Tobacco quitlines

Evidence Rating  
Scientifically Supported
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

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.

Expected Beneficial Outcomes (Rated)

  • Increased quit rates

Evidence of 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.

Proactive counseling is more effective than reactive counseling and three or more counseling sessions appear more effective than fewer sessions4. Combining quitlines with other interventions such as mass communication campaigns and efforts to encourage health care providers to refer patients to quitlines increases quitline use and tobacco cessation1. Combining quitlines with technology-based efforts (e.g., internet- or cell phone-based services)8 and providing counseling in multiple languages9 can also support cessation.

Providing tobacco cessation medication such as nicotine replacement therapy (NRT) with quitline services increases quit rates1, 10 and call volume1. Telephone counseling with NRT increases smoking quit rates more than medication alone11. Quitlines combined with NRT have been shown to increase quit rates for active military personnel, veterans, and their dependents5, and smokers with low incomes12. Telephone counseling may also increase smokeless tobacco cessation13.

Quitlines are considered cost effective1.

Impact on Disparities

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 medication14

Implementation Resources

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. - US Department of Health and Human Services (US 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 use - 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-Stead 2013a* - Stead LF, Hartman-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews. 2013;(3):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):1514-63.

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 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.

9 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.

10 Smith 2013* - Smith TJ. One Stop Service Center Initiative: Strategies for serving persons with disabilities. Journal of Rehabilitation. 2013;79(1):30-36.

11 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.

12 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.

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

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

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