Implementation of Tobacco Cessation Quitline Practices in the United States and Canada

Objectives. We examined relationships between implementation of tobacco quitline practices, levels of evidence of practices, and quitline reach and spending. Methods. In June and July 2009, a total of 176 quitline funders and providers in the United States and Canada completed a survey on quitline practices, in particular quitline-level implementation for the reported practices. From these data, we selected and categorized evidence-based and emerging quitline practices by the strength of the evidence for each practice to increase quitline efficacy and reach. Results. The proportion of quitlines implementing each practice ranged from 3% (text messaging) to 92% (providing a multiple-call protocol). Implementation of practices showing higher levels of evidence for increasing either reach or efficacy showed moderate but significant positive correlations with both reach outcomes and spending levels. The strongest correlation was between reach outcomes and spending levels (r = 0.80; P < .01). Conclusions. The strong relationship between quitline spending and reach reinforces the need to increase quitline funding to levels commensurate with national cessation goals.