TABLE 1—

Tobacco Quitline Practices by Evidence Level, Implementation, and Correlation With Treatment Reach and Spending per Smoker: United States and Canada, 2009

Quitline Practice	Efficacy Evidence Level	Reach Evidence Level	Quitlines Reporting “Full” or “High” Implementation (n = 62), No.	Correlation of Implementation Score With Quitline-Level Treatment Reach, r	Correlation of Implementation Score With Quitline-Level Spending per Smoker, r
Provide a multiple-call protocol (≥ 2 calls for the same quit attempt).	B	D	57	−0.23	−0.34**
Provide self-help materials for tobacco users regardless of the reason for calling or services selected.	A	D	53	0.02	−0.05
Provide reactive (inbound) counseling.	B	D	51	0.04	−0.09
Provide self-help materials to proxy callers (nontobacco users calling on behalf of, or to help, someone else).	B	D	51	0.18	0.13
Provide proactive (outbound) telephone counseling.	A	B	50	0.03	−0.08
Conduct an evaluation of the effectiveness of the quitline.	C	D	48	0.07	0.19
Serve callers without insurance coverage.	C	B	46	0.04	0.20
Fax-to-quit or fax referral program.	D	B	46	−0.20	−0.16
Provide self-help materials for tobacco users who receive counseling.	A	D	46	0.23	0.16
Provide free (or discounted) nicotine replacement therapy (NRT) to callers.a	A	B	37	0.26	0.28*
Provide counseling immediately to all callers who request it (either through real-time staff capacity or on-call staff capacity).	C	D	37	0.14	−0.06
Conduct mass media promotions for the mainstream population.	B	B	35	0.41**	0.30*
Train provider groups on the first 2 or 3 A's (Ask whether a patient uses tobacco, Advise them to quit, Assess their interest in quitting) and refer interested patients to quitlines (with or without a fax referral program).	B	B	32	0.16	0.09
Integrate telephone counseling with Web-based, Internet-based or e-Health programs through referrals or combinations of phone and those services.	B	D	30	−0.05	−0.15
Conduct mass media promotions for targeted populations.	B	B	25	0.27	0.31*
Integrate telephone counseling with face-to-face cessation services through referrals or combinations of phone and those services.	D	D	25	0.15	0.18
Refer callers with insurance to health plans that provide telephone counseling.	C	D	18	0.10	0.02
Staff the quitline with counselors who meet or exceed masters-level training.	D	D	14	−0.20	−0.13
Recontact relapsed smokers for reenrollment in quitline services.	C	B	12	−0.08	−0.12
Obtain Medicaid or other insurance reimbursement for counseling provided to callers.	B	D	8	−0.06	0.16
Supplement quitline services with Interactive Voice Response (IVR) services (e.g., automated check-in IVR calls for relapse prevention).	C	D	4	0.03	0.19
Use text messaging to provide tailored support with, or instead of, telephone counseling.	B	D	2	0.11	−0.10

Note. A = practices that are effective, as indicated by findings of 1 or more meta-analyses or multiple high-quality single studies; B = practices with only 1 high-quality, or several inferior-quality (smaller sample size, single site, or small effect size), peer-reviewed journal articles and no meta-analyses documenting their effectiveness; C = practices that have been recommended by a reputable organization such as the Centers for Disease Control and Prevention but have no peer-reviewed journal articles documenting their effectiveness; D = practices that were not supported by any scientific evidence or recommendations from reputable organizations.

^aThe survey included 2 NRT-related practices: provide free (or reduced) NRT to callers without requiring registration for telephone counseling, and provide NRT but require registration for counseling. On the basis of qualitative follow-up with survey respondents, we combined the 2 practices; the highest level of implementation for either NRT practice was recorded as the final response for “provide free (or discounted) NRT to callers.”

*P < .05; **P < .01.