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Abstract

Tobacco smoking is the leading cause of preventable morbidity and mortality in the United States.^1-4 Fortunately, the health benefits of quitting are substantial⁵ and most smokers are motivated to quit, with just more than half attempting to quit each year. Unfortunately, only about 6% of all smokers are successful in quitting each year.⁶ Quitlines deliver telephone-based tobacco cessation services throughout the United States to help smokers quit (http://www.naquitline.org/) and have demonstrated impressive efficacy and real-world effectiveness,^7-11 yet they reach only 1% to 2% of smokers annually.^12,13 Given that 95% of all households in the United States have telephone service,¹⁴ few intervention delivery modalities are likely to have a broader reach. Therefore, quitlines could serve a much larger population of smokers than at present.^12,13 Cessation treatments such as those delivered by quitlines generally have not been well integrated or institutionalized within health care systems,¹² and formalizing partnerships with health care providers that include well-defined referral mechanisms has been identified as a key strategy for increasing the impact of quitlines.¹³ Even modest increases in the reach and efficacy of quitlines could affect smoking prevalence dramatically at the population level.¹⁵