"Real-world" effectiveness of reactive telephone counseling for smoking cessation: a randomized controlled trial

Abstract

Background: Reactive telephone helplines for smoking cessation (where all calls to counselors are smoker initiated) are increasingly used in the United States. However, limited data from randomized controlled trials are available on their effectiveness. The study objective was to evaluate the real-world effectiveness of reactive telephone counseling for smoking cessation using a randomized controlled trial study design.

Methods: The study was implemented during a period from 2003 to 2006 to evaluate a reactive telephone helpline run by the American Lung Association chapter of Illinois-Iowa. The 990 new callers, all adult current smokers who called the helpline, were randomized on their first call into one of the two following groups: a control group that received only mailed self-help literature (n = 496); and a study group that received supplemental live reactive telephone counseling (n = 494). Telephone follow-up was completed at 1, 3, 6, and 12 months after study enrollment by interviewers blinded to group assignment. Seven-day point prevalence rates of self-reported abstinence at follow-up evaluations were compared between the two groups using an intent-to-treat design.

Results: The two groups did not differ significantly in baseline demographics and smoking-related behavior. The abstinence rates (ranging between 0.09 and 0.15) were not significantly different between the two groups at 1-, 3-, 6-, and 12-month follow-up evaluations. Post hoc subgroup analysis showed that black callers had lower abstinence rates at the 3- and 12-month follow-up evaluations as compared with white callers.

Conclusion: Supplemental live, reactive telephone counseling does not provide greater success in smoking cessation than self-help educational materials alone.

Figure 1

Schematic flow diagram of recruitment, randomization, and follow-up in the study (using the Consolidated Standards of Reporting Trials [or CONSORT] standards). Note: At the 1-month follow-up, 722 subjects participated, 44 participants withdrew, and 224 subjects missed follow-up. At the 3-month follow-up, 707 subjects participated, 55 participants withdrew, and 228 subjects missed follow-up. At the 6-month follow-up, 611 subjects participated, 74 participants withdrew, and 305 subjects missed follow-up. At the 12-month follow up, 521 subjects participated, 95 participants withdrew, and 374 subjects missed follow-up.