RESEARCH PAPER
Effectiveness of proactive and reactive services at the Swedish National Tobacco Quitline in a randomized trial
Eva Nohlert 1  
,  
John Öhrvik 2
,  
 
 
More details
Hide details
1
Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
2
Department of Medicine, Karolinska Institutet, Stockholm, Sweden
3
Department of Public Health Sciences, Social Medicine, Karolinska Institutet and Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
4
Reykjavik University, Reykjavik, Iceland
CORRESPONDING AUTHOR
Eva Nohlert   

Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås 721 89, Sweden
Publish date: 2014-06-03
 
Tobacco Induced Diseases 2014;12(June):9
KEYWORDS
ABSTRACT
Background:
The Swedish National Tobacco Quitline (SNTQ), which has both a proactive and a reactive service, has successfully provided tobacco cessation support since 1998. As there is a demand for an increase in national cessation support, and because the quitline works under funding constraints, it is crucial to identify the most clinically effective and cost-effective service. A randomized controlled trial was performed to compare the effectiveness of the high-intensity proactive service with the low-intensity reactive service at the SNTQ.

Methods:
Those who called the SNTQ for smoking or tobacco cessation from February 2009 to September 2010 were randomized to proactive service (even dates) and reactive service (odd dates). Data were collected through postal questionnaires at baseline and after 12 months. Those who replied to the baseline questionnaire constituted the study base. Outcome measures were self-reported point prevalence and 6-month continuous abstinence at the 12-month follow-up. Intention-to-treat (ITT) and responder-only analyses were performed.

Results:
The study base consisted of 586 persons, and 59% completed the 12-month follow-up. Neither ITT- nor responder-only analyses showed any differences in outcome between proactive and reactive service. Point prevalence was 27% and continuous abstinence was 21% in analyses treating non-responders as smokers, and 47% and 35%, respectively, in responder-only analyses.

Conclusions:
Reactive service may be used as the standard procedure to optimize resource utilization at the SNTQ. However, further research is needed to assess effectiveness in different subgroups of clients.

 
REFERENCES (31)
1.
WHO: WHO Report On The Global Tobacco Epidemic, 2011. 2011, Geneva: World Health Organization (WHO).
 
2.
Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, Faith Dorfman S, Froelicher ES, Goldstein MG, Healton CG, Nez Henderson P, Heyman RB, Koh HK, Kottke TE, Lando HA, Mecklenburg RE, Mermelstein RJ, Dolan Mullen P, Orleans CT, Robinson L, Stitzer ML, Tommasello AC, Villejo L, Wewers M-E: Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. 2008, Rockville, MD: U.S. Department of Health and Human Service. Public Health Service.
 
3.
Helgason AR, Lund KE, Adolfsson J, Axelsson S: Tobacco prevention in Swedish dental care. Community Dent Oral Epidemiol. 2003, 31 (5): 378-385. 10.1034/j.1600-0528.2003.00111.x.
 
4.
Stead M, Angus K, Holme I, Cohen D, Tait G: Factors influencing European GPs’ engagement in smoking cessation: a multi-country literature review. Br J Gen Pract. 2009, 59 (566): 682-690. 10.3399/bjgp09X454007.
 
5.
Stead LF, Perera R, Lancaster T: A systematic review of interventions for smokers who contact quitlines. Tob Control. 2007, 16 (Suppl 1): i3-i8.
 
6.
Borland R, Segan CJ: The potential of quitlines to increase smoking cessation. Drug Alcohol Rev. 2006, 25 (1): 73-78. 10.1080/09595230500459537.
 
7.
Smith SS, Keller PA, Kobinsky KH, Baker TB, Fraser DL, Bush T, Magnusson B, Zbikowski SM, McAfee TA, Fiore MC: Enhancing tobacco quitline effectiveness: identifying a superior pharmacotherapy adjuvant. Nicotine Tob Res. 2013, 15 (3): 718-728. 10.1093/ntr/nts186.
 
8.
Willemsen MC, van der Meer RM, Bor S: Description, Effectiveness, and Client Satisfaction of 9 European Quitlines: Results of the European Smoking Cessation Helplines Evaluation Project (ESCHER). 2008, Den Haag: STIVORO.
 
9.
Stead LF, Hartmann-Boyce J, Perera R, Lancaster T: Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2013, 8: CD002850.
 
10.
Stead LF, Perera R, Lancaster T: Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2006, 3: CD002850.
 
11.
Ferguson J, Docherty G, Bauld L, Lewis S, Lorgelly P, Boyd KA, McEwen A, Coleman T: Effect of offering different levels of support and free nicotine replacement therapy via an English national telephone quitline: randomised controlled trial. BMJ. 2012, 344: e1696-10.1136/bmj.e1696.
 
12.
Gilbert H, Sutton S: Evaluating the effectiveness of proactive telephone counselling for smoking cessation in a randomized controlled trial. Addiction. 2006, 101 (4): 590-598. 10.1111/j.1360-0443.2006.01398.x.
 
13.
Lichtenstein E, Zhu SH, Tedeschi GJ: Smoking cessation quitlines: an underrecognized intervention success story. Am Psychol. 2010, 65 (4): 252-261.
 
14.
The National Swedish Board of Health and Welfare and Swedish National Institute of Public Health: Public health in Sweden - Annual report 2013. 2013, Stockholm: The National Swedish Board of Health and Welfare and Swedish National Institute of Public Health.
 
15.
Swedish National Institute of Public Health: Tobacco and Weaning. 2009, Östersund: Swedish National Institute of Public Health.
 
