Barriers to Telephone Quitline Use Among Methadone-Maintained Smokers

Abstract

Introduction: Drug users have high rates of tobacco use and tobacco-related disease. Telephone quitlines promote smoking cessation, but their reach among drug users is unknown. We thus aimed to assess utilization of and barriers to telephone quitlines among methadone-maintained smokers. Methods: Subjects were opioid-dependent smokers in Bronx, New York, methadone treatment programs who were enrolled in a clinical trial of varenicline. All subjects were offered referral to a free, proactive quitline. We examined quitline records, surveyed barriers to quitline use, and queried reasons for declining referral. Results: Of the 112 subjects enrolled, 47% were male, 54% were Hispanic, and 28% were Black. All subjects were offered referral, and 25 (22% of study participants) utilized the quitline. Quitline utilizers (vs. nonutilizers) were significantly more likely to have landline phone service (72 vs. 42%, p = .01), interest in quitline participation (92 vs. 62%, p < .01), and willingness to receive calls (96 vs. 76%, p = .02). Nonutilizers were significantly more likely to report cell phone service lapse (38 vs. 14%, p = .04), and difficulty charging cell phones (19 vs. 0%, p = .02). Reasons for quitline refusal included: (a) skepticism of quitline efficacy; (b) aversion to telephone communication; (c) competing life demands (e.g., drug treatment, shelter); and (d) problems with cell phone service or minutes. Conclusions: Despite several limitations to quitline access among methadone-maintained smokers, routine quitline referral was associated with 22% utilization. To expand provision of smoking cessation treatment to opioid-dependent smokers, interventions to promote routine quitline referral in substance abuse treatment programs warrant investigation.

When Free Is Not for Me: Confronting the Barriers to Use of Free Quitline Telephone Counseling for Tobacco Dependence

“…One must have free available minutes to be able to use the quitline for free telephone counseling. These findings are also supported by previous studies in which a large proportion of low-income HIV positive smokers [ 21 ] and methadone maintained smokers [ 22 ] reported telephone availability as a barrier to use of the quitline. While quitlines are often assumed to be attractive and accessible to lower income groups, a lack of the telephonic resources needed to use the service clearly prevents access.…”

“…At the time this study was conducted, the Arkansas quitline had been providing evidence-based treatment for tobacco dependence free of charge for several years; however, the Arkansas Mississippi Delta counties demonstrated rates of participation 1–2 standard deviations below the mean smoker participation rate for other counties in the state [ 20 ]. Recent evidence suggests that a lack of consistent telephonic services along with skepticism about the treatment provided through quitlines and an aversion to communicating by telephone contribute to non-use of quitlines among HIV-positive and methadone maintained smokers [ 21 , 22 ].…”

Interventions to Reduce Tobacco-Related Health Disparities

“…However, individuals who believed their mental health conditions would interfere with cessation were less likely to quit than their counterparts who did not share these beliefs. Griffin and colleagues 10 examined potential barriers to quitline use among methadone maintained, opioid dependent smokers. Their results highlight factors associated with a lack of quitline use to include inconsistent cell phone service and phone charging issues.…”

Characterizing Cardiovascular Health and Evaluating a Low-Intensity Intervention to Promote Smoking Cessation in a Food-Assistance Population

“…Although state quit line services have been shown to increase the odds of quitting by 60% in the general population [15], <10% of smokers who are trying to quit and are aware of quit lines, are actually using them [22]. Non-utilizers of the state quit line have been identified as those who do not have a land-line telephone, have lapses in cell phone service, and report skepticism of quit line efficacy [23]. The lack of impact of the current brief smoking cessation education program on intention to quit and quit line uptake could be attributed to the intensity of the intervention.…”