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
More details
Hide details
Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
Department of Medicine, Karolinska Institutet, Stockholm, Sweden
Department of Public Health Sciences, Social Medicine, Karolinska Institutet and Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
Reykjavik University, Reykjavik, Iceland
Submission date: 2015-08-28
Acceptance date: 2016-01-26
Publication date: 2016-02-03
Corresponding author
Eva Nohlert   

Centre for Clinical Research, Uppsala University, Västmanland County Hospital, 721 89 Västerås, Sweden
Tobacco Induced Diseases 2016;14(February):5
A previous randomized controlled trial (RCT) of the Swedish National Tobacco Quitline detected no significant differences in smoking cessation outcomes between proactive and reactive services at 12-month follow-up. However, the response rate was only 59 % and non-responders were over-represented in the proactive service. We performed a drop-out analysis to assess the smoking status of initial responders and non-responders.

At 29–48 months after the first call, a postal questionnaire with six questions was sent to 150 random clients from the RCT database, with equal numbers from the proactive and reactive services as well as responders and non-responders at 12-month follow-up. Clients who did not return the questionnaire were contacted by telephone. The outcome measures were point prevalence (PP) and 6-month continuous abstinence (CA), and their associations with response status at 12 months were assessed by logistic regression.

The response rate was 74 % (111/150). Abstinence was significantly higher among initial responders than non-responders (PP 54 % vs. 32 %, p = .023 and CA 49 % vs. 21 %, p = .003). The odds ratios for initial responders vs. initial non-responders were, for PP = 2.5 (95 % CI 1.1–5.6, p = .024), and for CA = 3.7 (95 % CI 1.5–8.9, p = .004), after adjusting for proactive/reactive service.

Non-responders to a 12-month follow-up smoking cessation questionnaire in a quitline setting were more likely to be smokers 1.5–3 years later. We propose a conservative correction factor of 0.8 for self-reported abstinence in telephone-based cessation studies if the response rate is approximately 55–65 %.

