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Am Fam Physician. 2007;75(5):650

Clinical Question

Does telephone counseling help smokers quit?

Evidence-Based Answer

Telephone counseling can improve long-term smoking cessation rates. Multiple proactive calls are more effective than a single reactive call.

Practice Pointers

Telephone counseling services (called quitlines, helplines, or hotlines) may offer counseling for smoking cessation. Telephone counseling can be a single session in response to a smoker's call (i.e., reactive), multiple sessions initiated by a counselor (i.e., proactive), or a combination of these types. Telephone counseling services are readily available to smokers who are planning a quit attempt or to former smokers trying to avoid a relapse. These services reach an estimated 1 to 6 percent of adult smokers each year, and some target specific at-risk populations such as pregnant, adolescent, or low-income smokers.1

This Cochrane review identified 48 randomized or quasirandomized trials evaluating telephone counseling for smokers or for those who have recently quit smoking. All trials measured abstinence from smoking for at least six months. Comparison groups generally received brief advice from a physician during an office visit and/or printed self-help materials. Reactive interventions showed no significant effect (two trials; n = 1,804; pooled odds ratio [OR] = 1.12; 95% confidence interval [CI], 0.84 to 1.50). Proactive interventions showed a modest benefit (29 trials; n = 17,467; pooled OR = 1.33; 95% CI, 1.21 to 1.47). Multiple proactive callback sessions after contact was initiated by a motivated quitter were most successful (eight trials; n = 18,468; pooled OR = 1.41; 95% CI, 1.27 to 1.57).

The intensity of telephone counseling also improved its effectiveness. In this Cochrane review, the frequency of calls ranged from one to 12 calls over six months. Regression analysis provided significant evidence that higher calling intensity had a greater effect on quit rates. Seven trials of low-intensity interventions with one or two calls showed no significant effect (seven trials; n = 4,225; OR = 1.00; 95% CI, 0.80 to 1.24). Medium-intensity interventions with three to six calls showed a modest benefit (19 trials; n = 11,877; pooled OR = 1.38; CI, 1.23 to 1.55).

Proactive telephone counseling for smoking cessation helps motivated quitters stay abstinent. Three or more calls significantly increase the odds of smoking cessation compared with standard self-help materials or brief physician advice. Clinicians should identify proactive telephone counseling services for smoking cessation and provide this information to patients who want to quit smoking.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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