NEJM EMBARGO: 5 P.M. (EASTERN) WEDNESDAY, OCT. 2
UCSD Study Shows Smokers' Quitlines Work
Phone-based smoking cessation programs, called quitlines, are cropping up all over the United States and in other countries. But are they doing any good? Is the intervention effect demonstrated in clinical trials translating to real-world service settings?
New findings drawn from the statewide California Smokers' Helpline by cancer prevention researchers at the University of California, San Diego (UCSD) suggest these programs are effective. This research is reported in the October 3 issue of the New England Journal of Medicine.
In 1990, UCSD Cancer Center researchers started a clinical trial on telephone counseling for smoking cessation. The results were so encouraging that in 1992 the California Department of Health Services decided to make it a statewide service. The California Smokers' Helpline was the first statewide quitline funded by a state health department.
Today, 33 states in the U.S. have established similar quitlines. Many large managed care organizations have also set up systemwide quitlines to help their members. The new U.S. Public Health Service Clinical Guidelines (2000) recommend the use of quitlines, following extensive review of the clinical trials on telephone counseling.
"Positive results from clinical trials got people excited about starting new quitlines. And some of the early quitlines have done a good job reaching large number of smokers, in particular underserved populations," said the study's lead author, Shu-Hong Zhu, Ph.D., director of the California Smokers' Helpline and a member of the Rebecca and John Moores UCSD Cancer Center. "But it's important to know whether real-world quitline services are able to maintain the effectiveness found in clinical trials, especially since there's a significant and growing public investment in this type of service."
Zhu explained that treatments proven in clinical trials sometimes fail in practice because of possible changes in the conditions under which the original results were obtained. The counselors may not have the same skills or enthusiasm as the ones who worked on the clinical trials. And quality control measures, a critical element in behavioral interventions, may suffer under the pressure to meet clients' expressed needs in a large public health setting.
Zhu and colleagues developed an innovative study design in which they embedded a randomized control group into the normal operations of the quitline. The randomization procedure did not affect callers' ability to receive treatment.
The study recruited 3,282 participants, who were randomly assigned to a treatment or control group. All participants received a packet of self-help materials. All were told counseling was available if they called back after receiving the materials. Those in the treatment group were assigned to receive up to seven counseling sessions, and those in the control group also received counseling if they called back for it after randomization. Those in the control group who did not call back remained as self-help subjects.
After factoring out the control subgroup that received counseling and the corresponding treatment subgroup, the researchers found that counseling approximately doubled abstinence rates at 1, 3, 6 and 12 months.
"Quitting smoking is a difficult thing to do. The reality is that even with a successful program's help, many smokers relapse within a year," said Zhu, a UCSD associate professor of Family and Preventive Medicine. "Still, we've shown there's a significantly higher probability of long-term success for people who go through a quitline program than for those who don't."
The California Smokers' Helpline is an ongoing statewide quitline operated by the University of California, San Diego that provides free cessation services to state residents. Programs are available for teens and adults, in six languages. Today the service, which has been a model for many other quitlines, receives calls from more than 55,000 tobacco users per year. Over a third of Helpline callers are from ethnic minority backgrounds.
Co-authors are Christopher M. Anderson, B.A., Gary J. Tedeschi, Ph.D., Bradley Rosbrook, M.S., Cynthia E. Johnson, B.A., Michael Byrd, M.A., and Elsa Gutierrez-Terrell, M.A., all from the UCSD Department of Family and Preventive Medicine.
This work was supported by a grant from the California Department of Health Services.
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