This study offers a preliminary look at e-cigarette use among state quitline callers and is perhaps the first to describe e-cigarette use in a large group of tobacco users seeking treatment. The notable rates of e-cigarette use and use of e-cigarettes as cessation aids, even though the U.S. Food and Drug Administration has not approved e-cigarettes for this purpose, should inform policy and treatment discussions on this topic.

Objectives: State and national tobacco quitlines have expanded rapidly and offer a range of services. We examined the effectiveness and cost effectiveness of offering callers single session versus multisession counselling, with or without free nicotine patches. Methods: This 362 randomised trial included 4614 Oregon tobacco quitline callers and compared brief (one 15-minute call), moderate (one 30-minute call and a follow-up call) and intensive (five proactive calls) intervention protocols, with or without offers of free nicotine patches (nicotine replacement therapy, NRT). Blinded staff assessed tobacco use by phone at 12 months. Results: Abstinence odds ratios were significant for moderate (OR = 1.22, CI = 1.01 to 1.48) and intensive (OR = 1.29, CI = 1.07 to 1.56) intervention, and for NRT (OR = 1.58, CI = 1.35 to 1.85). Intent to treat quit rates were as follows: brief no NRT (12%); brief NRT (17%); moderate no NRT (14%); moderate NRT (20%); intensive no NRT (14%); and intensive NRT (21%). Relative to brief no NRT, the added costs for each additional quit was $2467 for brief NRT, $1912 for moderate no NRT, $2109 for moderate NRT, $2641 for intensive no NRT, and $2112 for intensive NRT. Conclusion: Offering free NRT and multisession telephone support within a state tobacco quitline led to higher quit rates, and similar costs per incremental quit, than less intensive protocols.T he past decade has produced a dramatic nationwide dissemination of a new form of behavioural therapy. In 1999, only four states (Oregon, Arizona, California, and Massachusetts) provided centralised telephone support services (quitlines) and none offered free nicotine replacement therapy (NRT). By 2005, all states in the United States, all provinces of Canada, Australia, New Zealand and many countries in the European Union and elsewhere had established quitlines. [1][2][3] Services range from information, counselling, and referral in a single call to multisession counselling with proactive followup. [4][5][6] More than 18 states currently provide NRT to some or all callers. 1 Cessation medications, including nicotine replacement, 7 8 bupropion, 9 and varenicline, 10-12 all increase success rates. Proactive, multiple session telephone counselling 7 13-16 also improves outcomes, and the efficacy of cessation quitlines has been confirmed in statewide programmes 17-19 serving large and diverse populations. 4 6 20 21 The US clinical practice guideline for tobacco concluded that both medications and quitlines are effective. 7 Proactive quitlines provide support over multiple contacts, but are more convenient than group counselling and are often provided free of charge. These features allow quitlines to attract more and more diverse, tobacco users than do group programmes. 22 The efficacy and broad reach of quitlines create a potentially large population impact.Few randomised trials have assessed the relative effectiveness and cost effectiveness of alternative quitline services. Borland 23 and Zhu 24 found that adding follow-up calls to an init...

Background Phone-based tobacco cessation programs have been proven effective and widely adopted. Web-based solutions exist; however, the evidence base is not yet well established. Many cessation treatments are commercially available, but few integrate the phone and Web for delivery and no published studies exist for integrated programs.Objective This paper describes a comprehensive integrated phone/Web tobacco cessation program and the characteristics, experience, and outcomes of smokers enrolled in this program from a real-world evaluation.Methods We tracked program utilization (calls completed, Web log-ins), quit status, satisfaction, and demographics of 11,143 participants who enrolled in the Free & Clear Quit For Life Program between May 2006 and October 2007. All participants received up to five proactive phone counseling sessions with Quit Coaches, unlimited access to an interactive website, up to 20 tailored emails, printed Quit Guides, and cessation medication information. The program was designed to encourage use of all program components rather than asking participants to choose which components they wanted to use while quitting.Results We found that participants tended to use phone services more than Web services. On average, participants completed 2-2.5 counseling calls and logged in to the online program 1-2 times. Women were more adherent to the overall program; women utilized Web and phone services significantly (P = .003) more than men. Older smokers (> 26 years) and moderate smokers (15-20 cigarettes/day) utilized services more (P < .001) than younger (< 26 years) and light or heavy smokers. Satisfaction with services was high (92% to 95%) and varied somewhat with Web utilization. Thirty-day quit rates at the 6-month follow-up were 41% using responder analysis and 21% using intent-to-treat analysis. Web utilization was significantly associated with increased call completion and tobacco abstinence rates at the 6-month follow-up evaluation.Conclusions This paper expands our understanding of a real-world treatment program combining two mediums, phone and Web. Greater adherence to the program, as defined by using both the phone and Web components, is associated with higher quit rates. This study has implications for reaching and treating tobacco users with an integrated phone/Web program and offers evidence regarding the effectiveness of integrated cessation programs.

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This investigation was designed to identify the risk factors associated with different stages of cigarette use in a large biracial adolescent sample. A questionnaire assessing smoking habits and variables thought to be related to smoking was administered to 6,967 7th graders. Analysis revealed that the best predictor of experimentation with cigarettes was the perception that they were easily available. Regular smoking appeared to be heavily influenced by cost. Social influences contributed to both experimental and regular smoking, but the impact of social models varied with ethnicity and gender. Analysis further revealed that weight-related variables were closely tied to regular smoking. Implications of the findings for smoking prevention programs are discussed.

Importance: Several national health care-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments, such as quitline (telephone-based tobacco cessation services) assistance. The most notable examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise. Refer. (AAR) programs. Unfortunately, rates of primary care referrals to quitlines are low, and most referred smokers fail to call for assistance.Objective: To evaluate a new approach-Ask-Advise-Connect (AAC)-designed to address barriers to linking smokers with treatment.Design: A pair-matched, 2-treatment-arm, grouprandomized design in 10 family practice clinics in a single metropolitan area. Five clinics were randomized to the AAC (intervention) and 5 to the AAR (control) conditions. In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record, and smokers were given brief advice to quit. In the AAC clinics, the names and telephone numbers of smokers who agreed to be connected were sent electronically to the quitline daily, and patients were called proactively by the quitline within 48 hours. In the AAR clinics, smokers were offered a quitline referral card and encouraged to call on their own. All data were collected from February 8 through December 27, 2011.Setting: Ten clinics in Houston, Texas.Participants: Smoking status assessments were completed for 42 277 patients; 2052 unique smokers were identified at AAC clinics, and 1611 smokers were identified at AAR clinics.Interventions: Linking smokers with quitlinedelivered treatment.Main Outcome Measure: Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) conceptual framework and defined as the proportion of all identified smokers who enrolled in treatment.Results: In the AAC clinics, 7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics (t 4 = 9.19 [P Ͻ .001]; odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion of smokers enrolling in treatment. Conclusions and Relevance:The system changes implemented in the AAC approach could be adopted broadly by other health care systems and have tremendous potential to reduce tobacco-related morbidity and mortality.

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Background-Smoking remains the primary preventable cause of death and illness in the U.S. Effective, convenient treatment programs are needed to reduce smoking prevalence.