The Association between Quitline Characteristics and Smoking Cessation by Educational Attainment, Income, Race/Ethnicity, and Sex

Abstract

Little research examines how tobacco quitlines affect disparities in smoking cessation in the United States. Our study utilized data from the Tobacco Use Supplement to the Current Population Survey (2010, 2011, 2012, 2015, 2018) (TUS-CPS) and state-level quitline data from the North American Quitline Consortium and National Quitline Data Warehouse. We ran multilevel logistic regression models assessing a state-run quitline’s budget, reach, number of counseling sessions offered per caller, and hours of operation on 90-day smoking cessation. Multiplicative interactions between all exposures and sex, race/ethnicity, income, and education were tested to understand potential effect modification. We found no evidence that budget, reach, number of counseling sessions, or hours available for counseling were associated with cessation in the main effects analyses. However, when looking at effect modification by sex, we found that higher budgets were associated with greater cessation in males relative to females. Further, higher budgets and offering more sessions had a stronger association with cessation among individuals with lower education, while available counseling hours were more strongly associated with cessation among those with higher education. No quitline characteristics examined were associated with smoking cessation. We found evidence for effect modification by sex and education. Despite proven efficacy at the individual-level, current resource allocation to quitlines may not be sufficient to improve rates of cessation.

Impact of the ‘10,000 lives’ program on Quitline referrals, use and outcomes by demography and Indigenous status

“…Studies conducted in other countries have reported similar findings to our study. Although significant disparities exist in uptake of Quitline in different age, gender, socio-economic and ethnic groups [24,25], initiatives such as tailoring Quitline services, incentivising people who smoke and referrers to use Quitline services can help to effectively address disparities in Quitline use [26,27]. Our study produced evidence that an initiative like '10,000 Lives' can effectively increase the uptake of those programs and reduce the disparities in different population groups.In Australia, referrals to and uptake of Quitline among Aboriginal and Torres Strait Islander peoples are lower than non-Indigenous people.…”

A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S.

“…It is possible that quitlines assist in smoking cessation similarly for historically marginalized populations and their nonmarginalized counterparts, but given the additional barriers marginalized communities face to quitting, it might not always translate to sustained smoking cessation. It may be that quitlines are successful in aiding in cessation among populations that are disproportionately impacted by tobacco, 61 although more tailored efforts are needed to close the gap in cessation-related disparities.…”