16.
Helgason AR, Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H: Factors related to abstinence in a telephone helpline for smoking cessation. Eur J Public Health. 2004, 14 (3): 306-310. 10.1093/eurpub/14.3.306.
 
17.
Tomson T, Helgason AR, Gilljam H: Quitline in smoking cessation: a cost-effectiveness analysis. Int J Technol Assess Health Care. 2004, 20 (4): 469-474.
 
18.
Hosmer DW, Lemeshow S: Applied logistic regression. 1989, New York: Wiley.
 
19.
Lindqvist H, Forsberg LG, Forsberg L, Rosendahl I, Enebrink P, Helgason AR: Motivational Interviewing in an ordinary clinical setting: a controlled clinical trial at the Swedish National Tobacco Quitline. Addict Behav. 2013, 38 (7): 2321-2324. 10.1016/j.addbeh.2013.03.002.
 
20.
Segan CJ, Borland R: Does extended telephone callback counselling prevent smoking relapse?. Health Educ Res. 2011, 26 (2): 336-347. 10.1093/her/cyr009.
 
21.
An LC, Schillo BA, Kavanaugh AM, Lachter RB, Luxenberg MG, Wendling AH, Joseph AM: Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy. Tob Control. 2006, 15 (4): 286-293. 10.1136/tc.2005.014555.
 
22.
Carlin-Menter S, Cummings KM, Celestino P, Hyland A, Mahoney MC, Willett J, Juster HR: Does offering more support calls to smokers influence quit success?. J Public Health Manag Pract. 2011, 17 (3): E9-E15. 10.1097/PHH.0b013e318208e730.
 
23.
Etter JF, Perneger T, Ronchi A: Distributions of smokers by stage: International comparison and association with smoking prevalence. Prev Med. 1997, 26: 580-585. 10.1006/pmed.1997.0179.
 
24.
Pan W: Proactive telephone counseling as an adjunct to minimal intervention for smoking cessation: a meta-analysis. Health Educ Res. 2006, 21 (3): 416-427. 10.1093/her/cyl040.
 
25.
Alberg AJ, Patnaik JL, May JW, Hoffman SC, Gitchelle J, Comstock GW, Helzlsouer KJ: Nicotine replacement therapy use among a cohort of smokers. J Addict Dis. 2005, 24 (1): 101-113. 10.1300/J069v24n01_09.
 
26.
Alpert HR, Connolly GN, Biener L: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation. Tob Control. 2013, 22 (1): 32-37. 10.1136/tobaccocontrol-2011-050129.
 
27.
Gilljam H, Galanti R: Role of snus (oral moist snuff) in smoking cessation and smoking reduction in Sweden. Addiction. 2003, 98: 1183-1189. 10.1046/j.1360-0443.2003.00379.x.
 
28.
Lund KE, Scheffels J, McNeill A: The association between use of snus and quit rates for smoking: results from seven Norwegian cross-sectional studies. Addiction. 2011, 106 (1): 162-167. 10.1111/j.1360-0443.2010.03122.x.
 
29.
Fagerstrom K, Rutqvist LE, Hughes JR: Snus as a smoking cessation aid: a randomized placebo-controlled trial. Nicotine Tob Res. 2012, 14 (3): 306-312. 10.1093/ntr/ntr214.
 
30.
Society for Research on Nicotine and Tobacco Subcommittee on Biochemical Verification: Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002, 4 (2): 149-159. 10.1080/14622200210123581.
 
31.
Tomson T, Bjornstrom C, Gilljam H, Helgason A: Are non-responders in a quitline evaluation more likely to be smokers?. BMC Public Health. 2005, 5 (1): 52-10.1186/1471-2458-5-52.
 
 
CITATIONS (6):
1.
Expanding the reach of the Quitline by engaging volunteers to market it in hospitals and shopping venues – a pilot study
Fadi Hammal, Alyssa Chappell, Katherine Pohoreski, Barry A. Finegan
Tobacco Induced Diseases
 
2.
A Cluster-Randomized Controlled Trial Evaluating the Effectiveness and Cost-Effectiveness of Tobacco Cessation on Prescription in Swedish Primary Health Care: A Protocol of the Motivation 2 Quit (M2Q) Study
Anne Leppänen, Peter Lindgren, Carl Johan Sundberg, Max Petzold, Tanja Tomson
JMIR Research Protocols
 
3.
Non-responders in a quitline evaluation are more likely to be smokers – a drop-out and long-term follow-up study of the Swedish National Tobacco Quitline
Eva Nohlert, John Öhrvik, Ásgeir R. Helgason
Tobacco Induced Diseases
 
4.
Motivational interviewing for smoking cessation
Nicola Lindson-Hawley, Tom P Thompson, Rachna Begh
Cochrane Database of Systematic Reviews
 
5.
An individually-tailored smoking cessation intervention for rural Veterans: a pilot randomized trial
Mark W. Vander Weg, Ashley J. Cozad, M. Bryant Howren, Margaret Cretzmeyer, Melody Scherubel, Carolyn Turvey, Kathleen M. Grant, Thad E. Abrams, David A. Katz
BMC Public Health
 
6.
Self-perceived ability to cope with stress and depressive mood without smoking predicts successful smoking cessation 12 months later in a quitline setting: a secondary analysis of a randomized trial
Eva Nohlert, John Öhrvik, Ásgeir R. Helgason
BMC Public Health
 
eISSN:1617-9625