Tobacco quitlines

Evidence Rating  
Evidence rating: Scientifically Supported

Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.

Health Factors  
Decision Makers
Date last updated

Quitlines provide behavioral counseling to tobacco users who want to quit. Cessation specialists schedule follow-up calls after the specialist or tobacco user makes initial contact using a proactive quitline; reactive quitlines rely solely on tobacco users to make future contact. Some quitlines provide additional interventions such as mailed materials, web-based support, text messaging, or tobacco cessation medications1. Many quitlines offer services in multiple languages2.

Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.

What could this strategy improve?

Expected Benefits

Our evidence rating is based on the likelihood of achieving these outcomes:

  • Increased quit rates

What does the research say about effectiveness?

There is strong evidence that proactive quitlines increase tobacco cessation1, 3, 4, 5, 6, 7. State-1 and community-sponsored quitlines have demonstrated effects on cessation6, 8.

Proactive counseling is more effective than reactive counseling and three to five counseling sessions appear more effective than one session alone4. Combining quitlines with other interventions such as mass communication campaigns, texting apps, and efforts to encourage health care providers to refer patients to quitlines, increases quitline use and tobacco cessation1. Combining quitlines with technology-based efforts such as internet- or cell phone-based services like texting9, 10 and providing counseling in multiple languages11 can also support cessation. Referrals from providers based in community health centers may increase participation among minority populations8. Text-based outreach to patients may connect smokers to quitlines12.

Providing tobacco cessation medication such as nicotine replacement therapy (NRT) with quitline services increases quit rates1, 13 and call volume1. Telephone counseling with NRT increases smoking quit rates more than medication alone14. Quitlines combined with NRT have been shown to increase quit rates for active military personnel, veterans, and their dependents5, and smokers with low incomes15.

Telephone counseling may increase smokeless tobacco cessation16, 17. Experts suggest quitline services expand to include and recruit e-cigarette users18.

Quitlines are considered cost effective1, 19.

How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples

All fifty states have quitlines. Most quitlines proactively call and counsel clients multiple times and offer free tobacco cessation medication20.

The American Indian Commercial Tobacco Program (AICTP) is a culturally tailored quitline focusing on cessation of commercial tobacco use for men, women, and elders of all ages and tribal nations21.

Implementation Resources

AICTP - American Indian Commercial Tobacco Program. Quit commercial tobacco for good with the American Indian Commercial Tobacco Program (AICTP).

NAQC-US - North American Quitline Consortium (NAQC). Promoting evidence based quitline services across diverse communities in North America. United States profiles.

NAQC-Quitline - North American Quitline Consortium (NAQC). Promoting evidence based quitline services across diverse communities in North America. - U.S. Department of Health and Human Services (U.S. DHHS). Speak to an expert.

CDC-Quitlines 2004 - Centers for Disease Control and Prevention (CDC). Telephone quitlines: A resource for development, implementation, and evaluation. Atlanta: Office on Smoking and Health, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); 2004.


* Journal subscription may be required for access.

1 CG-Tobacco - The Guide to Community Preventive Services (The Community Guide). Tobacco.

2 NAQC-US - North American Quitline Consortium (NAQC). Promoting evidence based quitline services across diverse communities in North America. United States profiles.

3 West 2015 - West R, Raw M, McNeill A, et al. Health-care interventions to promote and assist tobacco cessation: A review of efficacy, effectiveness and affordability for use in national guideline development. Addiction. 2015;110(9):1388-1403.

4 Cochrane-Matkin 2019 - Matkin W, Ordóñez-Mena JM, Hartmann-Boyce J. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews. 2019;(5):CD002850.

5 Klesges 2015 - Klesges RC, Ebbert JO, Talcott GW, et al. Efficacy of a tobacco quitline in active duty military and TRICARE beneficiaries: A randomized trial. Military Medicine. 2015;180(8):917-925.

6 AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514-1563.

7 Mottillo 2009 - Mottillo S, Filion KB, Bélisle P, et al. Behavioural interventions for smoking cessation: A meta-analysis of randomized controlled trials. European Heart Journal. 2009;30(6):718-30.

8 Russo 2018 - Russo ET, Reid M, Taher R, Sharifi M, Shah SN. Referral strategies to a tobacco quitline and racial and/or ethnic differences in participation. Pediatrics. 2018;141(Suppl 1):e20171026.

9 Abroms 2016 - Abroms LC, Carroll P, Boal AL, Mendel JA, Carpenter KM. Integrated phone counselling and text messaging services at quitlines: An acceptability study. Journal of Smoking Cessation. 2016;11(1):5-11.

10 Danielsson 2014 - Danielsson AK, Eriksson AK, Allebeck P. Technology-based support via telephone or web: A systematic review of the effects on smoking, alcohol use and gambling. Addictive Behaviors. 2014;39(12):1846-1868.

11 Cummins 2015 - Cummins SE, Wong S, Bonnevie E, et al. A multistate Asian-language tobacco quitline: Addressing a disparity in access to care. American Journal of Public Health. 2015;105(10):2150-2155.

12 Krebs 2020 - Krebs P, Sherman SE, Wilson H, et al. Text2Connect: A health system approach to engage tobacco users in quitline cessation services via text messaging. Translational Behavioral Medicine. 2018;10(1):292-301.

13 Smith 2013a - Smith SS, Keller PA, Kobinsky KH, et al. Enhancing tobacco quitline effectiveness: Identifying a superior pharmacotherapy adjuvant. Nicotine Tob Res. 2013;15(3):718-728.

14 Cochrane-Stead 2015 - Stead LF, Koilpillai P, Lancaster T. Additional behavioural support as an adjunct to pharmacotherapy for smoking cessation. Cochrane Database of Systematic Reviews. 2012;(12):CD009670.

15 Bernstein 2016 - Bernstein SL, Weiss J-M, Toll B, Zbikowski SM. Association between utilization of quitline services and probability of tobacco abstinence in low-income smokers. Journal of Substance Abuse Treatment. 2016;71:58-62.

16 Nethan 2018 - Nethan ST, Sinha DN, Chandan K, Mehrotra R. Smokeless tobacco cessation interventions: A systematic review. Indian Journal of Medical Research. 2018;148(4):396-410.

17 Cochrane-Ebbert 2015 - Ebbert J, Elrashidi M, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews. 2015;(2):CD004306.

18 Vickerman 2021 - Vickerman KA, Carpenter KM, Raskob MK, et al. Vaping and e-cigarettes within the evolving tobacco quitline landscape. American Journal of Preventive Medicine. 2021;60(3 Suppl 2):S142-S153.

19 Wilson 2019 - Wilson DK, Lorig K, Klein WMP, et al. Efficacy and cost-effectiveness of behavioral interventions in nonclinical settings for improving health outcomes. Health Psychology. 2019;38(8):689-700.

20 NAQC-Quitline facts - North American Quitline Consortium (NAQC). What is a Quitline: Factsheets, materials, and world quitline map.

21 AICTP - American Indian Commercial Tobacco Program. Quit commercial tobacco for good with the American Indian Commercial Tobacco Program (AICTP).