World Health Organization. WHO report on the global tobacco epidemic. Geneva: World Health Organization; 2011.
Swedish National Public Health Survey - Health on Equal Terms, 2014 [Internet]. Folkhälsomyndigheten [Public Health Agency of Sweden]. 2015 [cited January 22, 2015]. Available from: http://www.folkhalsomyndighete....
The National Board of Health and Welfare. Register data of the harmful effects of tobacco smoking. Stockholm: Socialstyrelsen [The National Board of Health and Welfare]; 2014.
Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville: U.S. Department of Health and Human Service. Public Health Service; 2008.
Stead LF, Hartmann-Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2013;8:CD002850.
Sogaard AJ, Selmer R, Bjertness E, Thelle D. The Oslo Health Study: The impact of self-selection in a large, population-based survey. Int J Equity Health. 2004;3(1):3.
NAQC. Measuring quit rates. Quality Improvement Initiative. Phoenix: North American Quitline Consortium (NAQC); 2009. [January 19, 2016]. Available from:
NAQC. Results from the 2013 NAQC Annual Survey of Quitlines: North American Quitline Consortium (NAQC). 2014. [January 19, 2016]. Available from:
Tillgren P, Haglund BJ, Lundberg M, Romelsjo A. The sociodemographic pattern of tobacco cessation in the 1980s: results from a panel study of living condition surveys in Sweden. J Epidemiol Community Health. 1996;50(6):625–30.
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.
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):306–10.
Tomson T, Helgason AR, Gilljam H. Quitline in smoking cessation: a cost-effectiveness analysis. Int J Technol Assess Health Care. 2004;20(4):469–74.
Nohlert E, Ohrvik J, Helgason AR. Effectiveness of proactive and reactive services at the Swedish National Tobacco Quitline in a randomized trial. Tob Induc Dis. 2014;12(1):9.
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):2321–4.
Nohlert E, Ohrvik J, Tegelberg A, Tillgren P, Helgason AR. Long-term follow-up of a high - and a low-intensity smoking cessation intervention in a dental setting--a randomized trial. BMC Public Health. 2013;13:592.
Murray RP, Connett JE, Rand CS, Pan W, Anthonisen NR. Persistence of the effect of the Lung Health Study (LHS) smoking intervention over eleven years. Prev Med. 2002;35(4):314–9.
Miguez MC, Becona E. Abstinence from smoking ten years after participation in a randomized controlled trial of a self-help program. Addict Behav. 2008;33(10):1369–74.
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). The Hague: STIVORO; 2008.
Ferguson J, Docherty G, Bauld L, Lewis S, Lorgelly P, Boyd KA, et al. 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.
Lien RK, Schillo BA, Goto CJ, Porter L. The effect of survey nonresponse on quitline abstinence rates: Implications for practice. Nicotine Tob Res. 2016;18(1):98–101.
Brogger J, Bakke P, Eide GE, Gulsvik A. Contribution of follow-up of nonresponders to prevalence and risk estimates: a Norwegian respiratory health survey. Am J Epidemiol. 2003;157(6):558–66.
Christensen AI, Ekholm O, Kristensen PL, Larsen FB, Vinding AL, Glumer C, et al. The effect of multiple reminders on response patterns in a Danish health survey. Eur J Public Health. 2015;25(1):156–61.
Verlato G, Melotti R, Olivieri M, Corsico A, Bugiani M, Accordini S, et al. Asthmatics and ex-smokers respond early, heavy smokers respond late to mailed surveys in Italy. Respir Med. 2010;104(2):172–9.
Edwards P, Roberts I, Clarke M, DiGuiseppi C, Pratap S, Wentz R, et al. Increasing response rates to postal questionnaires: systematic review. BMJ. 2002;324(7347):1183.
Nakash RA, Hutton JL, Jorstad-Stein EC, Gates S, Lamb SE. Maximising response to postal questionnaires - a systematic review of randomised trials in health research. BMC Med Res Methodol. 2006;6:5.
Edwards PJ, Roberts I, Clarke MJ, Diguiseppi C, Wentz R, Kwan I, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst Rev. 2009;3:MR000008.
Society for Research on Nicotine and Tobacco Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4(2):149–59.
The Effect of Tailored Web-Based Feedback and Optional Telephone Coaching on Health Improvements: A Randomized Intervention Among Employees in the Transport Service Industry
Madeleine Solenhill, Alessandra Grotta, Elena Pasquali, Linda Bakkman, Rino Bellocco, Ylva Trolle Lagerros
Journal of Medical Internet Research
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
Cigarette, waterpipe and e-cigarette use among an international sample of medical students. Cross-sectional multicenter study in Germany and Hungary
Erika Balogh, Nóra Faubl, Henna Riemenschneider, Péter Balázs, Antje Bergmann, Károly Cseh, Ferenc Horváth, Jörg Schelling, András Terebessy, Zoltán Wagner, Karen Voigt, Zsuzsanna Füzesi, István Kiss
BMC Public Health
Geosimulation approach for filling the gap of non-response smoking data from the census 2013: A spatial analysis of census area unit geographies
Melanie N. Tomintz, Ross Barnett
New Zealand Geographer
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
Telephone counselling for smoking cessation
William Matkin, José Ordóñez-Mena, Jamie Hartmann-Boyce
Cochrane Database of Systematic Reviews
Russian and Chinese Natural Gas Industries: Perspectives on Sustainable Growth
Zhen Wang, George Kleiner, Zinaida Bragina, Artem Denisov, Alina Steblyanskaya
International Journal of Public Administration
Smoker motivations and predictors of smoking cessation: lessons from an inpatient smoking cessation programme
JHJ See, TH Yong, SLK Poh, YC Lum
Singapore Medical Journal
Did psychosocial status, sociodemographics and smoking status affect non-attendance in control participants in the Danish Lung Cancer Screening Trial? A nested observational study
Jessica Malmqvist, Volkert Siersma, Hanne Thorsen, Bruno Heleno, Jakob Rasmussen, John Brodersen
BMJ Open