Reading the results of the study, “‘Real-World’ Effectiveness of Reactive Telephone Counseling for Smoking Cessation: A Randomized Controlled Trial,” one might mistakenly assume that the study showed that quit lines may not be cost effective.  However, the authors conclude that offering proactive calls (i.e. more counseling) may, as numerous studies have shown, prove to be the most cost-effective method for helping people quit tobacco, whereas shifting to a more reactive treatment mode (reactive calls) is no better than sending information in the mail.  It is no surprise that quit rates were so low (1-15%) and that there were no differences between these two forms of minimal assistance. The study population was largely unemployed, low income, and had low education levels and low ratings of confidence in quitting.  Each of these characteristics has been associated with lower quit rates.

Still, this article provides further evidence of the addictive nature of tobacco.  Over three quarters of smokers in the US want to quit, and many have tried. It is common knowledge that it generally takes several attempts before one has quit for good and that providing more intensive treatment results in better quit rates. Quit lines remain the most cost-effective tobacco treatment available due to their ability to reach large populations of smokers and provide convenient and effective cessation aids in the form of specialized proactive counseling and cessation medications such as the nicotine patch or gum.  This study provides further evidence that people need more than just mailed materials or one support call.

In fact, tobacco addiction should be treated as a chronic, recurring condition whereby smokers need repeated, proactive, collaborative treatment that continues until the person has established a stable quit.  Providing less than this may undermine a person’s confidence in quitting and subsequent motivation to make further quit attempts. Given that a large proportion of smokers attempt to quit on their own or with minimal support, it is not surprising that confidence is low and that fewer than 3% use the national quit lines that are free and available in every state.  Funneling more money to state quit lines to allow them to provide reactive telephone counseling and counselor initiated follow-up with access to free NRT and unlimited re-enrollments provides a better chance at helping smokers quit for good and thus to reduce the prevalence of smoking.