We examined factors associated with awareness and utilization of smoking quitlines in a national sample. While approximately half of the U.S. population is aware of quitlines, only 9% of those smokers who are aware report having ever called a quitline. Both being aware and having called a quitline was associated with smoking status, such that those who reported current or former smoking were more likely to be aware and to have called a quitline than those who had never smoked. Those who are aware of this service appear to be in groups less likely to make quit attempts, including those who are younger and have less education. This is consistent with previous research that has shown that quitlines are an effective way to reach young adult smokers (Cummins, Bailey, Campbell, Koon-Kirby, & Shu-Hong, 2007
). This result is encouraging given that young smokers tend to report higher rates of smoking but are as interested in quitting as older adults (Solberg, Boyle, McCarty, Asche, & Thoele, 2007
). Individuals with less education may have additional barriers to cessation including social factors and work environment (Ki Moon Bang, 2001
). As expected, those individuals who are actively engaged in medical information seeking and trust the government are more aware of quitlines. Given that the main quitline access number in the United States is government-sponsored, trusting the government may indicate that these individuals may pay more attention to promotions for 1-800-Quit-Now.
Of those aware of quitlines, nearly 80% were specifically aware of the national portal number, 1-800-Quit-Now. This level of awareness is quite high when considering that some states do not advertise this national portal number but rather a state specific number. In addition, there has not been a national paid media campaign for 1-800-Quit-Now. Although encouraging, ideally awareness of this number should be much higher. Quitlines are a free service that provide reduced obstacles to participation. While it is encouraging that those in groups that have historically been more difficult to engage in traditional cessation treatments appear to be more aware of this service, this does not mean that all populations of concern are being reached. For example, awareness was lower among Blacks than Whites in this study. This finding suggests that continued outreach efforts to target diverse populations are warranted. It is important to note that there were no differences in ever calling a quitline by race; however, prior research suggests that quitlines may be an important resource for reaching diverse populations (Fiore et al., 2008
Nearly 10% of smokers who were aware of quitlines reported ever having called a quitline. Prior research has indicated that past year use in adult smokers is 1.1% to 1.7% (Ossip-Klein & McIntosh, 2003
). However, merely being aware of quitline services does not translate into behavior. Individuals with a family history of cancer and those with psychological distress were significantly more likely to have ever called a quitline. This is consistent with previous research that shows older adults with health problems and psychological distress are more likely to quit smoking than older adults with fewer problems (Sachs-Ericsson et al., 2009
). Specific data with regards to the causal impact of cancer history on quitline use is unavailable, and this is an important area for future research. Together, these findings indicate that quitlines should be prepared to address ancillary issues or comorbid conditions in addition to cessation support.
While younger smokers were more aware of quitlines, findings indicated that older smokers were more likely to call
a quitline. This is consistent with research showing that older adults are more likely to use behavioral or pharmacological cessation treatments (Shiffman, Brockwell, Pillitteri, & Gitchell, 2008
). Although the bivariate analysis indicates that factors such as age and household income are associated with calling a quitline, these factors were not statistically significant in the adjusted model. Unlike awareness, those who are using quitlines seem to be from the population at large rather than any specific demographic group. This suggests the strong need for strategies to increase engagement rather than simple awareness.
Results of the present study are informative; however, they must be considered in light of several limitations. We were interested in examining the characteristics of all individuals who were aware or had called a quitline, regardless of smoking status. While we might not expect nonsmokers to call the quitline, it is possible that they would do so on behalf of a loved one or encourage a loved one to use the service. This article was not focused on proxies; however, prior research has shown that 35% of quitline calls were made by proxies among Asian language speaking Asians (Zhu, Nguyen, Cummins, Wong, & Wightman, 2006
), (Wong, & Wightman, 2006). Future research should examine the use of proxies in quitline utilization and the effectiveness of strategies to both reach this population and aid in cessation among smokers. The HINTS dataset is a cross-sectional study, and future studies may wish to examine the barriers to quitline use longitudinally to understand causal influences, including cessation attempts and maintenance. There was a limited amount of questions pertaining to tobacco use and as a result details regarding tobacco quit history and specifics of quitline service use (e.g., call-back service, call frequency, quality of service) were not available.
Although the response rate for the RDD survey is relatively low, this reflects a decreasing trend in response rates observed for all RDD telephone surveys; the response rate for HINTS is comparable to other national RDD telephone surveys (Nelson, Powell-Griner, Town, & Kovar, 2003
). It cannot be determined from the data available whether systematic differences exist between responders and non responders. Low response rates are problematic when they introduce systematic differences between those who respond and those who do not, thereby limiting the generalizability of the results only to populations represented by responders (Groves, 1989
). The data used in our analyses were weighted according to population census data to ensure greater population representativeness.
Although overall use of quitlines is low relative to its potential, results indicate that populations of significant need are aware of quitlines. A better understanding is needed of populations that are using specific types of services and how effective these services are for these subgroups. A future focus on how to translate awareness into behavior is essential to increase the public health impact of quitlines. Increased funding for state-run quitlines is needed in order to maximize smokers’ utilization of the quitline via promotions and expand the capacity of quitlines to help as many smokers quit as possible. Tobacco quitlines are an effective means of providing wide reaching cessation treatment and are a cost-effective means to reducing the public health burden of tobacco.