekly Report) 54(25):625-628.